Impact of a high-risk multimorbidity integrated care implemented at the public health system in Chile

During recent years, multimorbidity has taken relevance because of the impact of causes in the system, people, and their families, which has been a priority in the health care plan. Interventions strategies and their implementation are still an emerging topic. In this context, Centro de Innovación en Salud ANCORA UC, together with Servicio de Salud Metropolitano Sur Oriente, implemented as a pilot study High-Risk Multimorbidity Integrated Care strategy. This study aimed to evaluate the impact of this strategy in terms of health services utilization and mortality. A cohort study was conducted with high-risk patients with multimorbidity, stratified by ACG®, intervened between April 2017 and December 2019. The studied population was 3,933 patients who belonged to similar size and location primary care centers. The impact analysis was performed used generalized linear models. Results showed that intervened patients had a significantly lower incidence in mortality (OR 0.56; 95% CI 0.40–0.77), hospital admissions, length of stay, and the number of hospital emergency consultancies. With the proper barriers and facilitators of a real context intervention, the implementation process allowed the systematization and consolidation of the intervention provided in this study. The training for new roles and the constant implementation support from the Centro de Innovación en Salud ANCORA UC team were essential in the progress and success of the intervention. A complete description of the high-risk intervention strategy is provided to contribute to this emerging topic and facilitate its scale-up. We can conclude that this complex intervention was feasible to be implemented in a real context. The Ministry of Health has taken the systematization and consolidation of the conditions for the national scale-up.

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Evaluation of community coalition training effects on youth hospital-admitted injury incidence in Victoria, Australia: 2001–2017

Injury Prevention ◽

10.1136/injuryprev-2019-043386 ◽

2019 ◽

Vol 26 (5) ◽

pp. 463-470 ◽

Cited By ~ 1

Author(s):

Janneke Berecki-Gisolf ◽

Bosco Rowland ◽

Nicola Reavley ◽

Barbara Minuzzo ◽

John Toumbourou

Keyword(s):

Risk Factors ◽

Injury Risk ◽

Negative Binomial ◽

Hospital Admissions ◽

Intervention Strategy ◽

Age Groups ◽

Negative Binomial Regression ◽

Population Based ◽

Injury Incidence ◽

The Impact

BackgroundInjuries are one of the three leading causes of morbidity and mortality for young people internationally. Although community risk factors are modifiable causes of youth injury, there has been limited evaluation of community interventions. Communities That Care (CTC) offers a coalition training process to increase evidence-based practices that reduce youth injury risk factors.MethodUsing a non-experimental design, this study made use of population-based hospital admissions data to evaluate the impact on injuries for 15 communities that implemented CTC between 2001 and 2017 in Victoria, Australia. Negative binomial regression models evaluated trends in injury admissions (all, unintentional and transport), comparing CTC and non-CTC communities across different age groups.ResultsStatistically significant relative reductions in all hospital injury admissions in 0–4 year olds were associated with communities completing the CTC process and in 0–19 year olds when communities began their second cycle of CTC. When analysed by subgroup, a similar pattern was observed with unintentional injuries but not with transport injuries.ConclusionThe findings support CTC coalition training as an intervention strategy for preventing youth hospital injury admissions. However, future studies should consider stronger research designs, confirm findings in different community contexts, use other data sources and evaluate intervention mechanisms.

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Proactive, multidisciplinary approach to supportive medicine: Improving health outcomes and care utilization.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6537 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6537-6537

Author(s):

Brooke Worster ◽

Valerie P Csik ◽

Jared Minetola ◽

Gregory D. Garber ◽

Alison Petok ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Cancer Patients ◽

