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

2019 ◽  
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.

scholarly journals 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 ◽  
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.

Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Carolyn Foster ◽  
Dana Schinasi ◽  
Kristin Kan ◽  
Michelle Macy ◽  
Derek Wheeler ◽  
...  
Keyword(s):  
Health Care ◽  
Digital Literacy ◽  
Care Delivery ◽  
Digital Health ◽  
Health Care Team ◽  
Models Of Care ◽  
Health Data ◽  
Care Needs ◽  
Case Examples ◽  
Health Technologies

Remote patient monitoring (RPM) is a form of telemedicine that involves the collection and transmission of health data from a patient to their health care team by using digital health technologies. RPM can be leveraged to aggregate and visualize longitudinal patient-generated health data for proactive clinical management and engagement of the patient and family in a child’s health care. Collection of remote data has been considered standard of care for years in some chronic pediatric conditions. However, software limitations, gaps in access to the Internet and technology devices, digital literacy, insufficient reimbursement, and other challenges have prevented expansion of RPM in pediatric medicine on a wide scale. Recent technological advances in remote devices and software, coupled with a shift toward virtual models of care, have created a need to better understand how RPM can be leveraged in pediatrics to improve the health of more children, especially for children with special health care needs who are reliant on high-quality chronic disease management. In this article, we define RPM for the general pediatric health care provider audience, provide case examples of existing RPM models, discuss advantages of and limitations to RPM (including how data are collected, evaluated, and managed), and provide a list of current RPM resources for clinical practitioners. Finally, we propose considerations for expansion of this health care delivery approach for children, including clinical infrastructure, equitable access to digital health care, and necessary reimbursement. The overarching goal is to advance health for children by adapting RPM technologies as appropriate and beneficial for patients, families, and providers alike.

scholarly journals Editorial

2007 ◽  
Vol 31 (3) ◽  
pp. 449
Author(s):  
Deborah Yarmo-Roberts
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Models Of Care ◽  
Health Condition ◽  
Self Management ◽  
Health Care Needs ◽  
Model Of Care ◽  
Care Needs ◽  
Care Services ◽  
Care Facilitators

INDIVIDUALS ARE LIVING longer than ever before, with a propensity to acquire debilitating conditions, often with comorbidities. This necessitates care delivered from many sectors of the service system. This issue?s featured Models of Care article, ?Integrated care facilitation for older patients with complex health care needs reduces hospital demand? on page 451 describes a model of care which aimed to coordinate health care services for older adults. One of the successes of this model was the employment of personal care facilitators, who assisted the patients in understanding their health condition, which promoted self-management in accessing required services.

Adverse Events, Functional Decline, and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization

2020 ◽  
pp. 073346482092421
Author(s):  
Amanda Fox ◽  
Margaret MacAndrew ◽  
Katy Wyles ◽  
Catherine Yelland ◽  
Elizabeth Beattie
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Allied Health ◽  
Care Delivery ◽  
Functional Decline ◽  
Models Of Care ◽  
Policy And Practice ◽  
Care Needs ◽  
Number Of Patients ◽  
The Impact

The number of patients attending acute care hospitals with a diagnosis of dementia is increasing. The impact of hospitalization on function and adverse events is perceived to be greater for patients with dementia than those without. This study compared adverse events (falls, wounds, delirium, medication errors, infections, and incontinence), functional decline, and allied health therapy for patients with and without dementia ( n = 240). Patients with dementia experienced significantly more adverse events and constant observation by staff, were more dependent with mobility, hygiene and feeding, more often nil by mouth, confused, and incontinent. Patients with dementia were significantly more likely to receive speech and physiotherapy, although they did not significantly improve in function during their hospital stay. Conversely, patients without dementia significantly improved in mobility and continence. The unique health care needs of patients with dementia need to inform models of care, policy, and practice to support safe health care delivery in this vulnerable population.

