scholarly journals Impact and Usability of a Care Management and Coordination System in Delivering Services to Vulnerable Populations: Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Rubina Rizvi ◽  
Courtney VanHouten ◽  
Tiffani J Bright ◽  
Mollie M McKillop ◽  
Shira Alevy ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Technology Acceptance ◽  
Care Management ◽  
Care Delivery ◽  
Mixed Methods Study ◽  
Homeless Population ◽  
Theory Approach ◽  
Complex Needs ◽  
Coordination System ◽  
Sonoma County

BACKGROUND People with complex needs, such as those experiencing homelessness, require concurrent, seamless support from multiple social service agencies. Sonoma County, CA has one of the nation’s largest homeless populations among largely suburban communities. To support client-centered care, the county deployed a Care Management and Coordination System (CMCS). This system was comprised of Watson Care Manager (WCM), a front-end system, and Connect 360, which is an integrated data hub that aggregates information from various systems into a single client record. OBJECTIVE This study evaluated the perceived impact and usability of WCM in delivering services to the homeless population in Sonoma County. METHODS A mixed methods study was conducted to identify ways in which WCM helps to coordinate care. Interviews, observations and surveys were conducted, and transcripts and field notes were thematically analyzed and directed by a grounded theory approach. Responses to the Technology Acceptance Model (TAM) survey were analyzed. RESULTS Sixteen participants were interviewed, including WCM users (n=8) and department leadership (n=8). Three interdisciplinary team meetings were observed, and WCM users (n=8) were surveyed. WCM provided a central shared platform where client-related, up-to-date, comprehensive, and reliable information from participating agencies was consolidated. Factors that facilitated WCM use were users’ enthusiasm regarding the tool functionalities, scalability and agency collaboration. Constraining factors included the (a) suboptimal awareness of care delivery goals and functionality of the system among the community, (b) sensitivities about data sharing and legal requirements and (c) constrained funding from government and non-government organizations. Overall, users found WCM to be a useful tool that was easy to use and helped to enhance performance. CONCLUSIONS WCM supports delivery of care to individuals with complex needs. Integration of data and information in a CMCS can facilitate coordinated care. Future research should examine WCM and similar CMCSs in diverse populations and settings.

A Mixed-Methods Study of Multi-Level Factors Influencing Mammography Overuse: Implications for De-implementation.

2021 ◽  
Author(s):  
Jessica D. Austin ◽  
Parisa Tehranifar ◽  
Carmen B. Rodriguez ◽  
Laura Brotzman ◽  
Mariangela Agovino ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Older Women ◽  
Survey Data ◽  
Mammography Screening ◽  
Care Delivery ◽  
Interview Data ◽  
Mixed Methods Study ◽  
Spanish Speaking ◽  
Factors Influencing ◽  
Multi Level

Abstract Background There is growing concern that routine mammography screening is overused among older women. Successful and equitable de-implementation of mammography will require a multi-level understanding of the factors contributing to mammography overuse. Methods This explanatory, sequential, mixed-methods study collected survey data (n = 52, 73.1% Hispanic, 73.1% Spanish-speaking) from women ≥ 70 years of age at the time of screening mammography, followed by semi-structured interviews with a subset of older women completing the survey (n = 19, 63.2% Hispanic, 63.2% Spanish-speaking) and providers (n = 5, 4 primary care, 1 obstetrics and gynecology) to better understand multi-level factors influencing mammography overuse and inform potential de-implementation strategies. We conducted descriptive analysis of survey data and content analysis of qualitative interview data. Survey and interview data were examined separately, compared, integrated, and organized according to Norton and Chambers Continuum of Factors Influencing De-Implementation Process. Results Survey findings show that 87.2% of older women believe it is important to plan for an annual mammogram, 80.8% received a provider recommendation, and 78.9% received a reminder in the last 12 months to schedule a mammogram. Per interviews with older women, the majority were unaware of or did not experience overuse and intended to continue mammography screening. Findings from interviews with older women and providers suggest that there are multiple opportunities for older women to obtain a mammogram. Per provider interviews, almost all reported that overuse was not viewed as a priority by the system or other providers. Providers also discussed that variation in mammography screening practices across providers, fear of malpractice, and monetary incentives may be reasons for overuse. Providers identified potential strategies including patient and provider education around harms of screening, leveraging the electronic health record to identify women who may no longer benefit from screening, customizing system-generated reminder letters, and organizing workgroups to develop a standard process of care around mammography screening. Conclusions Multi-level factors contributing to mammography overuse are dynamic and reinforced. To ensure equitable de-implementation, there is a need for more refined theories, models, and frameworks for de-implementation with a strong patient-level component that considers the interplay between multilevel factors and the larger care delivery process.