Hospital Admissions ◽

Care Plan ◽

Cancer Center ◽

Care Plans ◽

Oncology Care ◽

The Impact

6537 Background: Evidence suggests that cancer patients who receive palliative care early in their disease have improved quality of life, decreased emergency department (ED) visits, and less aggressive end-of-life care. In 2017, the Sidney Kimmel Cancer Center at Jefferson established the Neu Center for Supportive Medicine and Cancer Survivorship (NCSMCS) as a model for integrated care in the outpatient setting for all cancer patients. A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Objectives: To use biopsychosocial screening at specified time points to identify needs and evaluate the impact of supportive care as part of standardized oncology care regardless of stage. Methods: This assessment utilized Oncology Care Model (OCM) data for Jefferson Medicare patients between 7/1/16 to 7/31/18. Incidence of ED admits ED/Observation and admissions were evaluated as well as ICU utilization and advanced care planning. Poisson regression was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI) to facilitate the comparison of post- vs. pre- incidence rates of hospitalization. Results: The post-intervention hospital admissions decreased by 31% in NCSMCS (IRR 0.69; 95% CI 0.48-0.98) and by 10% in Non-NCSMCS (IRR 0.90; 0.84-0.96) and advanced care plans were more likely to be on file for NCSMCS (9.0% vs. 4.9%). The intensive care unit (ICU) admissions were decreased by 17% among Non-NCSMCS (IRR 0.83; 95% CI 0.74-0.93). The utilization rates for ED admissions were not statistically different among both the groups. Conclusions: The preliminary data is promising and impact will be monitored as the intervention is expanded. Reducing admissions has benefits from both a cost savings as well as quality of life perspective. Future analyses will consider the impact of the intervention on a patient’s quality of life.

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Population Size Estimation of High-Risk Behavior in Isfahan, Iran: Using the Network Scale-up Method in 2018

Journal of Biostatistics and Epidemiology ◽

10.18502/jbe.v7i2.6711 ◽

2021 ◽

Author(s):

Meysam Abshenas Jami ◽

Mohamadreza Baneshi ◽

Maryam Nasirian

Keyword(s):

High Risk ◽

Sexual Behaviors ◽

Scale Up ◽

Risky Behaviors ◽

Size Estimation ◽

Sexual Relations ◽

Sex Worker ◽

Network Scale ◽

History Of ◽

The Impact

Background and Objective: Due to the impact of risky behaviors in the community and the need for getting information and planning in this regard, the number of people with high-risk sexual behaviors in Isfahan will be indirectly estimated by the network scale-up method. Method:In a cross-sectional study conducted in June2018in14districts of Isfahan, a sample of1000 people was recruited by a non-random multistage method and interviewed using a standard questionnaire to identify people with high-risk sexual behavior. Data are analyzed based on a network scale-up method in the STATA application. Results:According to a report by men, the prevalence of male Extra marital sexual relations (N=2437) and relation with paying prostituted women (N=1211), with non-paying prostituted women (N=298), Homosexuality (N=696) and history of traveling for sexual relations (N =880/100,000); And according to a report by women, the prevalence of female Extra marital sexual relations (N=1386) and Sex Worker women (Monetary) (N=946), Sex Worker women (Non-Monetary) (N=258), and history of travelling for sexual relations (N=13/100,000). In both sexes, the age group of18 to 30years was more at risk for sexual behaviors than other groups. Discussion and Conclusion: It seems that the prevalence of sexual high-risk behaviors in Isfahan is remarkable as the increased prevalence of sexually transmitted diseases, including HIV, but unfortunately, the required training is low in this regard, more attention should be paying to train people to prevent the prevalence of these high-risk sexual behaviors in society.

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Diagnostic accuracy and clinical impact of natriuretic peptide screening for the detection of heart failure in the community: a protocol for systematic review and meta-analysis

Wellcome Open Research ◽

10.12688/wellcomeopenres.15536.1 ◽

2019 ◽

Vol 4 ◽

pp. 169

Author(s):

