Dissertations / Theses on the topic 'Coordination of health care'
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Foskett-Tharby, Rachel Christine. "Coordination of primary health care." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/coordination-of-primary-health-care(987d5002-cf2f-4ece-8f53-f89ea2127e1e).html.
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Background: Improving coordination of care is a major challenge for health systems internationally. Tools are required to evaluate alternative approaches to improve coordination from the patient perspective. This study aimed to develop and validate a new measure of coordination for use in a primary care setting. Methods: Four methods were used. Firstly, a concept analysis was undertaken to identify the essential attributes of coordination drawing upon literature from health and organisational studies and to establish its boundaries with related concepts such as continuity of care, integration and patient centred care. Secondly, existing measures of coordination were reviewed to assess the extent to which item content reflected the definition arising from the concept analysis and to appraise psychometric properties. Thirdly, a new instrument, the Care Coordination Questionnaire (CCQ), was developed utilising items from existing questionnaires and others developed following focus groups with 30 patients. Ten cognitive interviews were used to evaluate the items generated. Finally, the CCQ was administered in a cross sectional survey to 980 patients. Item and model analyses were performed. Test-retest reliability was evaluated through a second administration of the CCQ after two weeks. Concurrent validity was evaluated through correlation with the Client Perceptions of Coordination Questionnaire (CPCQ). Construct validity was evaluated through correlation with responses to a global coordination item and a satisfaction scale and the testing of two a prior hypotheses: i) coordination scores would decrease with increasing numbers of providers and ii) coordination scores would decrease with increasing numbers of long-term conditions. Results: The concept analysis suggested that coordination should be considered as a process for the organisation of patient care characterised by: purposeful activity, information exchange, knowledge of roles and responsibilities, and responsiveness to change. The systematic review identified 5 existing measures of coordination and a further 10 measures which incorporated a coordination subscale. Only one demonstrated conceptual coverage but had poor psychometric properties. A new instrument was therefore developed and tested as described above. 299 completed surveys were returned. Respondents were predominantly elderly and of white ethnicity; approximately half were female. Five items were deleted following item analyses. Model analysis suggested a four factor two-level model of coordination comprising of 18 items. This correlated well with the CPCQ, the global coordination item and satisfaction scale. The a priori hypotheses were upheld. Retest reliability was acceptable at the patient group level. Conclusions: The CCQ has demonstrated good psychometric characteristics in terms of item responses, reliability and construct validity. Further exploration of these properties is required in a larger, more diverse sample before it can be recommended for widespread use, but it shows potential utility in the evaluation of different approaches to coordinating care.
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Selezneva, Natalia. "CARE COORDINATION IN MANAGING POPULATION HEALTH." Thesis, Ternopil, 2021. https://repository.tdmu.edu.ua//handle/123456789/17198.
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We are trying to bring attention and focus on the important role the nursing profession plays in improving patient’s experience and outcomes. Nurses are best positioned at the center of information exchanges and play critical through their routine interventions. Tasks that are often perceived as simple routine tasks, like: care planning, medication reconciliation, communications with the patient and other professionals, discharge instructions and education, are the very foundation of the successful care coordination intervention.
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Florini, Marita A. "Primary care providers' perception of care coordination needs and strategies in adult primary care practice." Thesis, State University of New York at Binghamton, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3630859.
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Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow.
Purpose: To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed.
Analysis: Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities.
Significance: A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.
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McGuiness, Clare Frances, and clare mcguiness@calvary-act com au. "Client perceptions : a useful measure of coordination of health care." The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020124.141250.
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Despite the many interventions and trials aimed at improving coordination of health care, there is currently no accepted measurement of coordination. My professional interests and an opportunity provided by the Care Plus (Coordinated Care) Trial in the ACT led me to consider client perceptions as a potentially appropriate measure. My research question is can coordination of health care be usefully measured through client perceptions?
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I addressed this question by developing and testing an instrument to measure perceptions of coordination called the Client Perceptions of Coordination Questionnaire (CPCQ). In the thesis I describe the processes of developing the instrument, testing it through use in several studies and considering how useful such an instrument may be for health services research. In addition to the Coordinated Care Trial, I conducted two validation studies - in a chronic pain population and a general practice sample.
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In Part 1 of the results I demonstrate good face, content and discriminant validity, and reliability of the instrument. Psychometric analysis of the CPCQ did not support scaling, and identified areas were the instrument could be improved. Nevertheless the underlying construct of client perception of coordination as a measure is entirely new, and it is therefore worthwhile to explore its associations with other health outcome data. In Part 2 I use a single item from the CPCQ, how often did you feel the care you received was well-coordinated? to explore this construct. I explore the influences upon on client perceptions of coordination, and examine its associations with service utilisation and health outcome data.
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The construct of perceived coordination, and the capacity of the CPCQ to measure it accurately show considerable promise as measures of health care. Consistent trends were found that suggested coordination was a complex construct, and that a stronger theoretical base was needed to interpret this complexity. Theory is the first of the phases of instrument development, and so I revisit these in order to summarise the strengths and weaknesses of the current CPCQ. Overall, the perceptions of coordination have surprisingly plausible associations with other health data, the effort to improve the instrument should be worthwhile for a wide range of health service evaluation and research.
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McGuiness, Clare Frances. "Client perceptions : a useful measure of coordination of health care." View thesis entry in Australian Digital Theses Program, 2001. http://thesis.anu.edu.au/public/adt-ANU20020124.141250/index.html.
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Robisnon, Brenda Joyce. "Is there an Association between Non-VA Medical Care Coordination and Utilization of Care?" ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2376.
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The Non-Veteran Administration Care (NVC) is a program in which the Veterans Health Administration purchases health care when it cannot provide the health services needed for eligible Veterans. The rising cost of this program led to audits by the Office of the Inspector General and other entities. The scholarly problem for this DNP Project was the lack of oversight, accountability, and management, found throughout the audits of NVC, as well as a lack of evaluation of NVC. The purpose of this project was to ascertain if there was a relationship between the Non-VA Care Coordination program (NVCC) and utilization of care. The NVCC was implemented to eliminate the deficiencies cited by audits. Sleep study and chiropractic consults for FY 2013 (pre-NVCC) and FY 2014 (post-NVCC) were examined. Sleep apnea service was available at the local Veteran Administration Medical Center and chiropractic service was not. Utilization of care was determined by emergency room (ER) visits and admissions related to the consult. A logic model was used to conceptualize the project and the longer-term implementation and evaluation of NVCC, and descriptive statistics were used to analyze trends in the chiropractic data (sleep study consults were excluded from the analysis due to the minute number). There were a total of 859 chiropractic consults and 2,184 approved visits analyzed. The results revealed that Veterans who utilized the consults had no ER visits or admissions related to referrals for chiropractic consults. Completed chiropractic consults remained proportionality the same both years. NVCC had no association with the utilization of care. This scholarly project contributes to social change by empowering consumers and providing transparency in the government through audits that facilitate quality improvement and evaluation of the NVCC program.
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Marti-Morales, Madeline. "Care coordination, family-centered care and functional ability in children with special health care needs in the United States." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/870.
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Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children's functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, and FA in CSHCN. The design of this study was a secondary analysis of data from the 2005--2006 National Survey of CSHCN. The study was guided by an adapted socioecological multilevel conceptual framework. Statistical methods included univariate, bivariate, and multiple logistic regression analysis. Results indicated that CC was associated with FA in CSHCN. CSHCN that did not receive CC had a 53% increased risk (OR =1.53, 95%CI 1.21--1.94, p < 0.001) for a limitation in FA compared to CSHCN that received CC, controlling for age, gender, number of conditions, household poverty level, parental educational level, and health insurance. FCC was not associated with a limitation in FA in CSHCN ( p = 0.61). Findings from this study were consistent with the socioecological multilevel framework and the literature on care coordination. This study contributed to positive social change by providing information that can be used by public health officials, health care providers and policy makers in developing policies to assure that care coordination is provided to CSHCN and their families in order to improve their health outcomes and functionality.
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Vollmar, Anne Marie. "Screening of Eye Coordination." The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1212005075.
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Guerrero, Lizette V. "Impact of care coordination on diabetes management| An analysis of processes and outcomes." Thesis, California State University, Long Beach, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1585639.
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This study examined the effects of care coordination on diabetes management processes and outcomes. The study predicted care coordination increases the likelihood of daily blood glucose monitoring, hemoglobin A1C checks at least twice a year, annual foot exams, annual eye exams, diabetes care plan being developed and a written copy provided to the patient, and self-confidence in ability to control and manage diabetes. The study also predicted a correlation between lack of care coordination and diabetics' non-adherence to diabetes medications, as well as a correlation between lack of care coordination and greater number of emergency room visits and hospitalizations among diabetics for diabetes-related issues.
Data obtained from the 2011-2012 California Health Interview Survey (CHIS) was analyzed using t-test and Chi-square. Though not all hypotheses were supported, the results of the study showed a significant relationship between care coordination and increased likelihood of hemoglobin A1C checks at least twice a year, annual foot exams, and diabetes care plans being developed and written copy provided to the patient. The study findings warrant further research on the effects of care coordination on diabetes management processes. Additional research on the effects of diabetes management processes on diabetes outcomes is recommended.
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Spradling, Rebecca Lynne Allen. "Development and coordination of a health care services program for foster children in a shelter care population." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2096.
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The purpose of this project is to support health promotion of children entering foster care, ensure that children receive all health care services needed, prevent the trauma of duplication of immunizations, and reduce disruption of health care as children move through the foster care system.
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Martinez, Diego A. "Informing the Design and Deployment of Health Information Technology to Improve Care Coordination." Scholar Commons, 2015. http://scholarcommons.usf.edu/etd/5987.
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In the United States, the health care sector is 20 years behind in the use of information technology to improve the process of health care delivery as compared to other sectors. Patients have to deliver their data over and over again to every health professional they see. Most health care facilities act as data repositories with limited capabilities of data analysis or data exchange. A remaining challenge is, how do we encourage the use of IT in the health care sector that will improve care coordination, save lives, make patients more involved in decision-making, and save money for the American people? According to Healthy People 2020, several challenges such as making health IT more usable, helping users to adapt to the new uses of health IT, and monitoring the impact of health IT on health care quality, safety, and efficiency, will require multidisciplinary models, new data systems, and abundant research. In this dissertation, I developed and used systems engineering methods to understand the role of new health IT in improving the coordination, safety, and efficiency of health care delivery.
