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Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems.
A questionnaire with 84 items was conducted with N = 254 healthcare exper...
Context in source publication
Context 1
... experts (care provider, payer and healthcare decision maker) as well as patients were ought to rate these items accord- ing to their individual meaning using a 5-point Likert scale in paper-and pencil-based surveys. The scale ranged from 'very important', 'important', 'so-so', 'less important' to 'not important' (Figure 2). The patient surveys as well as the expert version consisted of the same care-related items. ...Citations
... We believe that the goal of aligning patient and provider expectations should lie at the core of integrated care. 69 For instance, Clevenger and colleagues illustrated the importance of iterative conversations to align caregivers' and healthcare providers' views on appropriate medical interventions for the patient's clinical status in order to ensure the thoughtful use of resources and minimize harms to the patient. 34 While several other papers did highlight the importance of eliciting patient goals for their care, it was less clear how they addressed the aspect of aligning expectations. ...
The rising burden of neurological disorders poses significant challenges to healthcare systems worldwide. There has been an increasing momentum to apply integrated approaches to the management of several chronic illnesses in order to address systemic healthcare challenges and improve the quality of care for patients. The aim of this paper is to provide a narrative review of the current landscape of integrated care in neurology. We identified a growing body of research from countries around the world applying a variety of integrated care models to the treatment of common neurological conditions. Based on our findings, we discuss opportunities for further study in this area. Finally, we discuss the future of integrated care in Canada, including unique geographic, historical, and economic considerations, and the role that integrated care may play in addressing challenges we face in our current healthcare system.
... In den 2000er Jahren wurde der Blick immer stärker in Richtung Ermächtigung der PatientInnen gerichtet (Mitchell, Closson, Coulis, Flint, & Gray, 2000). Neueren Bestrebungen zufolge soll die Einführung von patientenzentrierte (auch beziehungsbasierter oder werte-basierter) Versorgung im gesamten "System" der Versorgung aktiviert werden, um den Bedarf/die Bedürfnisse von DienstleisterInnen und DienstnehmerInnen zu gewährleisten und ihnen gerecht zu werden (Juhnke, 2013;Porter, 2008). ...
Wie arbeiten verschiedene Berufsgruppen im Gesundheitswesen zusammen, um die PatientInnen bei Veränderungen ihres Ess- und Bewegungsverhaltens zu unterstützen? Im Rahmen einer Studie in Südtirol wurden hierzu AllgemeinmedizinerInnen, KrankenpflegerInnen, ErnährungstheraputInnen und PatientInnen befragt. Eine Erkenntnis daraus ist, dass zwar jede Berufsgruppe beansprucht, für diese Lebensstilveränderungen zuständig zu sein, sich aber in ganz unterschiedlicher Weise tatsächlich darum kümmert. Ganz klar ist auch die Lücke, die zwischen den Berufsgruppen existiert, herausgekommen. Sie arbeiten überwiegend für sich, weshalb die Frage aufkommt: Welcher Dialog findet überhaupt statt?
... 1398 Da im Allgemeinen, auch außerhalb der Integrierten Versorgung, Krankenkassen im Namen ihrer Versicherten die Rolle als Nachfrager von Sach-und Dienstleistungen der Leistungserbringer innehaben und in dieser Rolle die Qualität der erbrachten Versorgung überwachen, 1399 bedeutet die mit der Integrierten Versorgung verbundene Gestaltungsfreiheit nicht nur größere Entscheidungsspielräume, sondern auch mehr Verantwortung für Krankenkassen, was erhöhte Anforderun-1395 Vgl. Juhnke, C., Mühlbacher, A. C. (2013Mühlbacher, A. C. ( ), S. 8. 1396 Vgl. Schlösser, R., Schreyögg, J. (2005) Schmitz, J. (2008Schmitz, J. ( ), S. 12-18. ...