C. R. Goyder ◽

A. K. Roalfe ◽

N. R. Jones ◽

K. S. Taylor ◽

C. D. Plumptre ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Impact Analysis ◽

Hospital Admissions ◽

Alternative Pathway ◽

Meta Analysis ◽

Clinical Impact ◽

Cochrane Central Register ◽

Optimal Thresholds ◽

The Impact

Introduction: Patients diagnosed with heart failure in primary care have a better prognosis than those diagnosed in hospital. However, most cases are missed in the community. Recent attention has focussed on the potential of early detection through screening. Natriuretic peptides (NPs) are tested by GPs and used to rule out heart failure in patients presenting with symptoms. Evidence is now emerging that they may also have a role in screening but their accuracy in this context and the associated optimal thresholds, have not been established. The impact that NP screening would have on patients and health care systems also remains unclear. Methods: We aim to undertake a systematic search of the following sources: Ovid Medline, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Screening, data extraction and critical appraisal will be carried out independently and in duplicate by two reviewers. We will include studies based in the community with >100 participants that recruited a screened population. We will not add a study design filter and there will be no language restriction. The primary outcome will be the sensitivity and the specificity of NP screening and optimal thresholds for screening will be explored. Outcomes of interest for the impact analysis will include mortality, hospital admissions and cost effectiveness. This protocol has been developed in accordance with guidelines from the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). Discussion: This systematic review will identify how accurately NP screen for heart failure in the community and explore where NP screening thresholds should be set. It also aims to summarise the clinical impact of this strategy. Together, these results should inform future interventions that may provide an alternative pathway to facilitate improved detection of heart failure in the community. Registration: PROSPERO CRD42018087498; registered on 11 May 2018.

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From Resilience to Burnout in Healthcare Workers During the COVID-19 Emergency: The Role of the Ability to Tolerate Uncertainty

Frontiers in Psychology ◽

10.3389/fpsyg.2021.646435 ◽

2021 ◽

Vol 12 ◽

Author(s):

Michela Di Trani ◽

Rachele Mariani ◽

Rosa Ferri ◽

Daniela De Berardinis ◽

Maria G. Frigo

Keyword(s):

High Risk ◽

Healthcare Workers ◽

Linear Models ◽

Short Form ◽

Maslach Burnout Inventory ◽

Well Being ◽

High Risk Group ◽

Lazio Region ◽

Resilience Scale ◽

The Impact

The COVID-19 outbreak has placed extraordinary demands upon healthcare systems worldwide. Italy's hospitals have been among the most severely overwhelmed, and as a result, Italian healthcare workers' (HCWs) well-being has been at risk. The aim of this study is to explore the relationships between dimensions of burnout and various psychological features among Italian healthcare workers (HCWs) during the COVID-19 emergency. A group of 267 HCWs from a hospital in the Lazio Region completed self-administered questionnaires online through Google Forms, including the Maslach Burnout Inventory (MBI), Resilience Scale, and Intolerance of Uncertainty Scale Short Form (IU). Cluster analysis highlighted two opposite burnout risk profiles: low burnout and high-risk burnout. The high-risk group had lower resilience and greater difficulties in tolerating the uncertainty than the low-burnout group. A set of general linear models confirmed that both IU subscales, prospective and inhibition, moderated the relationship between resilience and burnout (specifically in the depersonalization dimension). In conclusion, the results showed that individual levels of resilience and one's ability to tolerate uncertainty have been significant factors in determining the impact of the COVID-19 emergency on HCWs. The use of emotional strategies that allow individuals to stay in a critical situation without the need to control it appears to protect against burnout in these circumstances.

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Diagnostic accuracy and clinical impact of natriuretic peptide screening for the detection of heart failure in the community: a protocol for systematic review and meta-analysis

Wellcome Open Research ◽

10.12688/wellcomeopenres.15536.2 ◽

2019 ◽

Vol 4 ◽

pp. 169

Author(s):

C. R. Goyder ◽

A. K. Roalfe ◽

N. R. Jones ◽

K. S. Taylor ◽

C. D. Plumptre ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Impact Analysis ◽

Hospital Admissions ◽

Alternative Pathway ◽

Meta Analysis ◽

Clinical Impact ◽

Cochrane Central Register ◽

Optimal Thresholds ◽

The Impact

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INTEGRATING ACUTE AND LONG-TERM SERVICES: DOES IT WORK, CAN IT WORK, WILL IT WORK?

Innovation in Aging ◽

10.1093/geroni/igz038.848 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S229-S230

Author(s):

Robert A Applebaum ◽

Jennifer Heston

Keyword(s):

Managed Care ◽

Integrated Care ◽

Care Management ◽

Service Providers ◽

Care Staff ◽

Care Plan ◽

Management Model ◽

Management Models ◽

The Impact

Abstract The expansion of managed long-term services and supports has generated considerable interest over the last decade. However, studies on the impact of these efforts have produced mixed findings. Additionally, there is limited information about the care management models used in implementation. This lack of data makes it impossible to assess whether differences in managed care plan approaches have an impact on participants. Our study sought to gain better understanding of the integrated care management models being implemented in Ohio’s MyCare Demonstration. Through qualitative interviews with 50 respondents, including area agency care managers, managed care staff, and service providers, we documented strengths and weaknesses of one integrated care management model used in Ohio’s demonstration. Understanding what is inside the black box of managed care/care management model implementation is key to gaining insights into whether such an approach can ultimately improve the health and long-term service systems for older people with disability.