It is well known that care coordination issues may result in preventable hospital readmissions. In this dissertation, I identified the status of the care coordination and hospital readmission issues in the United States, and the potential areas where systems engineering would make significant contributions (see Appendix B). This literature review introduced me to a second study (see Appendix C), in which I identified specific patient cohorts, within chronically ill patients, that are at a higher risk of being readmitted within 30 days. Important to note is that the largest volume of preventable hospital readmissions occurs among chronically ill patients. This study was a retrospective data analysis of a representative patient cohort from Tampa, Florida, based on multivariate logistic regression and Cox proportional hazards models. After finishing these two studies, I directed my research efforts to understand and generate evidence on the role of new health IT (i.e., health information exchange, HIE) in improving care coordination, and thereby reducing the chances of a patient to be unnecessarily readmitted to the hospital. HIE is the electronic exchange of patient data among different stakeholders in the health care industry. The exchange of patient data is achieved, for example, by connecting electronic medical records systems between unaffiliated health care providers. It is expected that HIE will allow physicians, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically, and thereby improving the speed, quality, safety and cost of patient care. The federal government, through the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, is actively stimulating health care providers to engage in HIE, so that they can freely exchange patient information. Although these networks of information exchange are the promise of a less fragmented and more efficient health care system, there are only a few functional and financially sustainable HIEs across the United States. Current evidence suggests four barriers for HIE: •Usability and interface issues of HIE systems •Privacy and security concerns of patient data •Lack of sustainable business models for HIE organizations •Loss of strategic advantage of "owning" patient information by joining HIE to freely share data To contribute in reducing usability and interface issues of HIE systems, I performed a user needs assessment for the internal medicine department of Tampa General Hospital in Tampa, Florida. I used qualitative research tools (see Appendix D) and machine learning techniques (see Appendix E) to answer the following fundamental questions: How do clinicians integrate patient information allocated in outside health care facilities? What are the types of information needed the most for efficient and effective medical decision-making? Additionally, I built a strategic gaming model (see Appendix F) to analyze the strategic role of "owning" patient information that health care providers lose by joining an HIE. Using bilevel mathematical programs, I mimic the hospital decision of joining HIE and the patient decision of switching from one hospital to another one. The fundamental questions I tried to answer were: What is the role of competition in the decision of whether or not hospitals will engage in HIE? Our mathematical framework can also be used by policy makers to answer the following question: What are the optimal levels of monetary incentives that will spur HIE engagement in a specific region? Answering these fundamental questions will support both the development of user-friendly HIE systems and the creation of more effective health IT policy to promote and generate HIE engagement. Through the development of these five studies, I demonstrated how systems engineering tools can be used by policy makers and health care providers to make health IT more useful, and to monitor and support the impact of health IT on health care quality, safety, and efficiency.
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Beringer, Antonia Jane. "People and processes : a structuration approach to the coordination of children's inpatient health care." Thesis, London South Bank University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429808.
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Porth, Leslie. "A Comparison of Regional Health Care Structures for Emergency Preparedness." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/330.
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Since 2001, increased policy attention and federal funding mechanisms have required more effective disaster response by government actors and private sector organizations, including the health care system. However, there is limited scholarly evidence documenting which structural elements have been associated with efficacious regional coalitions. This study addressed the gap by examining whether the number of different participating disciplines (a proxy for coalition roles), community setting, and prior weather-related disaster declaration influenced the number of activities (a proxy for coalition responsibilities) conducted by the health care coalition. Social network theory was the theoretical lens with which the study results were used to examine the relational structures within coalitions. The quantitative study was based on archival data from a survey in 2011 of 375 acute care hospitals in the United States. A general linear model analysis was conducted, and results suggest a statistically significant relationship between the number of disciplines and the number of conducted activities. As the number of different disciplines increases in a coalition, so do the different types of conducted activities. Based on the analysis, community setting--urban versus nonurban--and the occurrence of a federally declared, weather-related disaster did not influence the number of coalition activities. This study provides evidence that establishing network structures for health care coalitions will advance the field of health care emergency preparedness and disaster response. The findings from this research may promote social change by guiding future policy development and research necessary to develop resilient and efficacious disaster response systems, resulting in reduced loss of life and injury.
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Lee, Seung Yup. "Proactive Coordination in Healthcare Service Systems through Near Real-Time Analytics." Thesis, Wayne State University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10839804.
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The United States (U.S.) healthcare system is the most expensive in the world. To improve the quality and safety of care, health information technology (HIT) is broadly adopted in hospitals. While EHR systems form a critical data backbone for the facility, we need improved 'work-flow' coordination tools and platforms that can enhance real-time situational awareness and facilitate effective management of resources for enhanced and efficient care. Especially, these IT systems are mostly applied for reactive management of care services and are lacking when they come to improving the real-time "operational intelligence" of service networks that promote efficiency and quality of operations in a proactive manner. In particular, we leverage operations research and predictive analytics techniques to develop proactive coordination mechanisms and decision methods to improve the operational efficiency of bed management service in the network spanning the emergency department (ED) to inpatient units (IUs) in a hospital, a key component of healthcare in most hospitals. The purpose of this study is to deepen our knowledge on proactive coordination empowered by predictive analytics in dynamic healthcare environments populated by clinically heterogeneous patients with individual information changing throughout ED caregiving processes. To enable proactive coordination for improved resource allocation and patient flow in the ED-IU network, we address two components of modeling/analysis tasks, i.e., the design of coordination mechanisms and the generation of future state information for ED patients.
First, we explore the benefits of early task initiation for the service network spanning the emergency department (ED) and inpatient units (IUs) within a hospital. In particular, we investigate the value of proactive inpatient bed request signals from the ED to reduce ED patient boarding. Using data from a major healthcare system, we show that the EDs suffer from severe crowding and boarding not necessarily due to high IU bed occupancy but due to poor coordination of IU bed management activity. The proposed proactive IU bed allocation scheme addresses this coordination requirement without requiring additional staff resources. While the modeling framework is designed based on the inclusion of two analytical requirements, i.e., ED disposition decision prediction and remaining ED length of stay (LoS) estimation, the framework also accounts for imperfect patient disposition predictions and multiple patient sources (besides ED) to IUs. The ED-IU network setting is modeled as a fork-join queueing system. Unlike typical fork-join queue structures that respond identically to a transition, the proposed system exhibits state-dependent transition behaviors as a function of the types of entities being processed in servers. We characterize the state sets and sequences to facilitate analytical tractability. The proposed proactive bed allocation strategy can lead to significant reductions in bed allocation delay for ED patients (up to ~50%), while not increasing delays for other IU admission sources. We also demonstrate that benefits of proactive coordination can be attained even in the absence of highly accurate models for predicting ED patient dispositions. The insights from our models should give confidence to hospital managers in embracing proactive coordination and adaptive work flow technologies enabled by modern health IT systems.
Second, we investigate the quantitative modeling that analyzes the patterns of decreasing uncertainty in ED patient disposition decision making throughout the course of ED caregiving processes. The classification task of ED disposition decision prediction can be evaluated as a hierarchical classification problem, while dealing with temporal evolution and buildup of clinical information throughout the ED caregiving processes. Four different time stages within the ED course (registration, triage, first lab/imaging orders, and first lab/imaging results) are identified as the main milestone care stages. The study took place at an academic urban level 1 trauma center with an annual census of 100,000. Data for the modeling was extracted from all ED visits between May 2014 and April 2016. Both a hierarchical disposition class structure and a progressive prediction modeling approach are introduced and combined to fully facilitate the operationalization of prediction results. Multinomial logistic regression models are built for carrying out the predictions under three different classification group structures: (1) discharge vs. admission, (2) discharge vs. observation unit vs. inpatient unit, and (3) discharge vs. observation unit vs. general practice unit vs. telemetry unit vs. intensive care unit. We characterize how the accumulation of clinical information for ED patients throughout the ED caregiving processes can help improve prediction results for the three-different class groups. Each class group can enable and contribute to unique proactive coordination strategies according to the obtained future state information and prediction quality, to enhance the quality of care and operational efficiency around the ED. We also reveal that for different disposition classes, the prediction quality evolution behaves in its own unique way according to the gain of relevant information. (Abstract shortened by ProQuest.)
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Vanhook, Patricia M. "NP/RN Care Coordination for Chronic Disease Management in Rural America." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7422.
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Akuamoah-Boateng, Agyenim. "Competence of Behavioral Health Clinicians in Integrated Care Settings." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5443.
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Collaborative efforts between medical and behavioral health professionals is required to simultaneously treat individuals with medical and mental health disorders. However, there is lack of focus on the competencies and trainings needed by behavioral health clinicians (BHCs) transitioning to integrated primary care (IPC) settings. The purpose of this qualitative interpretive phenomenological study was to describe the lived experiences of BHCs who have transitioned from specialty outpatient behavioral healthcare settings to IPC settings. Semi-structured interview questions were used to collect data. Using interpretive phenomenological data analysis approach, themes and the shared meanings and experiences of 8 licensed BHCs were explored. Seven participants had graduate degrees and 1 participant had post-graduate degree. All participants had at least a year of experience working in IPC settings, worked full-time in North Carolina, and had over a year of experience in traditional behavioral healthcare settings. Results indicated that participants shared experiences in 5 themes: (a) clinical experience, (b) effective communication, (c) collaboration with primary care providers(PCPs), (d) continued education and trainings, and (e) care coordination. The outcome of this research will inform institutions, administrators, and credentialing boards to consider implementation of defined competencies for BHCs in community health centers that operate on IPC principles to ensure collaborative efforts between BHCs and PCPs in order to help provide effective holistic and affordable health care in a systems-based approach.
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Reynolds, Morgan E. "It takes two to un-tango: Modulating continuous participation in joint activity." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1594929298207994.
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Pascolo, Vanessa, and Ilda Agovic. "Hur samverkan mellan primärvård och hemsjukvård fungerar i praktiken : Sjuksköterskors upplevelser." Thesis, Högskolan Väst, Avdelningen för omvårdnad - avancerad nivå, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-12921.
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Background: During the last decades, advancements has been made in medicine and medical technology which has made it possible to care for elderly persons with multi morbidity in their own homes. The fact that the average length of in-hospital stay has become shorter is also a factor in that home health care has become more common. The medical responsibility for patients in home health care is divided between the home health care organization and the primary care provider, which makes collaboration between these two organizations an important and necessary part of the nurses' job. Ongoing care coordination and collaboration between primary care and home health care is generally described as poor and as an area that requires improvement. Therefore it is important to study nurses' experiences of collaboration in practice. Aim: To describe nurses' experiences of collaboration between primary care and home health care. Method: A semi-structured interview study was conducted with eleven nurses from four health centers and five home health care units in western Sweden. Qualitative content analysis was used to analyze the data.Results: The nurses' experiences of collaboration in practice showed that the medical rounds were a central part of collaboration, that there was a lack of distinct ways of communication and that both organizations were dependent on each other. The results also showed that regulatory systems affected collaboration, that there were boundaries and grey zones between the organizations, that the organizations used different solutions to replace collaboration and that it was important to have knowledge of the other organization. Conclusion: Because the organizations were dependent on each other to give care to the patient and there was a lack of distinct ways of communication, personal relationships became a facilitator for collaboration. Different strategies were used to bypass the obstacles in collaboration.Andelen äldre personer och personer med kroniska sjukdomar i befolkningen ökar, samtidigt som vårdtiderna i slutenvården förkortas. På grund av den medicintekniska utvecklingen finns det ökade möjligheter att få avancerad sjukvård i hemmet. Hemsjukvården delar det medicinska ansvaret för dessa patienter med primärvården och samverkan dem emellan är därför grundläggande för att kunna ge en god och sammanhållen vård till patienten. Skyldigheten att samverka är reglerat genom lagar och författningar. Trots detta finns det betydande brister i samverkan och vårdkoordinering mellan primärvård och hemsjukvård. För att få en ökad förståelse av detta är det av vikt att ta reda på sjuksköterskors upplevelse av hur samverkan fungerar i praktiken. Resultatet i den här studien bygger på intervjuer med elva sjuksköterskor inom primärvård och hemsjukvård, där de fått beskriva sina upplevelser av samverkan mellan primärvård och hemsjukvård. Resultatet av studien visade att ronden var en central del av samverkan. Det framkom också att sjuksköterskorna ansåg att det saknades tydliga formella kommunikationsvägar, vilket i kombination med att de var beroende av varandra för att ge vård till patienterna gjorde att personliga relationer och olika strategier användes för att förenkla samverkan. Organisationerna kunde också skapa olika alternativa lösningar för att ersätta samverkan mellan primärvården och hemsjukvården. I resultatet framkom att sjuksköterskorna även ansåg att regelverk påverkade samverkan. De tyckte att det var nödvändigt att ha en ram att förhålla sig till, men de ville också kunna vara flexibla vid behov. Detta eftersom de ansåg att det fanns ett gränsland mellan primärvård och hemsjukvård som upplevdes som en gråzon där uppgifter och behov ibland överlappade varandra.