Die Gewährleistung einer zeitgemäßen Gesundheitsversorgung und die diskriminierungsfreie Teilhabe der Bevölkerung daran gehören zu den zentralen politischen Zielen in Deutschland. Dabei sind sich Vertreter von Leistungserbringern, Kostenträgern, Politik und Wissenschaft weitgehend einig, dass in diesem Zusammenhang eine funktionierende Patientensteuerung notwendig ist, um die Leistungsfähigkeit des Gesundheitssystems langfristig zu erhalten, auch wenn insbesondere Patienten Vorbehalte gegen die stärkere Anwendung von versorgungssteuernden Managed-Care-Instrumenten haben. Daher stellt sich die Frage, welche Faktoren im deutschen Kontext die Umsetzung solcher Strukturen befördern können und welche Faktoren diese derzeit noch verhindern. Die vorliegende Dissertationsschrift zeigt Möglichkeiten solcher Patientensteuerung im Rahmen der Integrierten Versorgung auf, wobei Ansätze im Einflussbereich von Ärzten und Krankenkassen, aber insbesondere auch in dem von Patienten beleuchtet werden.
... The first step in a DCE is to select the attributes and levels to be included, which determines the validity of the DCE [28]. Based on a review of the literature, we adopted the conceptual framework for integrated care of Mühlbacher and colleagues [29]. As shown in Figure 1, it consists of 21 attributes under seven dimensions, incorporating individual-level, procedural-level, and organizational-level features. ...
... The paper is subject to some limitations. First, we were unable to adopt all 21 attributes from the conceptual framework [29] in a face-to-face questionnaire survey. Hence, we could not provide a complete picture of integrated care for the respondents. ...
... Framework of people-centered integrated care delivery(Mühlbacher, 2013). ...
Objectives: Fragmented healthcare in China cannot meet the needs of the growing number of type 2 diabetes patients. The World Health Organization proposed an integrated primary care approach to address the needs of patients with chronic conditions. This study aims to measure type 2 diabetes patients’ preferences for urban integrated primary care in China. Methods: A discrete choice experiment was designed to measure type 2 diabetes patient preferences for seven priority attributes of integrated care. A two-stage sampling survey of 307 type 2 diabetes mellitus (T2DM) patients in 16 community health stations was carried out. Interviews were conducted to explore the reasons underpinning the preferences. A logit regression model was used to estimate patients’ willingness to pay and to analyze the expected impact of potential policy changes. Results: Travel time to care providers and experience of care providers are the most valued attributes for respondents rather than out-of-pocket cost. Attention to personal situation, the attentiveness of care providers, and the friendliness and helpfulness of staff were all related to interpersonal communication between patients and health care providers. Accurate health information and multidisciplinary care were less important attributes. Conclusions: The study provides an insight into type 2 diabetes patients’ needs and preferences of integrated primary care. People-centered interventions, such as increasing coverage by family doctor and cultivating mutual continuous relationships appear to be key priorities of policy and practice in China.
... Patients often cite lack of communication between such services, 3 especially at the interface between services, and describe "falling between the gaps." 4 ...
Background
Person‐centredness is important in delivering care for long‐term conditions. New models of care aim to co‐ordinate care through integration of health and social care which require new ways of working, often remotely from the patient.
Objective
To describe how person‐centred care is enacted within multidisciplinary groups (MDGs) created as part of a new service, integrating health and social care for older people.
Methods
We followed the implementation of eight neighbourhood MDGs, observing and interviewing staff from three MDGs at different phases of programme implementation using semi‐structured topic guides.
Results
Thirty‐four MDG meetings were observed and 32 staff interviewed. Three core themes were identified which impacted on enactment of person‐centred care: the structural context of MDGs enabling person‐centred care; interaction of staff and knowledge sharing during the MDG meetings; and direct staff involvement of the person outside the MDG discussion.
Conclusions
This study provides new insights into attempts to enact person‐centred care within a new model of service delivery. Teams did what they could to enact person‐centred care in the absence of the “real” patient within MDG meetings. They were successful in delivering and co‐ordinating some aspects of care (eg prompting medication reviews, referring to social worker, health improvement and arranging further multidisciplinary team meetings for complex cases). This “absence of patients” and time pressures within the MDGs led to reliance on the “virtual” record, enhanced by additional “soft” knowledge provided by staff, rather than ensuring the patient's voice was included.
... Integrated care is a promising model of healthcare delivery that, to benefit the patients, focuses on collaboration and the sharing of information between professionals at different levels (Chouvara, Goulis, Labrinoudai, & Maglaveras, 2015). There are various definitions for integrated care, coordinated care, and disease management (Juhnke & Muhlbacher, 2013). For the purpose of this report, integrated care is defined as "the search to connect the health care system (acute, primary medical, and skilled) with other human service systems (e.g., long term care, education, and vocational and housing services) in order to improve outcomes (clinical, satisfaction, and efficiency)" (Leutz, 1999). ...
