Daily Hand-Off of Chronic Stroke Neurorehabilitation Patients to Expert Clinicians, With Resulting Significant Coordination Improvement: Care Model Development and Implementation

Background: New models of care delivery are necessary to meet workforce needs while delivering expert care in neurorehabilitation. Therefore, we sought to develop and assess the implementation of a new model of care for neurorehabilitation using a 5-member team of therapists (5-Team Model) for the treatment of individuals with chronic stroke, rather than a conventional single-therapist model. Methods: A mixed methods approach was employed; continuous quality improvement methods and quasi-experimental pre-test/post-test methods were used to assess the effectiveness of the new model. Six chronic stroke patients participated in an upper limb neurorehabilitation motor learning protocol 5 days/week, 5 hours/day (60 sessions; 300 hours); treatment was administered using the 5-Team Model approach to treatment. Results: Mean improvement on the Fugl Meyer (FM) was 11.5 points. All six participants demonstrated improvement on Fugl Meyer that was within or beyond the minimal clinically important difference (MCID) range of 4.25-7.25 points for chronic stroke. Results indicated that the 5-Team Model was effective in implementing care. Conclusions: The 5-Team Model for neurorehabilitation was successfully implemented, with patient hand-off every day to a different therapist; it produced clinically significant improvement on a measure of coordination (FM) which is comparable to or better than prior reports from a standard care model. This new model of care met the needs of the research team workforce for flexibility, while maintaining the level of quality of care. Successful implementation required addressing a series of hindering factors in an iterative manner and enhancing promoting factors. These elements included the context within which the change was implemented, the methods used in implementing the change, the evidence that the change was successful, and communication that the change was successful. The context requirements included existing framework and participating model members who were willing to exert the required effort for success, model champions. This high level of enthusiastic participation along with strong leadership contributed to long-term success, sustainability.

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Proactive and Integrated Management and Empowerment in Parkinson’s Disease: Designing a New Model of Care

Parkinson s Disease ◽

10.1155/2020/8673087 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Emma Tenison ◽

Agnes Smink ◽

Sabi Redwood ◽

Sirwan Darweesh ◽

Hazel Cottle ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

United Kingdom ◽

The Netherlands ◽

Integrated Management ◽

Models Of Care ◽

Model Of Care ◽

New Model ◽

Positive Effects ◽

The United Kingdom

Parkinson’s disease is the second most common neurodegenerative condition after Alzheimer’s disease. The number of patients will rise dramatically due to ageing of the population and possibly also due to environmental issues. It is widely recognised that the current models of care for people with Parkinson’s disease or a form of atypical parkinsonism lack continuity, are reactive to problems rather than proactive, and do not adequately support individuals to self-manage. Integrated models of care have been developed for other chronic conditions, with a range of positive effects. A multidisciplinary team of professionals in the United Kingdom and the Netherlands, all with a long history of caring for patients with movement disorders, used knowledge of deficiencies with the current model of care, an understanding of integrated care in chronic disease and the process of logic modelling, to develop a novel approach to the care of patients with Parkinson’s disease. We propose a new model, termed PRIME Parkinson (Proactive and Integrated Management and Empowerment in Parkinson’s Disease), which is designed to manage problems proactively, deliver integrated, multidisciplinary care, and empower patients and their carers. It has five main components: (1) personalised care management, (2) education and empowerment of patients and carers, (3) empowerment of healthcare professionals, (4) a population health approach, and (5) support of the previous four components by patient- and professional-friendly technology. Having mapped the processes required for the success of this initiative, there is now a requirement to assess its effect on health-related and quality of life outcomes as well as determining its cost-effectiveness. In the next phase of the project, we will implement PRIME Parkinson in selected areas of the United Kingdom and the Netherlands.

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Primary Nursing in a Short-Stay Unit

Creative Nursing ◽

10.1891/1078-4535.21.1.26 ◽

2015 ◽

Vol 21 (1) ◽

pp. 26-29 ◽

Cited By ~ 1

Author(s):

Jane Baynton

Keyword(s):

Care Delivery ◽

Patient Relationship ◽

Short Stay ◽

Model Of Care ◽

Care Model ◽

Primary Nursing ◽

Hospital Units ◽

Primary Nurse

Primary Nursing is a model of care delivery that has been shown to improve the quality of care provided to patients and enhance the nurse–patient relationship. Although there is considerable attention in the literature on Primary Nursing concerning inpatient hospital units, there has been no discussion of Primary Nursing in short-stay units. Our hospital aimed to introduce Primary Nursing into all the units including short-stay. Staff were educated about the role of the primary nurse using Koloroutis’s (2004) Relationship-Based Care model, comprising three crucial relationships: care provider’s relationship with patients and families, with self, and with colleagues. The primary nurse develops the plan of care for individual patients based on their therapeutic relationship, which is sustained for the patient’s length of stay in the unit.