scholarly journals Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

2019 ◽  
Vol 74 (5) ◽  
pp. 589-600 ◽  
Author(s):  
Kim N. Danforth ◽  
Erin E. Hahn ◽  
Jeffrey M. Slezak ◽  
Lie Hong Chen ◽  
Bonnie H. Li ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Delivery System ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Mixed Methods Study ◽  
Estimated Gfr ◽  
System A

scholarly journals The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol

2021 ◽  
Vol 18 (24) ◽  
pp. 13084
Author(s):  
Chiara Acquati ◽  
Tzuan A. Chen ◽  
Isabel Martinez Leal ◽  
Shahnjayla K. Connors ◽  
Arooba A. Haq ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mixed Methods ◽  
Cancer Care ◽  
Care Delivery ◽  
Mixed Methods Study ◽  
Black African ◽  
Related Quality ◽  
Health Related ◽  
Hispanic White

The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients’ quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients’ outcomes.

scholarly journals Perspectives on Acceptance and Use of a Mobile Health Intervention for the Prevention of Atherosclerotic Cardiovascular Disease in Singapore: Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
Victoria Haldane ◽  
Yao Guo Tan ◽  
Krichelle Wei Qi Teo ◽  
Joel Jun Kai Koh ◽  
Aastha Srivastava ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Mixed Methods ◽  
Technology Acceptance ◽  
Mobile Health ◽  
Technology Use ◽  
Mixed Methods Study ◽  
Intention To Use ◽  
Atherosclerotic Cardiovascular Disease ◽  
Mhealth Intervention

BACKGROUND Cardiovascular disease, including atherosclerotic cardiovascular disease (ASCVD), is a growing public health threat globally and many individuals remain undiagnosed, untreated, and uncontrolled. Simultaneously, mobile health (mHealth) interventions using short messaging service (SMS) have gained popularity globally. There is an opportunity for innovative approaches such as mHealth to encourage and enable adherence to medications for ASCVD and its risk factors. OBJECTIVE This study aimed to understand mobile technology acceptance, use, and facilitating conditions among the study population ahead of the design of an mHealth intervention. METHODS Using data from a mixed-methods study conducted in Singapore, we conducted a cross-sectional survey with 100 participants and in-depth, semistructured interviews with 20 patients. All participants were over the age of 40 years with ASCVD or its risk factors. Interviews were conducted in English and Mandarin and if needed translated to English. Nvivo 11 (QSR International) was used for analyses. RESULTS Participants reported their perspectives on technology use and preferences, including low or sporadic mobile phone use and usability concerns including small screen and text size, among others; the benefit of previous mHealth use in creating a favorable opinion of SMS for health information; trust in both the source of mHealth SMS, as well as in treatment; the formation of habits; and fear of sequelae or death for facilitating intention to use an mHealth intervention and adhere to medication. We also highlighted a case that underscored the importance of the period after diagnosis in habit forming as an opportunity for an mHealth intervention. CONCLUSIONS We explored both technology- and adherence-related factors that influence a patient’s intention to use an mHealth intervention for adherence to ASCVD medication in Singapore. We highlighted the importance of identifying the right opportunity to engage with patients and promote an mHealth intervention for adherence, such as immediately following diagnosis when patients are establishing medication-taking habits.

scholarly journals Pharmacist joint-working with general practices: evaluating the Sheffield Primary Care Pharmacy Programme. A mixed-methods study

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101611 ◽  
Author(s):  
Iuri Marques ◽  
Nicola Jane Gray ◽  
Jo Tsoneva ◽  
Peter Magirr ◽  
Alison Blenkinsopp
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Community Pharmacy ◽  
Care Delivery ◽  
Care Pathway ◽  
Large City ◽  
Pharmacy Practice ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
General Practices