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van, der Walt Nicolette. "Health managers’ experiences and perceptions of intersectoral collaboration at the primary health care level in two urban sub-districts of the Western Cape Province, South Africa." University of the Western Cape, 2020. http://hdl.handle.net/11394/8079.
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Magister Public Health - MPHBackground: Actions on addressing the social determinants of health are necessary for reducing health inequities and improving health outcomes. These actions can, however, fall outside the scope of the health sector alone and require collaborative actions across sectors. Through the Western Cape Government’s stated commitment to following a whole-of-society approach to increase the wellness of people, this Province has committed to exploring intersectoral collaboration and action for health. This study is therefore aimed at exploring the experiences and perceptions of intersectoral collaboration and action for health amongst mid-level and frMethodology: The study design was qualitative and explorative in nature, using non-probability sampling to deliberately select study participants that were both relevant to the study and represented a diversity of views. Semi-structured interviews were conducted with seven health managers and non-participant observation of one intersectoral meeting was utilised to observe interactions that were relevant to the study. A thematic coding analysis approach was followed to inductively determine themes and analyse the data.ontline health managers working at the primary health care level in two sub-districts within the City of Cape Town, Western Cape Province. Results: Intersectoral collaboration for health at the primary health care level tends to take the form of collaborations between government departments, between the department of health and non-governmental organisations, between the public and private health sectors and between the Department of Health and the communities it serves. These collaborations overwhelmingly focus on expanding health services provision rather than addressing the social determinants of health. Conclusion: The concept of intersectoral collaboration and partnerships at the primary health care level in two sub-districts of the City of Cape Town, Western Cape, is perceived by health managers as being critical in addressing the social determinants of health. In practice, however, intersectoral collaboration and partnerships tend to focus on expanding health service provision and have limited value for addressing social determinants of health.
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Distelhorst, Karen S. "Transitional Care, Neighborhood Disadvantage, and Heart Failure Hospital Readmission: A Moderated Mediation Analysis." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent158613074205556.
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Letostak, Tiasha Barik. "Relationships Among Financial, Clinical, and Organizational Factors in a Population of Children with Special Health Care Needs: A Secondary Analysis of the 2009/10 NS-CSHCN." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1436740534.
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Smeds, Magdalena. "Managing care pathways for patients with complex care needs." Licentiate thesis, Linköpings universitet, Logistik- och kvalitetsutveckling, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-156836.
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One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.
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Duff, Amanda. "Emergency Room Utilization of Participants with Mental Health Conditions Enrolled in Health Home Services." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3154.
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Large numbers of individuals utilize the ER each year for mental health reasons. The health home agency in this study was designed under the Affordable Care Act with the intention of increasing patient self-management thus decreasing high-cost service utilization. The effectiveness of health homes in reducing mental health-related ER visits has remained unexplored. In this study, the relationship between participation in this program and ER utilization was examined, using the theoretical framework of the Health Belief Model. The sample of 128 health home participants with documented mental health conditions was selected using systematic random sampling. A one-way, repeated-measures t-test and a one-way, repeated-measures ANCOVA were used to analyze hospital records for ER visits with a primary or secondary mental health diagnosis. The results indicated that health home participation did not have a statistically significant impact on ER utilization when comparing overall 12-month means or at quarterly anniversary dates when controlling for age, race, and gender. These findings suggested opportunities for improvement in professional practice, identified areas that require further research, and will be used to initiate discussion into the existing and potential value that health homes offer to the mental health clientele being served. Those discussions have the potential to create social change through infrastructure changes that lead to improved service coordination, increased resources for improving access and quality of care, and overall enhancement of outcomes for individuals with mental health conditions.
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DePuccio, Matthew J. "Examining How Primary Care Team Structures are Used and Their Effect on Cross-Disciplinary Relationships: A Qualitative Study." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/6071.
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Team-based primary care is an innovative care delivery model that has the potential to improve access to comprehensive, coordinated, and high-quality patient care. It is understood that in order for primary care teams to work effectively, health care providers must work across disciplinary boundaries and develop strong relationships that enable them to coordinate their roles and expertise. This research investigated how health care providers make use of different team structures (i.e., tools) to manage their interdependent work, enabling them to deliver team-based primary care. This research also examined how team structures influence the intra-team relationships important for coordinating care. By exploring the different ways primary care teams enact team structures, this research identifies ways primary care teams use team structures differently to address the needs of patients and coordinate team-based care.
In-person interviews were conducted at 7 primary care clinics participating in a population health management program in a southeastern city in the United States. Research participants from various health care disciplines (e.g., medicine, nursing, social work) were asked to describe their experiences delivering team-based primary care. Interviews were recorded, transcribed, and analyzed. Data were analyzed using a constant comparative approach in order to investigate how different team structures were used to address the needs of patients and the challenges of delivering team-based primary care.
The data suggested that primary care teams enact structures in different ways. In some teams, huddles were used to anticipate the specific needs of patients and coordinating care, referrals occurred via warm handoffs with co-located providers, and protocols were used to facilitate collaborative problem-solving. In other clinics, huddles were focused on clinic operations, referrals were performed using traditional methods (e.g., phone calls), and protocols were used to guide task delegation. Participants in some clinics described how team huddles were used to leverage high-quality relationships by fostering respectful interactions between team members. More research is needed to determine whether the use of patient-focused huddles, warm handoffs, and protocols that initiate problem-solving is associated with better patient outcomes, particularly for patient populations with complex medical and non-medical needs.
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Purdy, Eve Isabelle. "Doing Our Work Better, Together: An Application of Relational Coordination Theory to Explore and Shape Excellence in Trauma Care." Thesis, University of North Texas, 2019. https://digital.library.unt.edu/ark:/67531/metadc1538699/.
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I conducted a mixed-methods collaborative ethnography using the lens of relational coordination theory. This included a qualitative survey using an established tool to analyze the relational dimensions of multidisciplinary teamwork, participant observation, interviews, and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. I engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of each dimension of relational coordination in trauma care. Narrative survey and ethnographic findings further highlighted the centrality of team briefings and a translational simulation program in contributing positively to team culture and relational ties. A range of 16 interventions – focusing on structural, process and relational dimensions – were co-created with participants after reflecting on findings and are now being implemented and evaluated by various trauma care providers. Relational coordination theory is a valuable way to conceptualize the coordination of trauma care. Collaborative reflection on quantitative and narrative data through this lens can be used as a community-based quality improvement tool.
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Buse, Dieter Kent. "A policy analysis of aid coordination and management in the health sector of Bangladesh : assessing the instruments, exposing the agendas, and considering the prospects for government leadership." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1999. http://researchonline.lshtm.ac.uk/682279/.
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In the 1990s, the coordination and management of aid in the health sector became more firmly established on policy agendas as a result of concern that the increased volume of aid and increasing number and diversity of donors in the sector was leading to an unmanageable proliferation of demands on recipient Governments. Global interest in coordination, coupled with a dearth of critically-informed, conceptual or empirical, analyses of the subject, gave impetus to this in-depth examination of the processes at work. Based on a review of the literature, this study began by defining the issues and developing a typology of instruments used to coordinate aid. A conceptual framework was developed for assessing coordination mechanisms. The framework was tested through an historical analysis of aid coordination revealing the enabling and constraining factors governing progress in this area of development management. Bangladesh was chosen as a case study, primarily due to a long-standing, concerted effort of the World Bank to coordinate a number of bilateral donors through a country-based Consortium. Drawing upon interviews with stakeholders, documentary analysis, as well as a questionnaire survey, an entrenched, non-comprehensive system of aid coordination and management exercised by donors was exposed. Caution on the part of Government officials in assuming a prominent role in aid management was exacerbated by fragile systems and weak capacity. This was reinforced by aid agency practices. Evidence suggests that coordination may be less concerned with the purported aims of rationalising external assistance to Government's programmes, than with the desire among competing agencies for leadership in the sector. Aid agencies and Government recognise that aid coordination provides a powerful tool with which to exercise leverage over the policy process. This consideration has coloured their desire to lead coordination processes and conditioned the extent and manner they wish to be involved in coordination arrangements. Given the findings of this study, the prospects for improvements and government leadership in aid coordination and management appear equivocal at best.
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Shoajei, Azadeh. "Improving the oral health of elderly long-term care residents with support of an oral health coordinator." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/58908.
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Objective: The goal of this project was to determine whether an oral health coordinator (OHC) could improve the oral hygiene of residents in long term care facilities. Methods: This prospective study utilized 4 LTCFs in Courtenay, Comox Valley on Vancouver Island and included 126 residents with natural teeth (66% female, age range 63–101 years, and 34% male age range 62 -108 years). Residents’ oral hygiene was assessed at baseline and again at a 6-month using the Geriatrics Debris Index-Simplified (GDI-S) and Geriatrics Calculus Index-Simplified (GCI-S). The OHC provided in-service education & training of care aides and nursing staff with respect to daily mouth care over the six-months of the project. Results: The mean number of teeth per resident was 18. At baseline, 73% did not receive help for their daily mouth care, and after examination, 95.2% were recommended to receive assistance with their daily mouth care. A paired-samples t-test revealed no statistically significant difference in (GDI-S) and (GCI-S) measurements between baseline and 6-month follow-up. Conclusion: Although the OHC provided extensive training of care staff, the oral hygiene did not improve.Dentistry, Faculty of
Graduate
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Cohen, Deborah A. "Obtaining Genuine Family Involvement: Unpacking the System of Care Values and Principles." UKnowledge, 2014. http://uknowledge.uky.edu/csw_etds/9.
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Despite the federal government’s $1.5 billion investment between 1993 and 2010 to fund 164 separate community-based systems of care, there has been an extremely limited attempt to measure the impact of system of care. The impetus for this research is the struggle for how the value based concept of system of care is communicated within a community. While child mental health services researchers have published a number of randomized control trials to explore individual level supports for youth served in a system of care community, researchers have struggled to devise a way to measure system of care philosophy diffusion.
While system of care is a system level intervention, this study explored the role of the system of care value: family voice as it pertains to direct practice for children and families. The goal was to assess whether specific direct practices regularly associated with system of care (i.e., wraparound or home-based services) lead to greater family voice or if the mere presence of a high-functioning system of care community leads to equal family voice for all receiving community-based services.
The primary finding was a relationship between the perception of family functioning and perceived empowerment/self-efficacy. This finding suggests that as functioning improves, so does a caregiver’s perception of their personal empowerment/ self-efficacy. While the framing of this study was to “unpack” the system of care value of family voice, the findings do not support any clear cut explanation for how family voice is promoted or communicated to families. Based on the findings, it appears as if families feel more empowered as their child improves. Additional research needs to be done on the application of family voice within the practice setting to better understand how to best instruct staff to infuse family voice in their daily practice.
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Chiyaka, Edward Tafumaneyi. "Effectiveness of the Pathways Community Hub Model in Reducing Low Birth Weight Among High-Risk Pregnant Women." Kent State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=kent1564765507539083.
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Curran, Holly J. "Facilitating Collaboration Among School and Community Providers In Children's Mental Health." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4434.
