scholarly journals Shifting Care from Hospital to Community, A Strategy to Integrate Care in Singapore: Process Evaluation of Implementation Fidelity

2020 ◽  
Author(s):  
MILAWATY NURJONO ◽  
Pami Shrestha ◽  
Ian Yi Han Ang ◽  
Farah Shiraz ◽  
Ke Xin Eh ◽  
...  
Keyword(s):  
Health System ◽  
Functional Integration ◽  
Healthcare Delivery ◽  
Implementation Fidelity ◽  
Realist Evaluation ◽  
University Hospital ◽  
Specialist Care ◽  
Structured Interviews ◽  
National University ◽  
Further Development

Abstract Background: Accessibility to efficient and person-centered healthcare delivery drives healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. To improve this situation, the National University Health System (NUHS) Regional Health System (RHS) started an integrated care initiative, the Right-Site Care (RSC) program in 2014. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community. The aim of this study was to evaluate the implementation fidelity of the NUHS RHS RSC program using the modified Conceptual Framework for Implementation Fidelity (CFIF), at three distinct levels; providers, organizational, and system levels to explain outcomes of the program and to inform further development of (similar) programs. Methods: A convergent parallel mixed methods study using the realist evaluation approach was used. Data were collected between 2016-2018 through non-participatory observations, reviews of medical records and program database, together with semi-structured interviews with healthcare providers. Triangulation of data streams was applied guided by the modified CFIF. Results: Our findings showed four out of six program components were implemented with low level of fidelity, and 9,112 suitable patients were referred to the program while 3,032 (33.3%) declined to be enrolled. Moderating factors found to influence fidelity included: (i) complexity of program, (ii) evolving providers’ responsiveness, (iii) facilitation through synergistic partnership, training of PCC providers by specialists and supportive structures: care coordinators, guiding protocols, shared electronic medical record and shared pharmacy, (iv) lack of organization reinforcement, and (v) mismatch between program goals, healthcare financing and providers’ reimbursement. Conclusion: Functional integration alone is insufficient for a successful right-site care program implementation. Improvement in relationships between providers, organizations, and patients are also warranted for further development of the program.

scholarly journals Shifting Care from Hospital to Community, A Strategy to Integrate Care in Singapore: Process Evaluation of Implementation Fidelity

2019 ◽  
Author(s):  
Milawaty Nurjono ◽  
Pami Shrestha ◽  
Ian Yi Han Ang ◽  
Farah Shiraz ◽  
Ke Xin Eh ◽  
...  
Keyword(s):  
Health System ◽  
Functional Integration ◽  
Healthcare Delivery ◽  
Implementation Fidelity ◽  
Realist Evaluation ◽  
University Hospital ◽  
Specialist Care ◽  
Structured Interviews ◽  
National University ◽  
Further Development

Abstract Background: Accessibility to efficient and person-centered healthcare delivery drive healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. To improve this situation, the National University Health System (NUHS) Regional Health System (RHS) started an integrated care initiative,the Right-Site Care (RSC) program in 2014. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community. The aim of this study was to evaluate the implementation fidelity of the NUHS RHS RSC program using the modified Conceptual Framework for Implementation Fidelity (CFIF), at three distinct levels; providers, organizational, and system levels to explain outcomes of the program and to inform further development of (similar) programs. Methods: A convergent parallel mixed methods study using the realist evaluation approach was used. Data were collected between 2016-2018 through non-participatory observations, reviews of medical records and program database, together with semi-structured interviews with healthcare providers. Triangulation of data streams was applied guided by the modified CFIF. Results: Our findings showed four out of six program components were implemented with low level of fidelity, and 9,112 suitable patients were referred to the program while 3,032 (33.3%) declined to be enrolled. Moderating factors found to influence fidelity included: (i) complexity of program, (ii) evolving providers’ responsiveness, (iii) facilitation through synergistic partnership, training of PCC providers by specialists and supportive structures: care coordinators, guiding protocols, shared electronic medical record and shared pharmacy, (iv) lack of organization reinforcement, and (v) mismatch between program goals, healthcare financing and providers’ reimbursement. Conclusion: Functional integration alone is insufficient for a successful right-site care program implementation. Improvement in relationships between providers, organizations, and patients are also warranted for further development of the program.