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Digital Health Transformation of Integrated Care in Europe: Overarching Analysis of 17 Integrated Care Programs

Journal of Medical Internet Research ◽

10.2196/14956 ◽

2019 ◽

Vol 21 (9) ◽

pp. e14956 ◽

Cited By ~ 10

Author(s):

Erik Baltaxe ◽

Thomas Czypionka ◽

Markus Kraus ◽

Miriam Reiss ◽

Jan Erik Askildsen ◽

...

Keyword(s):

Health Care ◽

Integrated Care ◽

Program Analysis ◽

Digital Health ◽

Scale Up ◽

Implementation Process ◽

Strong Relationship ◽

Longitudinal Assessment ◽

Wide Range ◽

Assessment Strategies

Background Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the implementation process may be useful for future policy recommendations. Objective The aim of this study was to analyze the implementation of digital health tools to support health care and social care services, as well as to facilitate the longitudinal assessment of these services, in 17 selected integrated chronic care (ICC) programs from 8 European countries. Methods A program analysis based on thick descriptions—including document examinations and semistructured interviews with relevant stakeholders—of ICC programs in Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain, and the United Kingdom was performed. A total of 233 stakeholders (ie, professionals, providers, patients, carers, and policymakers) were interviewed from November 2014 to September 2016. The overarching analysis focused on the use of digital health tools and program assessment strategies. Results Supporting digital health tools are implemented in all countries, but different levels of maturity were observed among the programs. Only few ICC programs have well-established strategies for a comprehensive longitudinal assessment. There is a strong relationship between maturity of digital health and proper evaluation strategies of integrated care. Conclusions Notwithstanding the heterogeneity of the results across countries, most programs aim to evolve toward a digital transformation of integrated care, including implementation of comprehensive assessment strategies. It is widely accepted that the evolution of digital health tools alongside clear policies toward their adoption will facilitate regional uptake and scale-up of services with embedded digital health tools.

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Addressing the third delay: implementing a novel obstetric triage system in Ghana

BMJ Global Health ◽

10.1136/bmjgh-2017-000623 ◽

2018 ◽

Vol 3 (2) ◽

pp. e000623 ◽

Cited By ~ 8

Author(s):

David M Goodman ◽

Emmanuel K Srofenyoh ◽

Rohit Ramaswamy ◽

Fiona Bryce ◽

Liz Floyd ◽

...

Keyword(s):

Waiting Time ◽

Implementation Process ◽

Care Plan ◽

Implementation Barriers ◽

Free Standing ◽

Implementation Framework ◽

Low Resource ◽

Improvement Programme ◽

Active Implementation ◽

The Impact

Institutional delivery has been proposed as a method for reducing maternal morbidity and mortality, but little is known about how referral hospitals in low-resource settings can best manage the expected influx of patients. In this study, we assess the impact of an obstetric triage improvement programme on reducing hospital-based delay in a referral hospital in Accra, Ghana. An Active Implementation Framework is used to describe a 5-year intervention to introduce and monitor obstetric triage capabilities. Baseline data, collected from September to November 2012, revealed significant delays in patient assessment on arrival. A triage training course and monitoring of quality improvement tools occurred in 2013 and 2014. Implementation barriers led to the construction of a free-standing obstetric triage pavilion, opened January 2015, with dedicated midwives. Data were collected at three time intervals following the triage pavilion opening and compared with baseline including: referral indications, patient and labour characteristics, waiting time from arrival to assessment and the documentation of a care plan. An obstetric triage improvement programme reduced the median (IQR) patient waiting time from facility arrival to first assessment by a midwife from 40 min (15–100) to 5 min (2–6) (p<0.001) over the 5-year intervention. The triage pavilion enhanced performance resulting in the elimination of previous delays associated with the time of admission and disease acuity. Care plan documentation increased from 51% to 96%. Obstetric triage, when properly implemented, reduced delay in a busy, low-resource hospital. The implementation process was sustained under local leadership during transition to a new hospital.