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POS0268-HPR PATIENT-REPORTED ACTIVITY LIMITATIONS IN HIP AND KNEE OSTEOARTHRITIS IN PRIMARY CARE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2023 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 357-358

Author(s):

T. Moseng ◽

H. Solveig Dagfinrud ◽

B. Natvig ◽

N. Osteras

Keyword(s):

Primary Care ◽

Patient Education ◽

Patient Specific ◽

Activity Limitations ◽

Model Of Care ◽

Care Model ◽

New Model ◽

Knee Oa ◽

The Mean

Background:To ensure delivery of high-quality osteoarthritis (OA) care, structured care models incorporating patient education and exercise are increasingly implemented in primary care 1. A goal is to improve patients’ physical function and coping with daily life demands and activities. Yet, there is limited knowledge regarding the type and severity of activity limitations experienced by people with hip and knee OA.Objectives:1) To map activity limitations reported by patients with hip and knee OA participating in a research study implementing an OA care model in primary care. 2) To investigate potential changes in self-reported difficulty performing these activities from baseline to 12-weeks follow-up.Methods:A structured OA care model was implemented in six Norwegian municipalities between January 2015 and October 2017, using a stepped-wedge cluster-randomized controlled design. Implementation was facilitated by interactive workshops for general practitioners and physiotherapists (PTs). The PTs provided a 3-hour, group-based patient education program followed by individually tailored 8-12 weeks exercise with twice weekly 1-hour supervised group sessions. Patients with clinically or radiologically verified symptomatic hip or knee OA ≥45 years were eligible. Patients who received the new model of care completed the Patient-Specific Functional Scale (PSFS) at baseline by identifying between one and three “important activities that you are unable to do or are having difficulty with because of your hip or knee OA”. The patients rated their performance of the reported activities on an 11-point numeric rating scale (NRS) ranging from 0 (unable to perform activity) to 10 (perform activity with no problems). After 12 weeks the patients re-rated their previously identified activities. The reported activities were linked to the International Classification of Functioning, Disability and Health (ICF) at Chapter and Domain (second and third) level. Absolute change in scores from baseline to follow-up was calculated as the mean score of the reported activities. Change from baseline to follow-up was investigated using paired samples t-test. P-value was set to <0.05. Clinically important change was regarded 2 points on the 0-10 scale.Results:A total of 284 patients received the new model of care. The mean age was 63 (SD 10) years, and 211 (74%) were female. The main affected OA joint was the knee for 174 (61%), the hip for 100 (35%) and other joints (e.g. hand) for 9 (3%). The PSFS was completed by 152 (53%) patients, of which 13 reported one, 42 reported two and 97 reported three activities. A total of 382 activities were linked with ICF. Of these, 362 (95%) were linked to the Activities and Participation chapter (D). On second-level, 318 (83%) activities were linked to the Mobility domain (D4). On the third-level, the majority of activities were linked to the domains Changing body positions (d410) (26%), Walking (d450) (23%) and Moving around (d455) (25%). The patients reported significantly less difficulty performing their self-reported activities at 12 week follow-up (4.1 (SD 1.7) versus 6.3 (SD 1.8), mean change 2.1 (95% CI 1.8, 2.5), p<0.001).Conclusion:The majority of activity limitations reported by patients receiving a structured OA care model in primary care were within the ICF Mobility domain. The most common third-level ICF domains were Changing body positions, Walking and Moving around. After participating in OA patient education and structured 8-12 weeks of exercise, the patients reported a statistically significant and clinically important improvement in the difficulty of performing their individual activities.References:[1]Allen KD, Choong PF, Davis AM, et al. Osteoarthritis: Models for appropriate care across the disease continuum. Best practice & research. Clinical rheumatology. 2016;30(3):503-535.Disclosure of Interests:None declared

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Using the PEPPA framework to develop the nurse practitioner role in emergency care: Critical reflections

Nordic Journal of Nursing Research ◽

10.1177/2057158520988478 ◽

2021 ◽

pp. 205715852098847

Author(s):

Erika Boman ◽

Kim Gaarde ◽

Rika Levy-Malmberg ◽

Frances Kam Yuet Wong ◽

Lisbeth Fagerström

Keyword(s):