scholarly journals Shifting Care from Hospital to Community, A Strategy to Integrate Care in Singapore: Process Evaluation of Implementation Fidelity

2019 ◽  
Author(s):  
Milawaty Nurjono ◽  
Pami Shrestha ◽  
Ian Yi Han Ang ◽  
Farah Shiraz ◽  
Ke Xin Eh ◽  
...  
Keyword(s):  
Health System ◽  
Functional Integration ◽  
Healthcare Delivery ◽  
Implementation Fidelity ◽  
Realist Evaluation ◽  
University Hospital ◽  
Specialist Care ◽  
Structured Interviews ◽  
National University ◽  
Further Development

Abstract Background: Accessibility to efficient and person-centered healthcare delivery drive healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. To improve this situation, the National University Health System (NUHS) Regional Health System (RHS) started an integrated care initiative,the Right-Site Care (RSC) program in 2014. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community. The aim of this study was to evaluate the implementation fidelity of the NUHS RHS RSC program using the modified Conceptual Framework for Implementation Fidelity (CFIF), at three distinct levels; providers, organizational, and system levels to explain outcomes of the program and to inform further development of (similar) programs. Methods: A convergent parallel mixed methods study using the realist evaluation approach was used. Data were collected between 2016-2018 through non-participatory observations, reviews of medical records and program database, together with semi-structured interviews with healthcare providers. Triangulation of data streams was applied guided by the modified CFIF. Results: Our findings showed four out of six program components were implemented with low level of fidelity, and 9,112 suitable patients were referred to the program while 3,032 (33.3%) declined to be enrolled. Moderating factors found to influence fidelity included: (i) complexity of program, (ii) evolving providers’ responsiveness, (iii) facilitation through synergistic partnership, training of PCC providers by specialists and supportive structures: care coordinators, guiding protocols, shared electronic medical record and shared pharmacy, (iv) lack of organization reinforcement, and (v) mismatch between program goals, healthcare financing and providers’ reimbursement. Conclusion: Functional integration alone is insufficient for a successful right-site care program implementation. Improvement in relationships between providers, organizations, and patients are also warranted for further development of the program.

scholarly journals Orthopedist involvement in the management of clinical activities: a case study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
André Côté ◽  
Kassim Said Abasse ◽  
Maude Laberge ◽  
Marie-Hélène Gilbert ◽  
Mylaine Breton ◽  
...  
Keyword(s):  
Healthcare Delivery ◽  
University Hospital ◽  
Structured Interviews ◽  
Institutional Dynamics ◽  
Level Of Involvement ◽  
Hospital Governance ◽  
Efficiency And Effectiveness ◽  
Data Saturation ◽  
Orthopedic Care ◽  
Four Levels

Abstract Background The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists’ level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement. Methods We selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview. Results Our findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed. Conclusions Beyond simply identifying the underlying dynamics of orthopedists’ involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients.

A system-wide transformation towards integrated care in the Basque Country: A realist evaluation

2018 ◽  
Vol 21 (3) ◽  
pp. 98-108 ◽  
Author(s):  
Maider Urtaran-Laresgoiti ◽  
Arturo Álvarez-Rosete ◽  
Roberto Nuño-Solinís
Keyword(s):  
Health System ◽  
Social Care ◽  
Basque Country ◽  
Economic Recession ◽  
Realist Evaluation ◽  
System Transformation ◽  
Structured Interviews ◽  
Long Run ◽  
Health And Social Care ◽  
Care Systems

Introduction In 2010, in a context of severe economic recession, the Basque Government launched the Strategy to tackle the challenge of chronicity in the Basque Country to transform the Basque health system to cope with the challenges of chronicity, ageing, health system fragmentation and sustainability in the long run. Methods A realist evaluation has been conducted, and through a combination of research methods, information has been analysed to identify context, mechanisms and outcomes. The research provides a snapshot of the experience of a system-wide, complex health system transformation, which aims to identify ‘what has worked, for whom and under what circumstances’. Twenty-two semi-structured interviews held between June 2015 and December 2016, allowed us to obtain both retrospective and real-time accounts on the transformation phenomenon. Results Research pointed out that system-wide transformation requires time, effort, leadership, vision and narrative, as well as commitment, inclusiveness, collaborative decision-making processes with local implementers, ‘muddling through’ and constant learning. Key levers to shake and shift the health and social care systems towards closer alignment, coordination and integration to meet the needs of people include promoting collaborative relationships between health professionals to ensure care continuity, developing new staff roles, investing in integrated electronic health records, stratifying the population by risk and facilitating bottom-up innovation. Discussion Research has shown that system-wide changes in health and social care have been viable in the Basque Health System, although the interplay between context, mechanisms and outcomes is more complex than expected, leading to many unexpected factors, patterns and relationships.