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Interprofessional collaboration among school-based and community-based mental health providers in children's mental has been studied in relation to specific providers and as part of program evaluation; however, limited information exists as to how to overcome barriers to collaborative relationships. This study describes the experiences of school and community mental health service providers and those who supervise them. Using phenomenological methodology, three focus-group interview transcripts were analyzed by identifying recurrent themes relevant to the experience of collaboration from school and community providers' perspectives. Although participants viewed aspects of collaboration positively, barriers frequently interfered with collaborative relationships. Support for collaboration from state, district or organization administration was considered necessary for widespread collaboration across settings. To reduce time constraints on existing school staff, school-based professionals suggested it may be necessary to employ additional staff to manage collaborative relationships. Participants' ideas for funding included cutting costs, reducing risks, and grant writing. Jointly developing procedures, increasing accessibility by having services available within the school setting, and collecting outcome data regularly to share with stakeholders were discussed. Understanding the experiences of collaboration among school and community mental health providers has the potential to ignite social change by helping schools and community agencies overcome barriers to collaboration through improved coordination of services for children with unmet mental health needs.
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Marcu, Gabriela. "Designing for Collaborative Reflection." Research Showcase @ CMU, 2014. http://repository.cmu.edu/dissertations/400.
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A rise in chronic conditions has put a strain on our healthcare system. Treatment for chronic conditions spans time, agencies, and providers, making coordination a complex problem. Information systems such as electronic health records should be helping with the challenge of coordination, but research shows that often they do not. This thesis aims to alleviate this problem by examining the design of health information technology with an emphasis on social and organizational processes. The focus of this thesis is on the implications of continuous care over time: the shift from a single provider to team-based services, the emergence of patients and families as primary caregivers in the home, and the diffusion of data-driven decision making. I investigated these trends to understand the role of data in coordinating long-term care, and inform the design of information systems. I studied behavioral and mental health services for children, which are coordinated across clinical, home, and special education settings. I found coordination that was unstructured, unpredictable, and adaptive. I developed a conceptual framework, collaborative reflection, to describe my observations and distinguish my findings from the processes of time-critical and protocol-based care. I also found ways in which coordination was not data-driven, due to a lack of support and tools. Collaborative reflection thus illustrates how long-term coordination works when it is data-driven, informing a discussion of what is needed for coordination to be data-driven. Based on the process of collaborative reflection, and using participatory design, I developed Lilypad—a tablet-based information system for data-driven coordination. I conducted a five-month deployment study of Lilypad in the field, to examine its social impact. This study validated designing for collaborative reflection to improve the use of data in coordination. The contributions of this thesis are: a description of unstructured and informal workflow that drives long-term coordination in health services; the theoretical construct of collaborative reflection to inform the design of systems that improve coordination; a field deployment validation, demonstrating how designing for collaborative reflection improves coordination and avoids common unintended consequences of health information technology.
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Rodrigues, Ludmila Barbosa Bandeira. "Adaptação e validação de um instrumento para avaliar a coordenação das redes de atenção à saúde pela Atenção Primária à Saúde: fase I." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-20052014-201509/.
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As transformações nas estruturas demográfica, epidemiológica e nos padrões de morbimortalidade vêm levantando a necessidade de novas perspectivas de organização dos sistemas de saúde. Com o crescimento da prevalência das condições crônicas, foram notadas mudanças em relação às demandas e às necessidades de saúde da população requerendo a busca premente de novas respostas. Desse modo, os problemas relacionados à integração do sistema e à coordenação dos cuidados vêm recebendo atenção nas reformas dos sistemas de saúde, sobretudo no papel da atenção primária à saúde. Considera-se que os sistemas de saúde organizados em redes de atenção à saúde e coordenados pela atenção primária podem contribuir para a melhoria da qualidade clínica, dos resultados sanitários, da satisfação dos usuários (pela melhoria do acesso e da resolubilidade), além de reduzir os custos dos sistemas locais de saúde. O objetivo do estudo foi adaptar e validar para o Brasil o check list utilizado para avaliar o grau de integração das Redes de Atenção à Saúde. Trata-se de um estudo metodológico de corte transversal. A coleta de dados ocorreu no período de março a outubro de 2013. Participaram do estudo profissionais de saúde que atuam na Estratégia de saúde da família, recrutados na microrregião de Alfenas/MG. O processo envolveu duas etapas: validação semântica e teste piloto. Na validação semântica, realizaram- se três fases: avaliação e adaptação dos itens pelo grupo de especialistas, avaliação e sugestão dos itens por 50 profissionais de saúde e avaliação e certificação dos itens por 6 profissionais de saúde. Nesta etapa, os itens do instrumento mostraram- se compreensíveis pela população de referência. No teste piloto, não houve a presença dos efeitos floor e ceiling. A fidedignidade da consistência interna do instrumento foi satisfatória. A validade convergente foi satisfatória na maioria dos itens do instrumento, com algumas correlações apresentando valores inferiores a 0,30. Na validade discriminante, as correlações entre os itens e as dimensões as que pertencem em sua maioria, foi maiores ou significativamente maiores que suas correlações com as dimensões às quais não pertencem. Os resultados mostraram que o instrumento COPAS tem propriedades psicométricas satisfatórias, podendo no futuro se revelar como uma ferramenta útil aos gestores e aos trabalhadores para a reorganização dos sistemas de saúde localChanges in demographic, epidemiological structures and patterns of mortality have raised the need for the new organization perspectives of the health systems. With the prevalence growth on chronic conditions, it was possible to note changes in relation to the health needs and demands of the population requiring an urgent search for new responses. Thus, the problems related to the system integration and care coordination are receiving attention in the health systems reforms, especially, in the primary health care role. It is considered that the health systems organized in health care networks and coordinated by the primary health care may contribute to the improvement of clinical quality, health outcomes and users satisfaction (by improving access and problem-solving), besides reducing the costs of local health systems. The aim of this study was to adapt and validate for Brazil\'s checklist used to assess the degree of integration of Network Health Care. This is a methodological and cross- sectional study. Data collection occurred from March to October 2013. The health professionals who work in the Family Health Strategy participated in the study. They were recruited in the microregion of Alfenas /MG. The process involved two stages: semantic validation and pilot testing. There were 3 phases in the semantic validation: evaluation and adaptation of the items by the group of experts; evaluation and suggestion of the items by 50 health professionals; evaluation and certification of the items by 6 health professionals. In this step, the instrument\'s items proved to be understandable by the reference population. The internal consistency reliability of the instrument was satisfactory. The convergent validity was satisfactory for most of the instrument\'s items, with some correlations showing values lower than 0.30. In the discriminant validity, the correlations among items and dimensions to which they belong mostly were significantly larger or larger than the correlations with dimensions to which they do not belong to. Results showed that the instrument COPAS owns satisfactory psychometric properties, and in the future, it could become a useful tool for managers and workers to the reorganization of local health systems
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Duailibe, Felix Duarte de Barros. "Os mecanismos de controle previstos para as organizações sociais de saúde no Brasil: a comparação com mecanismos correlatos no controle de seviços de saúde." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-27072012-114258/.
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Diante do incremento das Organizações Sociais e outras entidades do Terceiro Setor atuantes de gestão de serviços públicos de saúde, a partir da previsão do Plano Diretor de Reforma do Aparelho do Estado na década de 1990, surgiram críticas doutrinárias de que não existe controle efetivo dessas entidades na sua atuação. Entendeu-se como componentes do Terceiro Setor: as Organizações Sociais, as Organizações da Sociedade Civil de Interesse Público, as Fundações de Apoio e os Serviços Sociais Autônomos. Assim, este trabalho, ao pesquisar e analisar a legislação que regulamenta a matéria e a doutrina que a estuda, identificou a tipificação das formas de controle existentes em três esferas governamentais, no nível Federal, no Estado de São Paulo e no Município de São Paulo, apontando, quando pertinentes, as comparações. Diferenças e semelhanças foram encontradas nas diferentes formas de controle existentes, na perspectiva do Controle Interno e do Controle Externo, este, pormenorizado no exercício decorrente dos Poderes constituídos (Executivo, Legislativo, Judicial). No controle externo pelo legislativo, prevalece o realizado pelo auxílio do Tribunal de Contas. No controle externo jurisdicional, além da centralidade do controle judicial, ainda há a marcante atuação do Ministério Público. Ainda encontrou-se relevante registro do valorizado controle externo exercido pela sociedade civil, comumente conhecido como controle social. A discussão foi pautada na interpretação jurídica, a qual tem implicações patentes nas instituições existentes e na Vida dos indivíduos que às leis estão submetidos. Essa análise, por importante à sociedade, dispôs-se a trazê-la à Saúde ColetivaThe increasing presence of Social Organizations and other Third Sector entities in the management of public health care services in Brazil, foreseen with the implementation of the Master Plan for State Reform in the 1990s has led to criticism as to the absence of effective controls of these entities performance. We studied and compared legislation regulating control mechanisms for Social Organizations in Health and other Third Sector entities in three government spheres, Federal, State and City of São Paulo. We identified similarities and dissimilarities in existing control mechanisms from an Internal and External Control perspective. External Control mechanisms are executed by the Executive, Legislative and Judiciary. In the Legislative the main control mechanism are the Auditory Courts, and in the Judiciary the Prosecutors. The legislation also mentions the importance of external control by the population, as part of social control mechanisms. The analysis is referenced by juridical knowledge, and demonstrates the contributions of this type of analysis for a Public Health perspective
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McManus, Lisa Sullivan. "The Patient-Centered Medical Home and Diabetes Mellitus Outcomes: A Systematic Review." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3310.
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Ineffectively managed chronic diseases such as diabetes mellitus (DM) increase overall health care expenditures and negatively affects health outcomes such as exacerbations, functional decline, disability, and death. The purpose of this systematic review (SR) was to review the DM outcomes reported by patient-centered medical homes (PCMHs). The goal was to determine how care coordination and evidence-based clinical management impacted financial and health outcomes. The SR followed the Cochrane protocol and complied with the PRISMA evidence-based minimum set for reporting. Overall, DM management in the PCMH demonstrated statistically significant completion rates for essential screenings and preventive care, including HgA1c (p = 0.0013), lipid management (p
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Wilson, Kris K. "Factors Associated with Provider Utilization of the Heath Information Exchange in the State of Hawaii." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4694.
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In a context where technology is increasingly being incorporated into health care practice, many U.S. health care providers and organizations are finding it challenging to connect disparate electronic documentation systems to retrieve patient information when coordinating care across providers and heath care entities. Local and regional health information exchange (HIE) systems were created to facilitate collecting information into one integrated patient record to address information transfer between heath care providers. Yet, adoption and use of HIEs have been low. The purpose of this study was to review the predictive factors accounting for physicians' use of a HIE in the U.S. state of Hawaii. Key factors from the technology acceptance model were evaluated to determine the behavioral intention resulting in actual use of the Hawaii health information exchange (HHIE). Physician characteristics (medical specialty, age, and gender) and location characteristics were also assessed. The total population of the study contained 1034 Hawaii physicians who have signed up to use the HHIE. Linear and logistic regression models were structured to evaluate the predictive nature of (a) use to determine if a physician has ever logged into the HIE and (b) usage to evaluate the extent to which a physician is logging into the HIE. Findings from the study reveal a predictive relationship between the characteristic of medical specialty and HHIE use when comparing primary care and emergency department physicians to physician specialists. Using study results, health care leaders can improve physician outreach and review barriers when using the HIE systems to coordinate care. Policy implications include the possible formulation of future requirements surrounding HIE physician participation.
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Duarte, Ligia Vanessa Silva Cruz. "Gestão do cuidado na atenção primária à saúde no estado de Goiás." Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/6985.