Emergency Department ◽

Nurse Practitioner ◽

Current Model ◽

Models Of Care ◽

Advanced Practice Nursing ◽

Model Of Care ◽

New Model ◽

New Models ◽

Nursing Roles ◽

Practitioner Role

In this article, we describe and critically reflect on how the PEPPA framework, a Participatory Evidence-based Patient-focused Process for Advanced Practice Nursing, was used to develop a new model of care including the nurse practitioner (NP) role in an emergency department in Norway, where the role is in its infancy. While there is limited earlier research on the applicability of the PEPPA framework, it was here found to be useful. Supported by the framework, we mapped the current model of care, identified stakeholders and participants, determined the need for a new model of care, identified priority problems and goals, and defined the new model of care and the NP role. The PEPPA framework is recommended to develop new models of care including the NP role. Nonetheless, the process has not been straightforward. It is noted that to communicate and establish the new role in a setting as demanding as an emergency department takes time. Support from the management team is essential to succeed in developing and establishing new models of care and new nursing roles, such as the nurse practitioner role.

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General medicine at the frontline of acute care delivery: Comparison with family medicine hospitalist model implementation in Singapore

Proceedings of Singapore Healthcare ◽

10.1177/2010105820937747 ◽

2020 ◽

pp. 201010582093774

Author(s):

Yi Feng Lai ◽

Si Yun Leow ◽

Sophia Yi-Fei Lee ◽

Jun Xiong ◽

Cher Wee Lim ◽

...

Keyword(s):

Family Medicine ◽

Usual Care ◽

Care Delivery ◽

General Medicine ◽

Healthcare Team ◽

Successful Implementation ◽

Care Model ◽

Team Members ◽

High Level ◽

Operational Issues

Introduction This mixed methods study seeks to assess the clinical outcomes and qualitative insights associated with the pragmatic implementation of a general medicine (GM) physician-led inpatient care model, first at Alexandra Hospital (AH) and then at Sengkang General Hospital (SKH), and to compare them with findings reported in an earlier implementation of the family medicine (FM) hospitalist model in Singapore. Methods Anonymous quantitative demographic and clinical data including length of stay, 30-day readmission rate, inpatient mortality rate and gross cost of hospitalisation bills were extracted from the hospital information system. Comparative analyses with the FM hospitalist model and usual care were made. Secondary qualitative data that were gathered focused on increased understanding of the proposed model, its perceived challenges and future opportunities for its implementation. Results The adapted GM care model implemented first at AH and then at SKH seemed to suggest that such a model run by physicians from various backgrounds was capable of producing similarly superior outcomes when compared with the FM hospitalist model piloted in 2011, which was juxtaposed with usual care. With regard to qualitative insights, three findings were reported: (a) perception of and mindset in relation to generalists, which illustrates the barriers to implementing GM; (b) education and training of generalists, which underlines the current lack of adequate supply of GM specialists; and (c) operational issues of care model implementation, which highlights the current mismatches between the prevailing healthcare philosophy and the requirements for successful implementation of the GM care model. Conclusion The success of a GM care model hinges on how it is operationalised. With clear protocols, definitions, and a high level of protocol compliance by healthcare team members, the intended outcomes show promise for replication at other interested sites.

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Emergency Medical Technician-Facilitated Telehealth Visits: A New Model to Expand Home-Based Primary Care for Homebound Seniors

Telehealth and Medicine Today ◽

10.30953/tmt.v5.180 ◽

2020 ◽

Author(s):

Karen A. Abrashkin ◽

A. Camille McBride ◽

Jill C. Slaboda ◽

Michael Kurliand ◽

Amparo Abel-Bey ◽

...

Keyword(s):

