What is known about this topic dSystem navigator roles for high-risk patients generally target populations whose medical condition and circumstances require support in accessing appropriate care. Concludes that the heterogeneity of models and interventions precludes direct comparison, but that navigators may be effective in assisting older patients as they transition between healthcare settings and in diverting older patients with serious and persistent medical conditions, from higher levels of care. AbstractTransitions between various healthcare services are potential points for fragmented care and can be confusing and complicated for patients, formal and informal caregivers. These challenges are compounded for older adults with chronic disease, as they receive care from many providers in multiple care settings. System navigation has been suggested as an innovative strategy to address these challenges. While a number of navigation models have been developed, there is a lack of consensus on the desired characteristics and effectiveness of this role. We conducted a systematic literature review to describe existing navigator models relevant to chronic disease management for older adults and to investigate the potential impact of each model. Relevant literature was identified using five electronic databases -Medline, CINAHL, the Cochrane database, Embase and PsycINFO between January 1999 and April 2011. Following a recommended process for health services research literature reviews, exclusion and inclusion criteria were applied to retrieved articles; 15 articles documenting nine discrete studies were selected. This review suggests that the role of a navigator for the chronically ill older person is a relatively new one. It provides some evidence that integrated and coordinated care guided by a navigator, using a variety of interventions such as care plans and treatment goals, is beneficial for chronically ill older adults transitioning across care settings. There is a need to further clarify and standardise the definition of navigation, as well as a need for additional research to assess the effectiveness and cost of different approaches to the health system.
In managing treatment for persons with mental illness, the primary care physician (PCP) needs to communicate with mental health (MH) professionals in various settings over time to provide appropriate management and continuity of care. However, effective communication between PCPs and MH specialists is often poor. The present study reviewed evidence on the quality of information transfer between PCPs and specialist MH providers for referral requests and after inpatient discharge. Twenty-three audit studies were identified that assessed the quality of content and nine that assessed strategies to improve quality. Results indicated that rates of item reporting were variable. Within the limited evidence on interventions to improve quality, use of structured forms showed positive results. Follow-up work can identify a minimum set of items to include in information transfers, along with item definitions and structures for holding this information. Then, methodologies for measuring data quality, including electronically generated performance metrics, can be developed.
IntroductionCare transitions are a common and frequently adverse aspect of health care, resulting in a high-risk period for both care quality and patient safety. Patients who have complex care needs and undergo treatment in multiple care settings, such as older patients with musculoskeletal disorders, may be at higher risk for poor care transitions.MethodsKey informant interviews were used to gather in-depth information on transitional care issues, particularly those which impact informational continuity, from the perspective of a range of health professionals (η=17) in care settings relevant to the care continuum of older patients with hip fractures.ResultsThree transitional care themes were identified; medical complexity impacts care trajectories, larger circles of care can be both beneficial and challenging, and a variety of channels and modes are required for meaningful information exchange. Many issues cut across each care setting, and address challenges to informational continuity among and between health care providers, patients, and caregivers.ConclusionsMedical complexity enlarges the circle of care which challenges care continuity. There may be fundamental elements which, regardless of care setting, strengthen transitional care quality. Standardized transitional care processes might help to offset informational discontinuity across care settings as a result of this population’s larger circles of care.
In this study we quantify the impact of a partnership between a dedicated health clinic for government assisted refugees (GARs), a local reception centre and community providers, on wait times and referrals. This study used a before and after, repeated survey study design to analyze archived administrative data. Using various statistical techniques, outcomes for refugees arriving 18 months prior to the introduction of the clinic were compared with those of refugees arriving in the 18 months after the clinic was established. Our investigation revealed wait times to see a health care provider decreased by 30 % with the introduction of a dedicated refugee health clinic. The likelihood of GARs being referred to physician specialists decreased by 45 %, but those referred were more likely to require multiple referrals due to increasingly complex medical needs. Referrals to non-physician specialist health care providers nearly doubled following the availability of the clinic. The time-limited, but intense health needs of GARs, require an integrated community-based primary healthcare intervention that includes dedicated health system navigators to support timely, more culturally appropriate care and successful integration.
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