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نتیجه جستجو - Care coordination

تعداد مقالات یافته شده: 3
ردیف عنوان نوع
1 Improving breast cancer care coordination and symptom management by using AI driven predictive toolkits
بهبود هماهنگی مراقبت از سرطان پستان و مدیریت علائم با استفاده از ابزارهای پیش بینی کننده هوش مصنوعی-2020
Integrated breast cancer care is complex, marked by multiple hand-offs between primary care and specialists over an extensive period of time. Communication is essential for treatment compliance, lowering error and complication risk, as well as handling co-morbidity. The director role of care, however, becomes often unclear, and patients remain lost across departments. Digital tools can add significant value to care communication but need clarity about the directives to perform in the care team. In effective breast cancer care, multidisciplinary team meetings can drive care planning, create directives and structured data collection. Subsequently, nurse navigators can take the director’s role and become a pivotal determinant for patient care continuity. In the complexity of care, automated AI driven planning can facilitate their tasks, however, human intervention stays needed for psychosocial support and tackling unexpected urgency. Care allocation of patients across centres, is often still done by hand and phone demanding time due to overbooked agenda’s and discontinuous system solutions limited by privacy rules and moreover, competition among providers. Collection of complete outcome information is limited to specific collaborative networks today. With data continuity over time, AI tools can facilitate both care allocation and risk prediction which may unveil non-compliance due to local scarce resources, distance and costs. Applied research is needed to bring AI modelling into clinical practice Keywords: Care coordination | Symptom management | Predictive tools | Care allocation | Nurse navigator | Multidisciplinary discussion
مقاله انگلیسی
2 Discussing Conservative Management With Older Patients With CKD: An Interview Study of Nephrologists
بحث در مورد مدیریت محافظه کار با بیماران سالمند مبتلا به بیماری مزمن کلیه: یک مطالعه مصاحبه با نفرولوژیست ها-2018
BACKGROUND: Although dialysis may not provide a large survival benefit for older patients with kidney failure, few are informed about conservative management. Barriers and facilitators to discussions about conservative management and nephrologists decisions to present the option of conservative management may vary within the nephrology provider community. STUDY DESIGN: Interview study of nephrologists. SETTING & PARTICIPANTS: National sample of US nephrologists sampled based on sex, years in practice, practice type, and region. METHODOLOGY: Qualitative semistructured interviews continued until thematic saturation. ANALYTICAL APPROACH: Thematic and narrative analysis of recorded and transcribed interviews. RESULTS: Among 35 semistructured interviews with nephrologists from 18 practices, 37% described routinely discussing conservative management ("early adopters"). 5 themes and related subthemes reflected issues that influence nephrologists decisions to discuss conservative management and their approaches to these discussions: struggling to define nephrologists roles (determining treatment, instilling hope, and improving patient symptoms), circumventing end-of-life conversations (contending with prognostic uncertainty, fearing emotional backlash, jeopardizing relationships, and tailoring information), confronting institutional barriers (time constraints, care coordination, incentives for dialysis, and discomfort with varied conservative management approaches), conservative management as "no care," and moral distress. Nephrologists approaches to conservative management discussions were shaped by perceptions of their roles and by a common view of conservative management as no care. Their willingness to pursue conservative management was influenced by provider- and institutional-level barriers and experiences with older patients who regretted or had been harmed by dialysis (moral distress). Early adopters routinely discussed conservative management as a way of relieving moral distress, whereas others who were more selective in discussing conservative management experienced greater distress. LIMITATIONS: Participants views are likely most transferable to large academic medical centers, due to oversampling of academic clinicians. CONCLUSIONS: Our findings clarify how moral distress serves as a catalyst for conservative management discussion and highlight points of intervention and mechanisms potentially underlying low conservative management use in the United States.
KEYWORDS: Geriatric nephrology; advanced CKD; chronic kidney disease (CKD); conservative management; dialysis; elderly; end-of-life planning; palliative care; patient-centered outcomes; qualitatitive study; qualitative methods; quality of life; semi-structured interviews; shared decision-making
مقاله انگلیسی
3 Care coordination in epilepsy: Measuring neurologists connectivity using social network analysis
هماهنگی مراقبت در صرع: اندازه گیری ارتباطات اعصاب با استفاده از تحلیل شبکه اجتماعی-2017
Objective: The study sought to quantify coordination of epilepsy care, over time, between neurologists and other health care providers using social network analysis (SNA). Methods: The Veterans Health Administration (VA) instituted an Epilepsy Center of Excellence (ECOE) model in 2008 to enhance care coordination between neurologists and other health care providers. Provider networks in the 16 VA ECOE facilities (hub sites) were compared to a subset of 33 VA facilities formally affiliated (consortium sites) and 14 unaffiliated VA facilities. The number of connections between neurologists and each provider (node degree) was measured by shared epilepsy patients and tallied to generate estimates at the facility level separately within and across facilities. Mixed models were used to compare change of facility-level node degree over time across the three facility types, adjusted for number of providers per facility. Results: Over the time period 2000–2013, epilepsy care coordination both within and across facilities significantly increased. These increases were seen in all three types of facilities namely hub, consortium, and unaffiliated site, relatively equally. The increase in connectivity was more dramatic with providers across facilities compared to providers within the same facilities. Conclusion: Establishment of the ECOE hub and spoke model contributed to an increase in epilepsy care coordi nation both within and across facilities from 2000 to 2013, but there was substantial variation across different facilities. SNA is a tool that may help measure coordination of specialty care.
Keywords: Social network analysis | Coordination of care | Health services | Epilepsy
مقاله انگلیسی
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