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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
INTRODUCTION: Studies highlight that care management actions would enable improvements in care continuity and integrality, as they would reduce barriers to access to different health services, performing them in a real and appropriate way. In Primary Health Care, it is necessary that chronic conditions be guided by management practices, aiming at integrating care levels, thus facilitating the ordering of flows and counterflows of people, products and information. This fact puts the PHC in a scenario of constant conflicts of responsibilities, to order and reorder health services and to have more synchronized care. OBJECTIVE: To evaluate care management in PHC using the parameters evaluated by PIAQ - PC in Goiás. METHODOLOGY: This is a cross - sectional study that evaluated PIAQ - PC results in Goiás in 2014. Secondary data from PIAQ-PC External Evaluation database from December 2013 to March 2014 were used. RESULTS: The results of this study allow us to state that there is fragility regarding a consistent registry of the territory, use of standardizations for conducts, agenda scheduling, consultations offering, risk classification and definition of well-defined flows of the user in health units system, in Basic Attention in Goiás, making care barriers and harming those who need them. CONCLUSION: The results found may support the managers' reflection on problems identification in coordination, flow and continuity of care and help in planning, programming and evaluation of intervention measures to be adopted by the Secretary of the State of Health of Goiás and the Municipal Health Secretariats, in order to structure Primary Health Care, making it more resolutive and less expensive.
INTRODUÇÃO: Estudos ressaltam que as ações de gestão do cuidado possibilitariam melhorias na continuidade e na integralidade da atenção, na medida em que reduziriam barreiras de acesso aos distintos serviços de saúde, articulando-os em tempo e local oportunos. No âmbito da Atenção Primária à Saúde, faz-se necessário que o cuidado às condições crônicas esteja orientado por práticas de gestão, com vistas a integrar os níveis assistenciais, facilitando assim, o ordenamento de fluxos e contrafluxos de pessoas, produtos e informações. Esse fato coloca a APS em um cenário de constantes conflitos de responsabilidades, para ordenar e reordenar serviços de saúde e garantir cuidados mais sincronizados. OBJETIVO: Avaliar a gestão do cuidado no âmbito da APS utilizando os parâmetros avaliados pelo PMAQ – AB no estado de Goiás. METODOLOGIA: Trata-se de um estudo transversal que avaliou os resultados do PMAQ-AB, em Goiás, em 2014.Foram utilizados dados secundários extraídos do banco de dados da Avaliação Externa do PMAQ-AB, entre dezembro de 2013 e março de 2014. RESULTADOS: Os resultados desse estudo permitem afirmar que existe fragilidade no que se refere a um registro consistente do território, uso de padronizações para condutas, programação da agenda, oferta de consultas, a classificação de risco e a definição de fluxos bem definidos do usuário dentro do sistema nas unidades de saúde, na Atenção Básica do estado de Goiás, gerando barreiras assistenciais e prejudicando aqueles que precisam dos seus serviços. CONCLUSÃO: Os resultados encontrados poderão subsidiar a reflexão dos gestores quanto a identificação de problemas na coordenação, fluxo e continuidade da atenção e auxiliar no planejamento, na programação e na avaliação de medidas de intervenção a serem adotadas pela Secretaria do Estado da Saúde de Goiás e pelas Secretarias Municipais de Saúde, a fim de estruturar a Atenção Primária tornando-a mais resolutiva e menos dispendiosa.
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Nilsson, Hanna, and Julia Johansson. "Samordning för barn och ungdomar med frekvent behov av sjukvård." Thesis, Tekniska Högskolan, Högskolan i Jönköping, JTH, Industriell organisation och produktion, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-24059.
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Purpose- The purpose of this project is to contribute to the knowledge of creating customer value through streamlining and coordination of patient flows for children and youth with frequent need of care on child and youth medical clinics. Method- One of the methods used for achieving the project's purpose is a case study on the Child and Youth Medicine Clinic at Länssjukhuset Ryhov in Jönköping. The case study has been used for collecting the empirical data that has been generated through interviews, observations and documents from the Child and Youth Health Clinic. Except the case study the authors also made studies in literature, which the collected empirical data has been anchored and related to. Together this led to the project's analysis and results. Results- When investigating the questions found in chapter one, it was determined standardized work is of great importance to create structure and implement procedures for the patient flows. A weak link in the patient flow has been identified, which is the sub-process coordination and planning. This constraint includes three types of requirements: patient requirements, requires of health professionals and legislated requirements. By paying attention to and taking into account these requirements a coordination function can be designed to streamline patient flows and increase the customer value. The authors concluded that a specific employment as a coordinator should be appointed. A coordinator provides opportunities for a personal communication between patients and health professionals. At the same time the coordinator is able to work with techniques for efficiency while taking into account the soft values in health care. Conclusions- There is a demand for coordination from health professionals and patients. A coordination function would streamline operations and contribute to increase the customer value. Taking into account the identified wastes and limitations a coordination can be possible. Research limitations- The project's data is collected during the case study that was conducted at the Child and Youth Health Clinic. Further case studies are desirable in other clinics and in other hospitals country wide. These studies will allow for a higher security when generalizing the results of the project.Syfte- Syftet med projektet är att bidra till kunskapen om att skapa kundvärde genom effektivisering och samordning av patientflöden för barn med frekvent behov av vård på barn- och ungdomsmedicinska kliniker. Metod- För att uppnå projektets syfte har bland annat en fallstudie på Barn- och ungdomsmedicinska kliniken på Länssjukhuset Ryhov i Jönköping genomförts. Fallstudien har använts för insamling av empiri, genom intervjuer, observationer samt dokument från Barn- och ungdomsmedicinska kliniken. Utöver denna fallstudie har även en litteraturstudie bedrivits, som den insamlade empirin har förankrats och relaterats till. Detta har gemensamt lett till projektets analys och resultat. Resultat- Det har framkommit att ett standardiserat arbetssätt är en förutsättning för att skapa struktur och införa rutiner gällande samordning för patientflöden. En svag länk i patientflödet har identifierats vilken är delprocessen samordning och planering. Denna länk innefattar tre typer av begränsningar, patientrelaterade begränsningar, begränsningar kopplade till vårdpersonal samt lagstiftade begränsningar. Genom att uppmärksamma och ta hänsyn till dessa begränsningar kan en samordningsfunktion utformas för att effektivisera patientflödet och höja kundvärdet. En specifik befattning som samordnare bör tillsättas, vilket ger möjlighet till personlig kontakt mellan patienter och vårdpersonal och kan även arbeta med tekniker för effektivisering samtidigt som hänsyn tas till mjuka värden. Slutsatser- Det finns en efterfrågan om samordning för såväl vårdpersonal som patienter. En samordningsfunktion skulle effektivisera verksamheten och bidra till ett ökat kundvärde. Genom att ta hänsyn till identifierade slöserier i patientflödet och begränsningar i vårdprocessen kan samordning möjliggöras. Begränsningar- Projektets empiri är insamlad under den fallstudie som bedrevs på Länssjukhuset Ryhov. Författarna hade önskat utöka sina perspektiv genom att involvera fler intervjupersoner för att ge projektet högre reliabilitet och validitet. Eftersom majoriteten av all personal med planeringsansvar på Barn- och ungdomsmedicinska kliniken intervjuats hade författarna behövt intervjua personal utanför det avgränsade området. Det hade även varit önskvärt att göra ytterligare fallstudier på andra kliniker och möjligtvis även på andra sjukhus i landet för att med högre säkerhet kunna generalisera projektets resultat. På grund av sekretesslagar och geografiska avstånd var detta inte möjligt.
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Horton, Jeryl Yvette. "Improving Self-Management in Patients With Chronic Conditions." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2489.
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Care Coordination Home Telehealth (CCHT) maintains a positive impact on the delivery of patient care in the primary care clinic at the Department of Veterans Administration Medical Center (VAMC). This quality improvement initiative targets patients with chronic conditions such as diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease. These patient are frequently seen in the emergency room, and are often admitted to the hospital, where they saturate the outpatient clinics' waiting room with multiple walk-ins. CCHT has, to some extent, reduced walk-ins, emergency room visits, and hospitalization while minimizing the strain on access to care at the VAMC. Sustaining self-management skills of veterans with chronic conditions at the VAMC continues to impose challenges. In this project, retrospective data from 95 randomly selected charts reviewed during a 2-year period were used to compare hospitalizations, emergency room visits, and primary care visits. The findings of the study indicate veterans enrolled in Home Telehealth show positive social change. The social change is evidenced by change in behavior patterns, such as maintaining a healthy diet, performing daily physical activity, and compliance with medication administration. Enrolled veterans had better outcomes regarding hospitalization, emergency room visits, and primary care visits. The data highlighted the need for incorporating disease-specific protocols guiding care coordinators at first point of contact with the veteran patient. Following these protocols may enhance communication style that matches the patient's stage of behavioral change with interventions.
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Åkesson, Johanna, and Josefine Ågren. "Digitala tidsbokningar i sjukvården : Identifiering av brister och förbättringsförslag för en effektivare tidsbokningsprocess." Thesis, Tekniska Högskolan, Jönköping University, JTH, Logistik och verksamhetsledning, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-49965.
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Syfte – Syftet med denna studie är att kartlägga hur digitala tidsbokningar i sjukvården används i nuläget, identifiera brister och ta fram förbättringsförslag för att skapa en effektivare tidsbokningsprocess. För att uppfylla syftet har tre frågeställningar formulerats: 1. Hur används digitala tidsbokningar i nuläget? 2. Vilka brister finns det i den digitala tidsbokningsprocessen som påverkar effektiviteten? 3. Hur kan den nuvarande digitala tidsbokningsprocessen effektiviseras? Metod – För att kunna uppnå studiens syfte har en fallstudie genomförts på kvinnohälsovården i Jönköping. Fallstudien bestod utav deltagande observationer och dokumentstudier. Även en litteraturstudie har genomförts vilket har legat till grund för det teoretiska ramverket som använts för analys av empiriska data. Resultat – I studien framkom det att kvinnohälsovården till viss del använder sig av digitala tidsbokningar. Fyra brister identifieras i tidsbokningsprocessen som påverkade effektiviteten. Dessa var schemaläggning, begränsat utbud på 1177, bristande användning av prognoser samt samordning. Efter att dessa brister identifierats kunde tre förbättringsförslag formuleras med syfte till att effektivisera tidsbokningsprocessen. Det första förbättringsförslaget gäller ett utökat utbud av tillgängliga tider på 1177. Det andra förbättringsförslaget handlar om hur prognoser kan användas i större utsträckning vid schemaläggning och planering av tillgängliga tider på 1177. Slutligen handlar det tredje förbättringsförslaget om hur en större samordning kan bidra till minskad tid för administration för barnmorskorna. Implikationer – I studien har brister identifierats och förbättringsförslag har tagits fram gällande hur tidsbokningsprocessen ska effektiviseras. Genom användning av förbättringsförslagen kan verksamheten bli mer samordnad och med hjälp av prognoser kunna tillgodose den efterfrågan som finns. Förbättringsförslagen skulle innebära nya arbetsrutiner för kvinnohälsovården. Ingen ny teori har skapats utifrån studien då den är baserad på redan existerande teori. Begränsningar – Studien utfördes endast på ett fallföretag vilket kan påverka studiens generaliserbarhet. Förbättringsförslagen gällande hur tidsbokningsprocessen kan effektiviseras har enbart beskrivits på ett teoretiskt plan och inte testats i praktiken. Studien har även främst varit av kvalitativ karaktär vilket medför att inga mätningar har gjorts gällande hur förbättringsförslagen har bidragit till en effektivare tidsbokningsprocess.Purpose – The purpose with this study is to chart the using of digital appointment bookings in the health care, identify deficits and to generate suggestions for improvements for a more efficient process regarding appointment bookings. To fulfil the purpose three research questions have been formulated: 1. How are digital appointment bookings currently being used? 2. What deficits are there in the digital appointment booking process that affects the efficiency? 3. In what way can the current digital appointment booking process be more efficient? Method – To be able to fulfil the purpose a case study was conducted at women’s health care in Jönköping. The case study consisted of participatory observations and document studies. A literature review was also conducted to establish the theoretical framework that was used to analyze the empirical data. Findings – The study showed that digital appointment bookings are partly being used in the women’s health care. Four deficits that affected the appointment booking process were identified. The deficits were scheduling, a limited supply of appointments at 1177, limited using of forecasts in the scheduling and planning of appointments and lack of coordination. Once these deficits were identified, three suggestions for improvements to a more efficient appointment booking process were formulated. The first suggestion was to extend the supply of appointments at 1177. The second suggestion was regarding how forecasts can be used for scheduling and planning of appointments at 1177 in a greater extent. Lastly, the third suggestion mentioned how a greater use of coordination can contribute to reduced administration for the midwives. Implications – The study identified deficits and suggestions for improvements regarding how the appointment booking process can become more efficient. By using the suggestions, the organization can become more coordinated and by using forecasts be able to meet the demand. The suggestions for improvements would lead to new work procedures for the women´s health care. No additional research has been developed through this study as it was based on already existing theories. Limitations – the study was only executed at one case company which can affect how generalized the results are. The suggestions for improvement regarding how the appointment booking process can become more efficient are only described in the theory and have not been tested in the reality. The study has mainly been a qualitative research which means that no measurements has been performed regarding on how the suggestions for improvements would lead to a more efficient appointment booking process.