Background: This study examined the effectiveness of Stanford University’s Chronic Disease Self-management Program (CDSMP) among men living with co-morbidities of chronic physical health disease and behavioral health disorders.
Methods: The study was conducted at a community-based, non-profit organization in partnership with a large suburban university. Two pilot studies were completed with the population of interest. Low-income adult males with behavioral health disorders were recruited to participate in the program provided by a local behavioral health agency. Facilitators trained in the CDSMP program administered it at the agency site, and participants attended weekly meetings. Descriptive data collected included health history, demographic information, and assessments of knowledge with the Chronic Disease Self-Efficacy Scale and the Chronic Disease Self-Management Questionnaire created by the Stanford Patient Education Research Center. Due to the small sample size, n=12, the Wilcoxon signed rank test was used to evaluate before and after differences in the sample. Results: For the participants, there were increases in overall activity, stretching activities, and equipment activities. Additionally, participants experienced a decrease in the number of days affected by poor physical or mental health. However, there was no significant increase in perceived self-efficacy, a factor in patient confidence and possibly compliance. Limitations included the small sample size, lack of a control group, and convenience sampling.
Conclusions: Various aspects of the program were helpful to some participants, but cultural factors made other areas less compatible for this population. A larger study, utilizing a comparison group, could generate data relevant to hypotheses based on these observations. By collecting qualitative data, focus groups could contribute to understanding the experiences and needs of the participants. Development of a curriculum for self-management of chronic disease with a focus on intercultural competence is presently of interest.
... The push for patient involvement is also supported by research that suggests while patients' and practitioners' views may be similar, they are not identical in all aspects of care. 5 Some studies have found, for example, that patients place higher priority than healthcare providers on availability, accessibility, and time for communication. [6][7] In a recent study where patients and their physicians both rated the patient-centeredness of the care, patients' ratings of the care correlated to better treatment outcomes while physician ratings of the same care did not predict positive results. ...
Patient engagement is increasingly recognized as a critical component in improving health care. Yet, there remains a gap in our understanding of the intricacies of rural patient engagement in health-related research. This article describes the process of engaging rural patients, caregivers and broader stakeholders to actively participate in an exploratory effort to understand rural perspectives around the patient-centered medical home model. Highlights of the project’s engagement activities demonstrate how giving voice to rural residents can have a significant impact. Lessons learned point to the importance of six factors for successful engagement of rural residents as partners in health care research: building relationships, defining expectations, establishing communication guidelines, developing shared understanding, facilitating dialogue, and valuing contributions.
... Patients are empowered to take a more active role in their health management and prevention [14] [15]. The use of Internet medical sites may allow patients to learn more about their health conditions, to schedule appointments, to see their laboratory analysis results, and to e-mail and have online discussions with doctors. ...
Healthcare Systems (HCSs) throughout the world undergo important changes driven by aging populations and advances in biomedical technologies. At the same time, in the current economic climate, many Western countries are struggling to reduce public spending on all kinds of services, including healthcare. With this tension between tightening budgets and skyrocketing costs, many countries are seeking to identify ways of using Information Technology (IT) and Monitoring Technologies (MTs) to improve the efficiencies of HCSs while not reducing, or possibly even improving, the quality of healthcare and their delivery. Many experiments have been in progress since the 1990s. This paper has conducted a review evaluating such HCSs in terms of advantages and drawbacks. The objective of this review is to provide some illustrative publications and works and examples of Health Information Technology (HIT) systems to finally determine the place of biomedical MTs in the future HCS. We present the healthcare delivery system (HCDS) organization with roles of the different stakeholders, state initiatives in healthcare information delivery systems and the new relation between the hospital and the home though a new equilibrium. We mentioned the increasing role of telemedicine (TM), telecare (TLC) and telemonitoring (TLM) and expectations for monitoring the elderly. These expectations lead to preventive approaches based on monitoring technologies and pervasive healthcare (PH) which made healthcare improvements and cost reductions possible. Finally, we show the challenges and opportunities of the hospital versus home healthcare delivery.