BackgroundThe NHS in the UK supports pharmacists’ deployment into general practices. This article reports on the implementation and impact of the Primary Care Pharmacy Programme (PCPP). The programme is a care delivery model that was undertaken at scale across a city in which community pharmacists (CPs) were matched with general practices and performed clinical duties for one half-day per week.AimTo investigate (a) challenges of integration of CPs in general practices, and (b) the perceived impact on care delivery and community pharmacy practice.Design & settingThis mixed-methods study was conducted with CPs, community pharmacy employers (CPEs), scheme commissioners (SCs), and patients in Sheffield.MethodSemi-structured interviews (n = 22) took place with CPs (n = 12), CPEs (n = 2), SCs (n = 3), and patients (n = 5). A cross-sectional survey of PCPP pharmacists (n = 47, 66%) was also used. A descriptive analysis of patient feedback forms was undertaken and a database of pharmacist activities was created.ResultsEighty-six of 88 practices deployed a pharmacist. Although community pharmacy contracting and backfill arrangements were sometimes complicated, timely deployment was achieved. Development of closer relationships appeared to facilitate extension of initially agreed roles, including transition from ‘backroom’ to patient-facing clinical work. CPs gained understanding of GP processes and patients’ primary care pathway, allowing them to follow up work at the community pharmacy in a more timely way, positively impacting on patients' and healthcare professionals’ perceived delivery of care.ConclusionThe PCPP scheme was the first of its kind to achieve almost universal uptake by GPs throughout a large city. The study findings reveal the potential for CP–GP joint-working in increasing perceived positive care delivery and reducing fragmented care, and can inform future implementation at scale and at practice level.

scholarly journals A Mixed-Methods Study of Multi-Level Factors Influencing Mammography Overuse: Implications for De-implementation.

2021 ◽  
Author(s):  
Jessica D. Austin ◽  
Parisa Tehranifar ◽  
Laura Brotzman ◽  
Carmen B. Rodriguez ◽  
Mariangela Agovino ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Older Women ◽  
Survey Data ◽  
Mammography Screening ◽  
Care Delivery ◽  
Interview Data ◽  
Mixed Methods Study ◽  
Spanish Speaking ◽  
Factors Influencing ◽  
Multi Level

Abstract Background There is growing concern that routine mammography screening is overused among older women. Successful and equitable de-implementation of mammography will require a multi-level understanding of the factors contributing to mammography overuse. Methods This explanatory, sequential, mixed-methods study collected survey data (n = 52, 73.1% Hispanic, 73.1% Spanish-speaking) from women ≥ 70 years of age at the time of screening mammography, followed by semi-structured interviews with a subset of older women completing the survey (n = 19, 63.2% Hispanic, 63.2% Spanish-speaking) and providers (n = 5, 4 primary care, 1 obstetrics and gynecology) to better understand multi-level factors influencing mammography overuse and inform potential de-implementation strategies. We conducted descriptive analysis of survey data and content analysis of qualitative interview data. Survey and interview data were examined separately, compared, integrated, and organized according to Norton and Chambers Continuum of Factors Influencing De-Implementation Process. Results Survey findings show that 87.2% of older women believe it is important to plan for an annual mammogram, 80.8% received a provider recommendation, and 78.9% received a reminder in the last 12 months to schedule a mammogram. Per interviews with older women, the majority were unaware of or did not experience overuse and intended to continue mammography screening. Findings from interviews with older women and providers suggest that there are multiple opportunities for older women to obtain a mammogram. Per provider interviews, almost all reported that overuse was not viewed as a priority by the system or other providers. Providers also discussed that variation in mammography screening practices across providers, fear of malpractice, and monetary incentives may be reasons for overuse. Providers identified potential strategies including patient and provider education around harms of screening, leveraging the electronic health record to identify women who may no longer benefit from screening, customizing system-generated reminder letters, and organizing workgroups to develop a standard process of care around mammography screening. Conclusions Multi-level factors contributing to mammography overuse are dynamic and reinforced. To ensure equitable de-implementation, there is a need for more refined theories, models, and frameworks for de-implementation with a strong patient-level component that considers the interplay between multilevel factors and the larger care delivery process.

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