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Engström, Karl. "Snabbare och säkrare övergång för patienter från primärvård till specialistpsykiatri : En empirisk fallstudie av antagandens betydelse för ett förbättringsarbete kring remisser och samverkan." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-40701.
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Bakgrund I Sandviken är vården av vuxenpsykiatrisk problematik uppdelad mellan primärvård och specialistpsykiatri. Patientöverföringen via remisser innebar en osäker vård och fördröjd tid till specialistpsykiatriska insatser då cirka 50 % av remisserna avvisades från två av hälsocentralerna. Syfte Syftet med förbättringsarbetet var att minska andelen avvisade remisser och korta tiden från remiss vid hälsocentral till psykiatriska insatser vid specialistpsykiatrin. Studiesyftet var att ta reda på vilka antaganden som fanns bland samverkande aktörer och betydelsen av dessa för förbättringsarbetet. Metod Den förutbestämda förbättringsidén utgjordes av en remissmall. Flera olika förbättringsverktyg användes i förbättringsarbetet med central utgångspunkt från att basera beslut på fakta. Studien var en empirisk fallstudie med kvalitativ innehållsanalys av dokument, observationer och följande intervjuer. Resultat Förbättringsarbetets syfte uppnåddes inte med den testade remissmallen. Studien visade att antaganden kring vad som behövde och kunde göras bidrog till att remissmallen inte blev en hållbar lösning. Slutsatser Förbättringsarbetet visade vikten av att testa nya idéer. Den förutbestämda remissmallen var inte en hållbar lösning. En koppling sågs mellan de samverkande aktörernas antaganden kring vad som behövde och kunde göras, liksom på vilket sätt, till vad som gjordes och hur. Detta bidrog till förbättringsarbetets utfall.Background In Sandviken, the adult psychiatric care is divided between Primary Health Centers and Psychiatry. The transferral of patients was unsafe and meant prolonged time before psychiatric treatment was started as 50 % of the referrals were declined. Purpose The improvement project aimed to reduce the proportion of declined referrals and to reduce time between referral and psychiatric treatment. The study aimed to find out beliefs existing among stakeholders and the effect of these on the improvement work. Methods The idea to test, a referral template, was chosen in advance of the project start. Several improvement tools were used and one primary focus was to base decisions upon facts. The study was an empirical case study with qualitative analysis made on documents and interviews. Results The improvement project didn’t achieve the set aims. The study showed that beliefs about what was needed and possible to do, contributed to the results of the improvement work. Conclusions The improvement project showed the importance of testing new ideas. The referral template wasn’t a working solution. Stakeholders beliefs about what was needed and possible to do, and how to do it, was shown to contribute to the results of the improvement work.
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Manoel, Rosimeire Aparecida [UNESP]. "A atividade de coordenação do trabalho na equipe da Estratégia de Saúde da Família: as contradições para a produção do cuidado na atenção psicossocial." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/149776.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Considerando a relevância que os serviços na Atenção Primária à Saúde (APS) assumem no processo de consolidação do Sistema Único de Saúde (SUS), convém trazer para o centro da discussão sobre a qualificação desses serviços a atividade de coordenação do trabalho na equipe, considerando o papel operativo desse trabalho na consolidação dessa política. Desse modo, o objetivo desse estudo foi analisar a atividade de coordenação do trabalho na equipe da Estratégia de Saúde da Família em interface com a produção do cuidado em saúde mental, tendo em vista explicitar as contradições para a consolidação da atenção psicossocial na APS. Trata-se de uma pesquisa de campo, cujo referencial teórico é o da Psicologia Histórico-Cultural, fundamentada no Materialismo Histórico e Dialético (MHD). A pesquisa foi realizada em um município de pequeno porte do Estado de São Paulo. Foram convidados a participar dessa pesquisa os trabalhadores atuantes na/junto à rede de atenção primária envolvidos no cuidado em saúde mental. Para a coleta de dados utilizou-se dois instrumentos: questionário para levantamento inicial das atividades relacionadas ao cuidado em saúde mental e grupo focal. Na primeira etapa obteve-se um total de 81 questionários (52 – Unidade Básica com Saúde da Família - UBSF; 01 – Núcleo de Apoio à Saúde da Família - NASF; 02 – Centro de Atenção Psicossocial - CAPS; 05 – Ambulatório de Saúde Mental; 04 - Residência Terapêutica; 12 – Centro de Referência de Assistência Social - CRAS; 05 – Centro de Referência Especializado de Assistência Social - CREAS). Realizou-se um total de dez encontros com os seis grupos formados (grupo técnico de enfermagem da UBSF; três grupos de Agentes Comunitários de Saúde - ACS; grupo de coordenadoras da Estratégia de Saúde da Família - ESF; grupo com trabalhadores da saúde mental). Com relação ao procedimento de análise dos dados, por referir a uma pesquisa explicativa, o conteúdo da fala torna-se seu principal recurso de análise. Para apreensão dessa realidade lançamos mão das categorias psicossociais consciência e atividade, buscando entender o movimento da consciência dos profissionais da APS que se dá em relação às atividades que eles desenvolvem em interação com a coordenação, com os outros profissionais da equipe e com os serviços da rede psicossocial na produção do cuidado em saúde mental. A análise foi sistematizada dentro da proposta dos núcleos de significação, seguindo em dois movimentos: do empírico ao abstrato e do abstrato ao concreto. Das análises do nosso objeto de estudo emergiram oito núcleos de significação: 1) A coordenação da equipe como “elo de ligação”; 2) O trabalho da equipe está centrado no médico; 3) Os tipos de vínculos de trabalho e seus impactos na rotatividade dos trabalhadores; 4) O cuidado em saúde mental exige tempo, escuta e vínculo; 5) Do reconhecer ao fazer frente às necessidades psicossociais: o sofrer e o pensar profissional; 6) ESF: porta de encaminhamento e medicação; 7) A distante, desconhecida e inexistente rede de atenção psicossocial; 8) As limitações e potencialidades da atividade do ACS para a atenção psicossocial. A partir da análise dos núcleos foram identificadas contradições históricas já conhecidas no processo de trabalho da ESF (generalista/especialista; encaminhar/referenciar; quantitativo/qualitativo e ter/não ter poder), ao mesmo tempo em que possibilitaram um avanço ao desvelar algumas particularidades, especialmente, quando inserido no cenário do cuidado de saúde mental em interface com a rede (trocador/prescritor; passar/responsabilizar; atender/acolher), recorte que nos permitiu compreender sob qual perspectiva de cuidado se assenta o trabalho na APS – o do modelo biomédico. A compreensão dos determinantes que estão por trás do processo de materialidade desse modelo, possibilita apontar para a necessidade de uma ressignificação na concepção da atividade de coordenação na ESF tanto nas políticas, buscando por sua valorização e qualificação de sua atuação como na significação dos profissionais, a fim de ampliar a concepção de cuidado dentro de uma perspectiva psicossocial, bem como possibilitar a grupalização e articulação das ações da equipe no caminho da humanização e integralidade do cuidado.
Considering the relevance that works on Primary Health Care (PHC) assume in the process of consolidation of the Unique System of Health (USH), it’s ok to bring to the center of the discussion about qualification of these services the activity coordination of the team work, considering the operative paper of this work in the consolidation of this politic. That way, the objective of this study was analyze the work coordination activity in the Family Health Strategy team in interface with the production of mental health care, in order to explain the contradictions for the consolidation of psychosocial care in PHC. Be about a field research, whose theoretical referential it’s the Cultural Historical Psychology, substantiated in Historic Materialism and Dialectical (HMD). The research where realized in one small size county of the São Paulo State. Were invited to participate of this research the workers acting in primary attention net involved on mental health care. To the collect of data was used two instruments: quiz for initial lifting of the activities related to care on mental health and focal group. On the first stage it was obteined 81 questionnaires (52- Basic Unite with Family Health – BUFH; 01 – Family Health Support Core – FHSC; 02 – Psychosocial Attention Core – PSAC; 05 – Mental Health Ambulatory - MHA; 04 Therapeutic Residence ; 12 –Reference Center of Social Assistance – RCSA; 05 – Specialized Reference Center of Social Assistance - SRCSA). Was performed a total of ten encounters with the six formed groups (Nursing Technician Group of FHBU; three groups of Community Agents of Health – CAH; group of Family Health Strategy Coordinators – FHSC; group with mental health workers). In relation with the proceed of analysis of data, by refer to a explanatory research, the content of speech becomes his major analysis resource. For the seizure of this reality we give up of the psychosocial category of consciousness and activity, seeking out to understand the movement of the professional consciousness of the PHC that is related to the activities they develop in interaction with the coordination, with the other professional that are part of the team and with the services of the psychosocial network in the production of the mental health care. The analysis was systemized within the purpose of the significance core, following two lines: from empyrean to the abstract and from the abstract to the concrete. From the analysis of the object appeared eight significance core: 1) The coordination team as “the link”; 2) the work of the team is focus on the doctor; 3) The types of work links and their impacts on worker turnover; 4) the care in mental health demands time, listening and tie; 5) From recognize to do according to the psychosocial necessities: the suffering and the professional thought; 6) FHS: the way to the routing and medication; 7) The distance and the unknown psychosocial network; 8) The limitations and potentialities of the CAH activities for the psychosocial care, they presented historical contradiction already known in the work process of the FHS (generalist/specialist; forward/refer, quantitative/qualitative, to have/ not have the power), in the same time that became possible an advance about unveiling some particularities, specially, when its inserted in the scenario of the mental health care in interface to the network (exchanger/prescriber; to pass/to charge, to attend/to welcome), this cutting allowed us to understand from what perspective of care is based the work in the PHC – the biomedical model. The understanding of the determinants that are behind of the materiality process in this model, allow to point to necessity of a redetermination of the conception of the coordination activity such in the politics, seeking for the valorization and qualification of its performance as in the professionals meanings, in order to enlarge the care conception with the psychosocial perspective, as well as to enable the grouping and the articulation of the team action in the way to humanize and integrality of the care.
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Manoel, Rosimeire Aparecida. "A atividade de coordenação do trabalho na equipe da Estratégia de Saúde da Família as contradições para a produção do cuidado na atenção psicossocial /." Botucatu, 2016. http://hdl.handle.net/11449/149776.