... In a systemic review of the current literature assessing the association between IDS and quality, the majority of studies have shown that IDSs have positive effects on the quality of care [1]. To achieve greater acceptance and satisfaction, providers and payers should consider patients' needs and expectations while implementing innovative IDSs [26]. In addition to implementing IDS programs in these remote areas, healthcare authorities and the local government also need to encourage locals who have completed specialist training at medical centers to return to their hometowns to serve their neighbors. ...
Background
To assess the utilization of and satisfaction with ophthalmic healthcare provided by integrated delivery system (IDS) since 2000 and vision-related quality of life (VRQoL) for residents of an offshore island of Taiwan.
Methods
Facilitators interviewed residents (age ≥ 50 years) with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) for VRQoL and a questionnaire on clinical information, ophthalmic care utilization and satisfaction.
Results
A total of 841 participants (response rate 93.4 %, 841/900) completed the questionnaire survey. Mean age was 63.7 (±10. 7) years. The common eye diseases were cataract (44.7 %), dry eye (15.5 %), and glaucoma (8.7 %). Among the participants, 61.0 % sought ophthalmic care under the IDS in the past year and 17.6 % experienced unmet ophthalmic needs in the past 6 months. Satisfaction with ophthalmic care under the IDS was 88.1 %. Determinants of dissatisfaction under the IDS were distance to healthcare facility and VRQoL. Predictors of VRQoL included age, residential area, marital status, occupation, comorbid condition, commercial insurance, household income, cataracts and glaucoma.
Conclusions
The implementation of IDS improves accessibility of ophthalmic care for residents of an offshore island. Geographic proximity to avail healthcare facility and VRQoL affect satisfaction with the IDS.
... Ultimately, these require researchers to share their decision making authority or knowledge which if not done can lead to co-option or tokenistic engagement efforts causing mistrust among patients and family caregivers [47]. Past experiences shape expectations and influence participants' willingness to engage in research [48,49]. One step investigators can take to overcome this barrier is asking participants about their preferred level of engagement (from passive to active roles) [50] and plan accordingly. ...
Plain English summary
The paper discusses engaging older adults living with frailty and their family caregivers. Frailty is a state that puts an individual at a higher risk for poor health outcomes and death. Understanding whether a person is frail is important because treatment and health care choices for someone living with frailty may be different from someone who is not (i.e., who is fit). In this review, we discuss strategies and hurdles for engaging older adults living with frailty across three settings: research, health and social care, and policy. We developed this review using published literature, expert opinion, and stakeholder input (including citizens). Engaging frail older individuals will be challenging because of their vulnerable health state - but it can be done. Points of consideration specific to engaging this vulnerable population include:In any setting, family caregivers (defined to include family, friends, and other social support systems) play an important role in engaging and empowering older adults living with frailty
Engagement opportunities need to be flexible (e.g., location, time, type)
Incentivizing engagement for researchers and citizens (financial and otherwise) may be necessary
The education and training of citizens, health and social care providers, and researchers on engagement practices
Patient-centered care approaches should consider the specific needs of individuals living with frailty including end-of-life care and advanced care planning
Influencing policy can occur in many ways including participating at institutional, regional, provincial or national committees that relate to health and social care.
Abstract
Older adults are the fastest growing segment of Canada’s population resulting in an increased number of individuals living with frailty. Although aging and frailty are not synonymous the proportion of those who are frail increases with age. Frailty is not defined by a single condition, but rather a health state characterized by an increased risk of physical, mental, or social decline, deterioration of health status, and death. Recognizing frailty is important because earlier detection allows for program implementation focused on prevention and management to reduce future hospitalization, improve outcomes, and enhance vitality and quality of life. Even though older adults living with frailty are significant users of health care resources, their input is under-represented in research, health care decision making, and health policy formulation. As such, engaging older adults living with frailty and their family caregivers is not only an ethical imperative, but their input is particularly important as health and social care systems evolve from single-illness focused to those that account for the complex and chronic needs that accompany frailty. In this review, we summarize existing literature on engaging older adults living with frailty and their family caregivers across three settings: research, health and social care, and policy. We discuss strategies and barriers to engagement, and ethical and cultural factors and implications. Although this review is mainly focused on Canada it is likely to be broadly applicable to many of the health systems in the developed world where aging and frailty pose important challenges.