Primary Care ◽

Home Visit ◽

Care Delivery ◽

Care Physician ◽

Emergency Medical Technician ◽

Care Model ◽

New Model ◽

Home Based Primary Care ◽

Home Based ◽

Medical Technician

Objective: As the number of older adults living in the United States grows, the gap between the capacity of home-based primary care (HBPC) services and the community demand will continue to widen. Older adults, living longer with mobility difficulties and multiple chronic medical conditions, often prefer to age in place, and new models of care are needed to meet this need. This article provides a framework for an innovative emergency medical technician (EMT)-facilitated telehealth program, the mobile telemedicine technician (MTT) program, which aims to increase access to medical care and efficiency within an HBPC program. Design: A descriptive framework outlining the deployment of an innovative telehealth model. Setting: An HBPC program serving homebound seniors in downstate New York. Participants: Homebound individuals enrolled in an HBPC program with advanced age (over half >90 years), 67% with 5–6 activities of daily living (ADL) dependencies, and high rates of dementia, congestive heart failure, chronic obstructive pulmonary disease (COPD), and diabetes requiring evaluation and treatment of acute conditions. Interventions: HBPC program enrollees requiring evaluation and treatment of acute conditions received a home visit from a telehealth-enabled EMT who has received additional training to provide in-home care. Following an evaluation, the EMT facilitated a telehealth visit via a two-way video conference between the patient and the primary care physician. Main outcome measures: Description of a novel telehealth care model, preliminary results from the first 100 MTT visits including the reason for visit, patient/caregiver, physician, and telehealth-enabled EMT satisfaction survey results. Results: The primary care provider was able to evaluate twice as many patients in a given time period using the new model as in the regular home visit care model. The most common visit reasons were related to skin conditions (22%), neurological conditions (19%), cardiovascular conditions (16%), and respiratory conditions (15%). Satisfaction rates were high from patients/caregivers (45% response rate, 60% strongly agreed and 29% agreed that they were satisfied with the care delivery experience), physician (six surveys over time from one physician, 100% strongly agreed on the effectiveness of care delivery model), and telehealth-enabled EMTs (eight surveys from four EMTs, 100% strongly agreed that they were satisfied with the care delivery experience). Conclusions: In this descriptive article, we outline a new model of care using telehealth-enabled EMTs making home visits to connect with a patient’s primary care physician who is centrally located. This model shows promise for expanding primary care services within the home.

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Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study

JMIR Nursing ◽

10.2196/15691 ◽

2020 ◽

Vol 3 (1) ◽

pp. e15691 ◽

Cited By ~ 2

Author(s):

Kayleigh Gordon ◽

Carolyn Steele Gray ◽

Katie N Dainty ◽

Jane DeLacy ◽

Patrick Ware ◽

...

Keyword(s):

Health Care ◽

Chronic Conditions ◽

Chronic Care ◽

Care Delivery ◽

Models Of Care ◽

Integrated Model ◽

Qualitative Description ◽

Model Of Care ◽

Care Needs ◽

Delivery Models

Background The growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population. Objective This qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care. Methods A qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs. Results The analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care. Conclusions Despite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care.

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Abstract 18205: Successful Implementation of a Tele-visit Multidisciplinary Program

Circulation ◽

10.1161/circ.132.suppl_3.18205 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Ami Bhatt ◽

Sarah Sossong ◽

Ada Stefanescu ◽

Lee H Schwamm

Keyword(s):

Care Delivery ◽

Technical Problem ◽

Healthcare Providers ◽

Great Majority ◽

Models Of Care ◽

Successful Implementation ◽

Office Visits ◽

Multidisciplinary Program ◽

Virtual Visits ◽

Consumer Assessment

Objectives: To design, implement and assess a patient and physician centered virtual visit program. Methods: Patients within the Cardiology and Neurology departments were enrolled in a real-time videoconferencing virtual visits program between April 1st 2014 and June 3rd 2015. Surveys were sent to patients who had at least one virtual visit between in the first 8 months to assess response to the use of the system and satisfaction, including the Consumer Assessment of Healthcare Providers and Systems survey (CAHPS). Results: There were 131 virtual visits in Cardiology and 419 visits in Neurology. The great majority of patients (83%) responded that they would definitely recommend a virtual visit to family or friends. Patients found the platform easy to use, with 74% of patients easily installing the product. Despite 42.5% reporting at least one technical problem, the overall patient satisfaction was high based on the CAHPS measures (Figure 1), and more than half of patients said they would even be willing to pay an up to $50 copay if needed for such visits. More than half of patients and providers felt that the quality of the visit was the same as in the office. While 45% of Cardiology patients felt the same during a virtual visit as in the office, 45% felt a stronger connection in person. Most providers felt virtual visits were either more efficient (38.5%) or just as long as office visits (50%), while 90% of patients thoughts their clinicians spent just as much time with them. Only 23.2% of patients overall however felt that a telephone call could definitely have addressed the same issue, emphasizing the value of the video conferencing platform. Conclusion: Virtual visits are well received by patients and providers, and considered by both to be efficient and useful. Implementing a virtual visit program with a design approach to assess and respond promptly to user feedback has encouraged adoption and holds promise for increasing the scale and integration into models of care delivery.

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