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Orientador: Sueli Terezinha Ferrrero MartinResumo: Considerando a relevância que os serviços na Atenção Primária à Saúde (APS) assumem no processo de consolidação do Sistema Único de Saúde (SUS), convém trazer para o centro da discussão sobre a qualificação desses serviços a atividade de coordenação do trabalho na equipe, considerando o papel operativo desse trabalho na consolidação dessa política. Desse modo, o objetivo desse estudo foi analisar a atividade de coordenação do trabalho na equipe da Estratégia de Saúde da Família em interface com a produção do cuidado em saúde mental, tendo em vista explicitar as contradições para a consolidação da atenção psicossocial na APS. Trata-se de uma pesquisa de campo, cujo referencial teórico é o da Psicologia Histórico-Cultural, fundamentada no Materialismo Histórico e Dialético (MHD). A pesquisa foi realizada em um município de pequeno porte do Estado de São Paulo. Foram convidados a participar dessa pesquisa os trabalhadores atuantes na/junto à rede de atenção primária envolvidos no cuidado em saúde mental. Para a coleta de dados utilizou-se dois instrumentos: questionário para levantamento inicial das atividades relacionadas ao cuidado em saúde mental e grupo focal. Na primeira etapa obteve-se um total de 81 questionários (52 – Unidade Básica com Saúde da Família - UBSF; 01 – Núcleo de Apoio à Saúde da Família - NASF; 02 – Centro de Atenção Psicossocial - CAPS; 05 – Ambulatório de Saúde Mental; 04 - Residência Terapêutica; 12 – Centro de Referência de Assistência Social - CRAS; 05... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Considering the relevance that works on Primary Health Care (PHC) assume in the process of consolidation of the Unique System of Health (USH), it’s ok to bring to the center of the discussion about qualification of these services the activity coordination of the team work, considering the operative paper of this work in the consolidation of this politic. That way, the objective of this study was analyze the work coordination activity in the Family Health Strategy team in interface with the production of mental health care, in order to explain the contradictions for the consolidation of psychosocial care in PHC. Be about a field research, whose theoretical referential it’s the Cultural Historical Psychology, substantiated in Historic Materialism and Dialectical (HMD). The research where realized in one small size county of the São Paulo State. Were invited to participate of this research the workers acting in primary attention net involved on mental health care. To the collect of data was used two instruments: quiz for initial lifting of the activities related to care on mental health and focal group. On the first stage it was obteined 81 questionnaires (52- Basic Unite with Family Health – BUFH; 01 – Family Health Support Core – FHSC; 02 – Psychosocial Attention Core – PSAC; 05 – Mental Health Ambulatory - MHA; 04 Therapeutic Residence ; 12 –Reference Center of Social Assistance – RCSA; 05 – Specialized Reference Center of Social Assistance - SRCSA). Was performed a total of ... (Complete abstract click electronic access below)
Doutor
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Hamdan, Rachel Malek. "Dimensions of Nurse-Physician Communication." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3350.
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Hospital leaders set quality and safety as high priorities in their strategic goals. Improving the quality and safety of patient care requires improving internal processes that have direct implications for patient care. Hospital leaders need to improve health care providers' communication as part of improving quality and safety. The problem addressed in this study was the lack of strategies health care administrators use to guide nurse-physician communication patterns in a university medical center in the Middle East. The purpose of this qualitative case study was to explore communication strategies that health care administrators use to guide nurse-physician communication. Relational coordination informed the conceptual framework of the study. The research question was designed to identify strategies health care administrators use to guide nurse-physician communication patterns. Data were collected and thematically analyzed through semistructured interviews with 5 administrators, 3 nurses, and 3 physicians, and the hospital policy manual. Analysis revealed 4 major themes: nurses' empowerment, nurses and physicians' accountability, multidisciplinary care delivery, and mutual respect. Strategies were identified through the exploration and analysis of the 4 themes. The key findings included that administrators considered holding nurses and physicians accountable for their work to be a key strategy that guides communication, and that effective communication is directly connected to mutual respect among different teams and individuals. The implications for social change include improved patient care and safety, and increased job satisfaction through health care leaders applying the identified strategies to enhance nurse-physician communication.
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Silva, Roberta Marinho da. "InduÃÃo centralizada da coordenaÃÃo dos cuidados pela atenÃÃo primÃria: estudo comparativo entre dois sistemas de saÃde universais." Universidade Federal do CearÃ, 2013. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12274.
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FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgicoA coordenaÃÃo dos cuidados pela atenÃÃo primÃria à saÃde (APS) ocupa uma posiÃÃo de destaque na agenda das polÃticas de saÃde de vÃrios paÃses. à uma alternativa possÃvel para o problema da segmentaÃÃo em sistemas de saÃde, que gera iniquidade e ineficiÃncia, desarticulaÃÃo da rede assistencial e prejuÃzo no acesso aos nÃveis de atenÃÃo mais complexos. O objetivo geral do estudo foi comparar a induÃÃo centralizada da coordenaÃÃo dos cuidados pela APS em dois sistemas de saÃde universais. Estudo de abordagem quanti-qualitativa, à classificado como exploratÃrio-descritivo, valendo-se de dados documentais e orÃamentÃrios e da realizaÃÃo de nove entrevistas semiestruturadas com sujeitos-chave correspondentes ao National Health Service (NHS), do Reino Unido, e ao Sistema Ãnico de SaÃde (SUS), do Brasil. Foi utilizada anÃlise de conteÃdo temÃtica, estatÃstica descritiva e anÃlise comparativa. A pesquisa obedeceu à ResoluÃÃo 196/96 do Conselho Nacional de SaÃde e obteve parecer favorÃvel (nÃmero 198.092). A pesquisa identificou que o fortalecimento da APS à a base inicial para viabilizar a coordenaÃÃo dos cuidados no Brasil. O MinistÃrio da SaÃde do Brasil vem desenvolvendo polÃticas nacionais que impactam indiretamente na coordenaÃÃo dos cuidados - PolÃtica Nacional de AtenÃÃo BÃsica, NÃcleos de Apoio à SaÃde da FamÃlia e Programa Nacional de Melhoria do Acesso e da Qualidade da AtenÃÃo BÃsica. A polÃtica de Redes de AtenÃÃo à SaÃde revelou-se fator limitante ao papel coordenador da APS. As Tecnologias de InformaÃÃo e ComunicaÃÃo surgiram com menos Ãnfase no Ãmbito federal. O incremento estrutural no TelessaÃde Brasil Redes e os Cadernos de AtenÃÃo BÃsica sobressaÃram por sua capacidade de induzir mudanÃas organizacionais nos serviÃos. O NHS estruturou a coordenaÃÃo dos cuidados pela APS a partir do contrato dos general practitioners e busca empoderÃ-los para gerir 60% do orÃamento do sistema. A pesquisa concluiu que o modelo de Estado federativo brasileiro dificulta a coordenaÃÃo dos cuidados pela APS, em comparaÃÃo ao Estado unitÃrio inglÃs. A municipalizaÃÃo e descentralizaÃÃo tornaram complexo o processo de coordenaÃÃo dos cuidados, cabendo ao MinistÃrio da SaÃde o papel de induzir, de forma vertical, e aos municÃpios, operar o sistema em cada ponto de atenÃÃo de forma horizontal, situaÃÃo que nÃo ficou bem alinhada e configurou um modelo oblÃquo, gerando uma contradiÃÃo no desenho federativo brasileiro e dificultando a coordenaÃÃo dos cuidados.
The coordination of care for the primary health care (PHC) occupies a prominent position on the agenda of the health policies of various countries. It is a possible alternative to the problem of segmentation of health systems, which generates inequity and inefficiency, disarticulation of the care network and impaired access to more complex levels of care. The general objective of this study was to compare the centralized induction of coordination of care by PHC in two universal health systems. This study has a quantitative and qualitative approach and it is classified as exploratory and descriptive, by using documental and budgetary data and performing nine semistructured interviews with key subjects corresponding to National Health Service (NHS), from the United Kingdom, and the Unified Health System (SUS) in Brazil. The thematic content analysis, descriptive statistics and e comparative analysis were used. The research followed the Resolution 196/96 of the National Health Council and obtained its assent under number 198 092. The research identified that the strengthening of PHC is the initial basis to facilitate the coordination of care in Brazil. The Ministry of Health of Brazil has been developing national policies which impact indirectly on coordination of care - National Policy for Primary Care, Centers of Support for Family Health and the National Program for Improving Access and Quality of Primary Care. The Politics of Health Care Networks proved to be limiting factor for coordinating role of the PHC. The Information and Communication Technologies have emerged with less emphasis on the federal level. The structural increase in BrazilÂs Telehealth Networks and Protocols Notebooks of Primary Care, stood by their ability to induce changes in the organizational processes of the services. The NHS structured care coordination by PHC from the contract of general practitioners and seeks to empower them to manage 60% of the budget system. The research concluded that the brazilian federal State model complicates the coordination of care by PHC, compared to the english unitary State. The municipalization and decentralization made the process of coordination of care more complex, leaving to the Ministry of Health the role of inducing vertically and, to the municipalities, operate the system at each point of care in a horizontal manner, a situation which was not well aligned and configured an oblique model, generating a contradiction in the brazilian federal design and bringing difficulties to the coordination of care.
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Aleluia, Ítalo Ricardo Santos. "Avaliação da coordenação do cuidado no âmbito da Atenção Primária à Saúde: um estudo de caso." Instituto de Saúde Coletiva, 2014. http://repositorio.ufba.br/ri/handle/ri/16337.
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A crescente prevalência das condições crônicas no cenário epidemiológico brasileiro exige transformações na organização dos serviços de saúde que viabilizem melhorias na integração e continuidade do cuidado. A Atenção Primária à Saúde (APS) assumiu papel prioritário para integrar cuidados, serviços e informações, e tem como atributo fundamental a coordenação do cuidado. Embora o processo de coordenar o cuidado seja colocado como atributo fundamental da APS, cumprir essa função ainda é uma tarefa de difícil operacionalização em diversos municípios brasileiros. Esse estudo teve como objetivo avaliar a coordenação do cuidado no âmbito da APS em um município do Estado da Bahia. Trata-se de um estudo de caso único, com dois níveis de análise, em duas equipes de Saúde da Família. Considerou-se com fontes primárias de evidência as informações registradas no diário de campo do pesquisador, dados obtidos mediante entrevistas semiestruturadas com profissionais, gestores e usuários da APS e, como fontes secundárias, o banco de dados do PMAQ-AB, a análise dos documentos da Secretaria Municipal de Saúde e das equipes de APS. Para avaliar a coordenação do cuidado, foram selecionadas condições traçadoras (a hipertensão e o diabetes) e elaborou-se uma imagem objetivo, com vistas a analisar comparativamente as equipes e estimar em que medida os critérios da coordenação do cuidado, adotados nesse estudo, têm sido cumpridos (ou não) por ambas. Adotou-se como categorias de análise o planejamento da assistência, a padronização de condutas, o referenciamento, a comunicação e o monitoramento do usuário. Os resultados evidenciaram que a coordenação do cuidado não tem sido cumprida por ambas as equipes, e que houve maior dificuldade para o cumprimento dos critérios relativos à padronização de condutas e à comunicação entre profissionais e serviços de saúde. A falta de protocolos assistenciais, a ausência de critérios para estratificação de riscos e o desconhecimento dos demais profissionais da rede, pelos profissionais da APS, dificultaram o compartilhamento de saberes e responsabilidades na construção de planos de cuidados. A ausência de registros informatizados e o descuido com os registros manuais da atenção prestada, certamente comprometeram a qualidade e a continuidade das informações assistenciais. A falta de tecnologias telecomunicativas e os problemas de articulação entre os serviços da rede colaboraram para a baixa comunicabilidade entre os níveis de atenção. Por fim, a ausência de sistemas informatizados, a desorganização e a insuficiência na oferta de exames e consultas restringiram o referenciamento vertical dos usuários, com baixa capacidade das equipes gerenciarem as filas de espera e monitorarem os fluxos e contrafluxos assistenciais. Considera-se de suma importância a implantação de sistemas informatizados e de tecnologias de telecomunicação; a criação e adoção de protocolos assistenciais, de estratégias de capacitação profissional, de avaliação e monitoramento regular dos serviços, que possam refletir sobre a capacidade das equipes de APS coordenarem o cuidado ao usuário. Reitera-se a importância de novas pesquisas que investiguem outros casos da microrregião, com eixos investigativos centrados na coordenação do cuidado e que considerem as relações e os conflitos do processo de trabalho entre os serviços e os profissionais dos três níveis de atenção.