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Impact Analysis of the Large-Scale Social Restrictions (PSBB) Policy Implementation in Jakarta

Journal of Indonesian Health Policy and Administration ◽

10.7454/ihpa.v5i2.4056 ◽

2020 ◽

Vol 5 (2) ◽

Cited By ~ 1

Author(s):

Hikmahwati Syafri ◽

Ekasafitri Sangadji ◽

Raden Roro Mega Utami

Keyword(s):

High Risk ◽

Population Density ◽

Policy Implementation ◽

Large Scale ◽

Impact Analysis ◽

Reproduction Number ◽

Top Down ◽

Mobility Index ◽

Policy Objectives ◽

The Impact

Abstract. Jakarta is the province with the highest population density in Indonesia and is also one of the main international gateways to enter Indonesia. These conditions cause a high risk of transmission COVID-19 in Jakarta. One of the government's decisions was applying the Large Scale Social Restrictions (PSBB) policy in Jakarta. This study is a documentation study with Sabatier and Mazmanian's top-down approach that aims to analyze the extent impact of policy implementation, in terms of the policy objectives and community compliance. Compliance analysis uses the results of the Covid-19 Outbreak Survey and Google mobility index. The result shows the compliance of the community in policy implementation. The impact of the PSBB implementation can be seen from the value of the Reproduction number (Rt), which has decreased since the PSBB policy was implemented. Based on those data, it can be concluded that the implementation of the PSBB in Jakarta has been going and implemented well; thus, the consistency from the community and also local government needs to be well maintained. Abstrak. Jakarta merupakan provinsi dengan tingkat kepadatan penduduk tertinggi di Indonesia yang juga sebagai pintu keluar masuknya manusia ke Indonesia. Hal ini menyebabkan resiko penularan COVID-19 di Jakarta menjadi sangat besar. Salah satu kebijakan pemerintah adalah PSBB di DKI Jakarta. Kajian ini merupakan studi dokumentasi dengan pendekatan top-down Sabatier dan Mazmanian yang bertujuan untuk melakukan analisis sejauh mana dampak suatu implementasi kebijakan, ditinjau dari tujuan kebijakan dan kepatuhan masyarakat. Analisis kepatuhan menggunakan hasil Survei Wabah Covid-19 dan indeks mobilitas Google. Hasilnya menunjukkan kepatuhan kelompok sasaran terhadap implementasi kebijakan. Dampak implementasi PSBB dapat terlihat dari nilai Reproduction number (Rt) yang semenjak diberlakukan kebijakan nilainya selalu mengalami penurunan. Berdasarkan keseluruhan data tersebut, maka dapat disimpulkan bahwa implementasi kebijakan PSBB di Jakarta telah berlangsung dan diimplementasikan dengan baik, tinggal menanti konsistensi masyarakat dan pemerintah daerah agar dapat terjaga dengan baik.Abstrak. Jakarta merupakan provinsi dengan tingkat kepadatan penduduk tertinggi di Indonesia yang juga sebagai pintu keluar masuknya manusia ke Indonesia. Hal ini menyebabkan resiko penularan COVID-19 di Jakarta menjadi sangat besar. Salah satu kebijakan pemerintah adalah PSBB di DKI Jakarta. Kajian ini merupakan studi dokumentasi dengan pendekatan top-down Sabatier dan Mazmanian yang bertujuan untuk melakukan analisis sejauh mana dampak suatu implementasi kebijakan, ditinjau dari tujuan kebijakan dan kepatuhan masyarakat. Analisis kepatuhan menggunakan hasil Survei Wabah Covid-19 dan indeks mobilitas Google. Hasilnya menunjukkan kepatuhan kelompok sasaran terhadap implementasi kebijakan. Dampak implementasi PSBB dapat terlihat dari nilai Reproduction number (Rt) yang semenjak diberlakukan kebijakan nilainya selalu mengalami penurunan. Berdasarkan keseluruhan data tersebut, maka dapat disimpulkan bahwa implementasi kebijakan PSBB di Jakarta telah berlangsung dan diimplementasikan dengan baik, tinggal menanti konsistensi masyarakat dan pemerintah daerah agar dapat terjaga dengan baik.

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