Intestinal parasite survey of Kyungpook National University Hospital patients

1971 ◽  
Vol 9 (2) ◽  
pp. 47 ◽  
Author(s):  
Dong Wik Choi ◽  
Sung Deok Park ◽  
Jae Woun Kim ◽  
Doo Hong Ahn ◽  
Young Myung Kim
Keyword(s):  
Intestinal Parasite ◽  
University Hospital ◽  
Hospital Patients ◽  
National University

scholarly journals COVID-19 does not stop obstetrics: what we need to change to go on safely birthing. The experience of a University Obstetrics and Gynecology Department in Milan

2020 ◽  
Vol 48 (9) ◽  
pp. 997-1000
Author(s):  
Nikita Alfieri ◽  
Stefano Manodoro ◽  
Anna Maria Marconi
Keyword(s):  
Health System ◽  
University Hospital ◽  
Obstetrics And Gynecology ◽  
Daily Routine ◽  
Clinical Services ◽  
Wuhan City ◽  
Set Up

AbstractSince SARS-COV-2 appeared in Wuhan City, China and rapidly spread throughout Europe, a real revolution occurred in the daily routine and in the organization of the entire health system. While non-urgent clinical services have been reduced as far as possible, all kind of specialists turned into COVID-19 specialists. Obstetric assistance cannot be suspended and, at the same time, safety must be guaranteed. In addition, as COVID-19 positive pregnant patients require additional care, some of the clinical habits need to be changed to face emerging needs for a vulnerable but unstoppable kind of patients. We report the management set up in an Obstetrics and Gynecology Unit during the COVID-19 era in a University Hospital in Milan, Italy.

Patient preferences for specialist outpatient video consultations: A discrete choice experiment

2021 ◽  
pp. 1357633X2110228
Author(s):  
Centaine L Snoswell ◽  
Anthony C Smith ◽  
Matthew Page ◽  
Liam J Caffery
Keyword(s):  
General Practitioner ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Patient Preferences ◽  
Choice Experiment ◽  
Healthcare Delivery ◽  
General Practitioner Practice ◽  
Specialist Care ◽  
Time Away ◽  
Out Of Pocket Costs

Introduction Telehealth has been shown to improve access to care, reduce personal expenses and reduce the need for travel. Despite these benefits, patients may be less inclined to seek a telehealth service, if they consider it inferior to an in-person encounter. The aims of this study were to identify patient preferences for attributes of a healthcare service and to quantify the value of these attributes. Methods We surveyed patients who had taken an outpatient telehealth consult in the previous year using a survey that included a discrete choice experiment. We investigated patient preferences for attributes of healthcare delivery and their willingness to pay for out-of-pocket costs. Results Patients ( n = 62) preferred to have a consultation, regardless of type, than no consultation at all. Patients preferred healthcare services with lower out-of-pocket costs, higher levels of perceived benefit and less time away from usual activities ( p < 0.008). Most patients preferred specialist care over in-person general practitioner care. Their order of preference to obtain specialist care was a videoconsultation into the patient’s local general practitioner practice or hospital ( p < 0.003), a videoconsultation into the home, and finally travelling for in-person appointment. Patients were willing to pay out-of-pocket costs for attributes they valued: to be seen by a specialist over videoconference ($129) and to reduce time away from usual activities ($160). Conclusion Patients value specialist care, lower out-of-pocket costs and less time away from usual activities. Telehealth is more likely than in-person care to cater to these preferences in many instances.

scholarly journals Circulating regulatory T cells predict efficacy and atypical responses in lung cancer patients treated with PD-1/PD-L1 inhibitors