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Ponthier, Nathalie. "Les réseaux de santé : espaces de cooperation entre professionnels et patients : étude comparative de deux reseaux de sante diabète." Thesis, Lyon 2, 2012. http://www.theses.fr/2012LYO20013/document.
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La loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de soins donne une définition unique des réseaux de santé. Ils représentent aujourd’hui une forme organisationnelle inscrite dans les politiques régionales de santé et sont soutenus financièrement par les agences régionales de santé (ARS). La recherche menée a pour objet la participation des personnes malades au fonctionnement et à l’activité d’un réseau de santé. En effet, si les textes législatifs consacrent la place de l’usager dans le système de soins et si la politique de santé proclame sa participation, qu’en est-il dans la réalité quotidienne des pratiques au sein d’un réseau de santé ? Cette recherche s’intéresse ainsi de manière plus spécifique aux interactions entre les professionnels et les usagers en envisageant le réseau comme un espace de coopération. L’étude comparative de deux réseaux de santé diabète montre comment – face à une double contrainte, celles des politiques de santé et celle d’une régulation économique dominante - ce dispositif est soumis à une logique gestionnaire le conduisant à devenir une réponse instrumentale aux dysfonctionnements du système de santé, tel que les cloisonnements multiples du système de santé, une pénurie démographique de professionnels médicaux ou encore une spécialisation technique croissante des activités en santé. Mais en même temps, ces réseaux constituent un espace expérimental propice à la mise en œuvre d’une pratique communautaire en santé. Le corpus de données a été constitué principalement à partir de 31 entretiens biographiques auprès des personnes diabétiques, d'entretiens thématiques auprès des professionnels salariés des réseaux et d’observations des pratiques d’éducation thérapeutique, une prestation de service proposée par les réseaux. Cette prestation de service interroge les modalités possibles d’un travail ensemble dans la gestion d’une maladie chronique entre les professionnels et les personnes malades. En fonction des conceptions en santé des professionnels et des logiques d’action en présence, l’étude montre deux tendances : une personne malade partenaire des soins et un patient auxiliaire de soins. Par ailleurs, les réseaux étudiés présentent des modalités organisationnelles différentes, un modèle linéaire et un modèle satellitaire où la coordination d’acteurs occupe une place majeure. Derrière ce terme de coordination se cache, dans les deux cas, un principe de rationalisation des activités en santé propre au système sanitaire actuel. Les réseaux sont ainsi soumis à une instrumentalisation économique, ils deviennent des prestataires de l’offre de soins sur un territoire. Cette instrumentalisation des réseaux de santé est mise en œuvre principalement par des procédures d’évaluation. Celles-ci s’appuient sur des données épidémiologiques et reposent sur une approche quantitative de résultats en santé. Dans une logique gestionnaire, la personne malade doit adopter des comportements conformes aux normes de santé pour permettre l’atteinte des objectifs organisationnels planifiés dans le cadre d’une politique de santé publique. Face au développement des maladies chroniques, le champ de la santé s’est modifié, mais le système de santé français reste organisé selon une logique biomédicale. L’évaluation prend appui sur des savoirs normatifs, et les pratiques des professionnels sont très imprégnées par cette logique biomédicale. Néanmoins, l’étude montre que les réseaux créent un espace propice à une pratique communautaire en santé par la création d’une proximité sociale. Les deux réseaux mettent en perspective une appropriation par les usagers des questions concernant leur santé. Une mise en mouvement des patients et des professionnels s’opère en marge des objectifs opérationnels affichés d’un réseau de santé. Ainsi, les réseaux constituent tout à la fois des espaces démocratiques réflexifs et un outil au service d’un processus de rentabilisation des activités en santéThe law of March 4th 2002 concerning patients' rights and the quality of the care system formalizes health networks and provides a single definition. They now account for an organizational form registered in regional politics of public health and are financially supported by the regional health agencies (RHA). The conducted research is about the sick's participation in a health network operation and activity. Indeed, if the legislation grants the user a thorough place in the health care system and if health policy proclaims his participation, what happens in the daily reality of practices within a health network? So this research deals more specifically with the interactions between professionals and users by considering the network as an area of cooperation. The comparative study of two Burgundy diabetes health networks shows how - facing a double constraint, those of public health policies and that of a dominant economic regulation - this device is subject to a managing logic leading to become an instrumental response to health system dysfunctions, such as multiple barriers of the health system, a demographic shortage of health professionals or even an increasing medical specialization of health activities. But even these networks constitute an experimental space favorable to the implementation of a community health practice.The data base has mainly been formed from 31 biographical interviews of diabetic people, thematic interviews of professionals employed in networks and observations of the patient's therapeutic education practices, a service offered by the two networks. This service examines the possible ways of working together in the management of chronic illness between professionals and the sick. According to the conceptions of health among professionals and logic of action involved, the study shows two trends: a sick person, either partner in patient care or in care giving.Moreover, the studied networks present two different organizational terms, a linear model and a satellite model where the coordination of actors plays a major role. Behind this term of coordination lies, in both cases, a principle of rationalization of health activities specific to the current health system. Networks are thus subject to an economic exploitation; they become providers of the offer of health care in a given territory. This instrumentation of health networks is mainly implemented by assessment procedures. It relies on epidemiological data and is based on a quantitative approach about health outcomes. In a managerial logic, the sick person should behave in accordance with health standards to enable the achievement of organizational goals planned as part of a public health policy.With the development of chronic diseases, the field of health has changed, but the French health system is still organized on a biomedical logic. The evaluation is based on normative biomedical knowledge, and professional practices are also very much imbued with biomedical logic. Nevertheless, the study shows that networks create a favorable space for a community health practice by creating a social proximity. Both networks put into perspective the idea that users have a hold on questions concerning their health. Patients and professionals become actors besides operational objectives displayed in a health network. Thus, networks are simultaneously democratic spaces of thought and a tool dedicated to the efficiency of health activities
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Sekatane, Nelisa Ayanda. "Exploration of support to nurses working in the tuberculosis programme in the primary health care facilities by management in the Matlosana sub-district / Nelisa Ayanda Sekatane." Thesis, North-West University, 2012. http://hdl.handle.net/10394/10263.
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Tuberculosis is a health threat, globally, in Africa, South Africa as well as in the North West Province. Although a number of positive interventions have been implemented, like the introduction of direct observation treatment strategy, still tuberculosis remains a threat. This may be due to the fact that while interventions to fight tuberculosis have been formulated and implemented, the most important resource in the Department of Health, which are nurses. Nurses working in the tuberculosis programme who play a vital role in the implementation of the health strategy are left behind and not given the proper support that they need to ensure the implementation of the health strategy. Nurses need to receive physical, emotional and social support from management so that they can give quality care to their patients.
The purpose of this study was to explore the support from management to nurses working in the tuberculosis programme in the primary health care facilities at the Matlosana sub-district so as to make recommendations to management with the aim of improving the nurses’ work life and consequently rendering quality care to the tuberculosis patients.
The research was conducted in the Matlosana sub-district in the North West Province of South Africa. A qualitative research design was used to explore and describe the support by management to nurses working in the tuberculosis programme in the primary health care facilities. A purposive voluntary sampling method was used to select participants who met the set criteria. In depth Semi structured interviews were conducted. Data was captured on an audio recorder, and transcribed verbatim. The researcher and the co-coder analysed the data after data saturation was reached. A consensus was reached on the categories that emerged.
The results showed that most facility managers lack knowledge about tuberculosis making it difficult for them to support nurses working in the tuberculosis programme. The lack of support resulted in the arousal of feelings such as frustration, feeling undermined, feeling unnoticed and unappreciated. It also resulted in resistant behaviours such as underperformance, loss of interest in their work, wanting to leave to where they will be supported and reluctance to take annual leave due to fear of piling work. However, few participants reported supportive experiences from both their facility managers and from the tuberculosis coordinator. Recommendations were made for the field of nursing education, community health nursing practice and nursing research with the aim of improving the nurses’ work life and consequently rendering quality care to the tuberculosis patients.MCur, North-West University, Potchefstroom Campus, 2013
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Aoki, Traci. "Dementia care coordination." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12044.
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Thesis (M.A.)--Boston UniversityBackground: Dementia is a chronic, irreversible condition that currently affects millions of Americans. With increasing life expectancies and an aging population, it is predicted that this number will triple within the next fifty years, possibly affecting 16 million Americans by 2050. The majority of care for these patients is provided by informal caregivers, usually their spouses or children. However, studies have shown that most informal caregivers feel they need more information about the disorder and the services available to help them, as well as on how to effectively care for their family member. Caring for a dementia patient is more stressful and burdensome than caring for someone who is solely physically impaired. Dementia caregivers experience higher rates of anxiety and depression, less time for personal activities, and greater difficulties maintaining jobs. Thus, interventions that provide caregivers with support and train them to properly care for dementia patients can be beneficial for both the patients and their families by reducing the adverse effects caregiving has on the caregiver’s mental and physical health while also improving the patient’s quality of care. Purpose: The purpose of this study is to evaluate the effects of the Alzheimer’s Association’s Dementia Care Coordination intervention on dementia patients and their caregivers. This study will determine whether the intervention improves the qualities of life of patients and caregivers, lowering their depression and hospitalization rates while also reducing caregivers’ levels of burden, distress, and anxiety.
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Youn, Kyungmin. "Orchestrated Informal Care Coordination." Research Showcase @ CMU, 2016. http://repository.cmu.edu/theses/109.
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Dunavan, Chad. "Care Coordination for Better Outcomes." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3244.
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A deficiency of care coordination and delayed discharge planning has contributed to increased lengths of stay for telemetry patients and has pressed staff to discharge patients expeditiously, potentially leading to increased 30-day readmissions. Rushing the discharge process on the day of discharge has resulted in breakdowns in communication and lack of collaboration amongst the health care team of this study, contributing to extended lengths of stay, increased readmissions, and low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores. This project highlighted a patient-centered care coordination team approach with 2 clinical registered nurses and a social worker who coordinated the discharge plan with the patients on admission. Discharge planning on admission and daily briefings involving care coordination and bedside staff reduced the length of stay, improved HCAPHS scores, and reduced 30-day readmissions by fostering better communication and collaboration. A 1-group pretest and posttest were utilized to compare data before care coordination and after care coordination. These findings yielded a length of stay reduction of 2.04 days, a 50% reduction in 30-day readmissions, and HCAPHS communication composite scores above the 50th percentile. The care coordination team exposed various programs and community resources that assisted with medications and durable medical equipment and suggested that companionship alleviated potential anxiety post discharge for those financially and socially burdened. The implications of a patient-centered team-based approach to discharge planning on admission eliminated barriers to discharge, improved patient knowledge of disease management, and provided a positive hospital experience.