Optimization of the care model for elderly in Poland

Physiotherapy ◽  
2013 ◽  
Vol 21 (4) ◽  
Author(s):  
Felicja Lwow ◽  
Małgorzata Korzeniowska ◽  
Joanna Dadacz ◽  
Ewa Hladik ◽  
Agata Łukojko ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Conditions ◽  
Institutional Care ◽  
Developed Countries ◽  
Social Aspect ◽  
Age Group ◽  
Care Needs ◽  
Optimal Health ◽  
Health Care Models ◽  
The Individual

AbstractThe demographic situation of Poland as well as other developed countries shows a growing number of people at retirement age. According to the data from GUS (Central Statistical Office), their number reached 6.5 mln in Poland in 2011, and the prognosis for shows 8,3 mln by the year 2035. The consequence of this fact is a necessity of including the specificity of this age group in the functioning of Polish health care as well as in preventive medicine and health promotion. Unifying the health needs of this age group would be disadvantageous due to the diversification of physical efficiency level in the psychosomatic and social aspect. Nevertheless, the key problem is to distinguish the optimal health care models which include not only chronic conditions and dysfunctions but also the quality of life and socially independent life style that guarantee the lack of isolation and social exclusion. Distinguishing the four action models, namely people considered as healthy by the system, autonomously functioning people with chronic conditions, and people who need other people or institutional care to function in a society, seems to cover the individual needs of this group. Concluding, the National Health Care needs to work out some proceeding algorithms for these models. The optimal program adjustment for the needs of the target group would most certainly improve the effectiveness of the Health Care.

COVID 19 and Special Care Dentistry: A Narrative Review

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1473-1476
Author(s):  
Ashwika Datey ◽  
Soumya Singhai ◽  
Gargi Nimbulkar ◽  
Kumar Gaurav Chhabra ◽  
Amit Reche
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Care Delivery ◽  
Special Care ◽  
World Health ◽  
Healthcare Sector ◽  
Health Care Needs ◽  
Oral Diseases ◽  
Care Needs

The COVID 19 outbreak has been declared a pandemic by the world health organisation. The healthcare sector was overburdened and overstretched with the number of patient increasing and requiring health services. The worst-hit population always are the people with special needs, whether it is children, pregnant females or the geriatric population. The need for the emergency kind of health services was so inflated that the other special population which required them equally as those patients with the COVID 19 suffered a lot. Dentistry was not an exception, and even that is also one of the important components of the health care delivery system and people requiring oral health care needs were also more. Those undergoing dental treatments would not have completed the treatment, and this would have resulted in various complications. In this situation, some dental emergency guidelines have been released by Centres for Disease Control (CDC) for the urgent dental care those requiring special care dentistry during the COVID 19 pandemic. Children with special care needs were considered more vulnerable to oral diseases; hence priority should have been given to them for dental treatments moreover in the future also more aggressive preventive measures should be taken in order to maintain oral hygiene and prevent many oral diseases. Guardians/caregivers should be made aware and motivated to maintain the oral health of children with special health care needs. This review mainly focuses on the prevention and management of oral diseases in children's with special care needs.

Prevalence of Psychiatric Diagnoses and Psychiatric Consultation Service Utilization on Inpatient Medical Units

2021 ◽  
pp. 107839032110055
Author(s):  
Bianca Reis ◽  
Jenny Hsin-Chun Tsai
Keyword(s):  
Health Care ◽  
Psychiatric Disorders ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Adult Patients ◽  
Psychiatric Diagnoses ◽  
Psychiatric Consultation ◽  
Consultation Service ◽  
Icd 10 ◽  
Delivery Models

OBJECTIVE This practice improvement project sought to determine the prevalence of psychiatric diagnoses among patients admitted to a community hospital’s inpatient medical units and which diagnoses were serviced by the hospital’s psychiatric consultation service. METHOD Electronic medical record data on adult patients of five medical units admitted with a psychiatric condition between October 1, 2019, and December 31, 2019, were used. Psychiatric ICD-10 ( International Classification of Diseases, 10th Revision) codes and diagnosis names extracted were categorized into seven major diagnostic groups. A total of 687 adult patients with 82 psychiatric ICD-10 codes were analyzed using descriptive statistics. RESULTS Substance-related and addictive disorders were the most prevalent psychiatric diagnoses. Ninety-six percent ( n = 658) of patients residing on medical floors with psychiatric disorders were hospitalized for a principal medical problem. Seventy-three cases received psychiatric consultations during their stay. Sixty percent ( n = 44) of those cases had psychiatric disorders from two or more diagnostic categories. CONCLUSIONS Multidisciplinary, team-based health care delivery models that include a psychiatric nurse can provide an effective approach to treat patients in community hospitals with multiple psychiatric and medical comorbidities. Hospitals could take a significant role in providing substance use disorder treatment and equipping medical nurses with training to competently care for patients with psychiatric disorders on medical units. Further research into the prevalence and impact of patients with co-occurring and multiple psychiatric diagnoses in community hospitals is needed to implement effective health care delivery models and provide appropriate treatment options in the community.

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