2021 ◽  
Author(s):  
Da Hyun Kang ◽  
Chaeuk Chung ◽  
Pureum Sun ◽  
Da Hye Lee ◽  
Song-I Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Advanced Nsclc ◽  
Checkpoint Inhibitors ◽  
Standard Of Care ◽  
Treg Cells ◽  
University Hospital ◽  
X Rays ◽  
Lung Cancer Patients ◽  
National University

Abstract Background Immune checkpoint inhibitors (ICIs) have become the standard of care for a variety of cancers, including non-small cell lung cancer (NSCLC). In this study, we investigated the frequency of pseudoprogression and hyperprogression in lung cancer patients treated with ICIs in the real world and aimed to discover a novel candidate marker to distinguish pseudoprogression from hyperprogression soon after ICI treatment. Methods This study included 74 patients with advanced NSCLC who were treated with PD-1/PD-L1 inhibitors at Chungnam National University Hospital (CNUH) between January 2018 and August 2020. Chest X-rays were examined on day 7 after the first ICI dose to identify changes in the primary mass, and the response was assessed by computed tomography (CT). We evaluated circulating regulatory T (Treg) cells using flow cytometry and correlated the findings with clinical outcomes. Results The incidence of pseudoprogression was 13.5%, and that of hyperprogression was 8.1%. On day 7 after initiation of treatment, the frequency of CD4+CD25+CD127loFoxP3+ Treg cells was significantly decreased compared with baseline (P = 0.038) in patients who experienced pseudoprogression and significantly increased compared with baseline (P = 0.024) in patients who experienced hyperprogression. In the responder group, the frequencies of CD4+CD25+CD127loFoxP3+ Treg cells and PD-1+CD4+CD25+CD127loFoxP3+ Treg cells were significantly decreased 7 days after commencement of treatment compared with baseline (P = 0.034 and P < 0.001, respectively). Conclusion Circulating Treg cells represent a promising potential dynamic biomarker to predict efficacy and differentiate atypical responses, including pseudoprogression and hyperprogression, after immunotherapy in patients with NSCLC.

scholarly journals Formative process evaluation of a guideline-driven process for improving the cultural responsiveness of alcohol and drug treatment services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara Farnbach ◽  
Julaine Allan ◽  
Raechel Wallace ◽  
Alexandra Aiken ◽  
Anthony Shakeshaft
Keyword(s):  
Culturally Responsive ◽  
Implementation Fidelity ◽  
Healthcare Services ◽  
Cultural Responsiveness ◽  
Free Text ◽  
Structured Interviews ◽  
Culturally Responsive Practice ◽  
Step Process ◽  
Treatment Services ◽  
Service Staff

Abstract Background To improve Australian Aboriginal and Torres Strait Islander people’s access to, and experience of, healthcare services, including Alcohol and other Drug (AoD) treatment services, principles and frameworks have been developed to optimise cultural responsiveness. Implementing those principles in practice, however, can be difficult to achieve. This study has five aims: i) to describe a five-step process developed to operationalise improvements in culturally responsive practice in AoD services; ii) to evaluate the fidelity of implementation for this five-step process; iii) to identify barriers and enablers to implementation; iv) to assess the feasibility and acceptability of this approach; and v) to describe iterative adaptation of implementation processes based on participant feedback. Methods Participating services were 15 non-Aboriginal AoD services in New South Wales, Australia. Implementation records were used to assess the implementation fidelity of the project. Structured interviews with chief executive officers or senior management were conducted, and interview data were thematically analysed to identify project acceptability, and the key enablers of, and barriers to, project implementation. Quantitative descriptive analyses were performed on the post-implementation workshop survey data, and responses to the free text questions were thematically analysed. Results A high level of implementation fidelity was achieved. Key enablers to improving culturally responsive practice were the timing of the introduction of the five-step process, the active interest of staff across a range of seniority and the availability of resources and staff time to identify and implement activities. Key barriers included addressing the unique needs of a range of treatment sub-groups, difficulty adapting activities to different service delivery models, limited time to implement change in this evaluation (three months) and the varied skill level across staff. The project was rated as being highly acceptable and relevant to service CEOs/managers and direct service staff, with planned changes perceived to be achievable and important. Based on CEO/management feedback after the project was implemented at the initial services, several improvements to processes were made. Conclusion The operationalisation of the five-step process developed to improve cultural responsiveness was feasible and acceptable and may be readily applicable to improving the cultural responsiveness of a wide variety of health and human services.

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