Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care

Stockdale, Susan; Zuchowski, Jessica L.; Rubenstein, Lisa V.; Sapir, Negar; Yano, Elizabeth M.; Altman, Lisa; Fickel, Jacqueline J.; McDougall, Skye; Dresselhaus, Timothy R.; Hamilton, Alison B.

doi:10.1097/hmr.0000000000000138

Cited by 23 publications

(17 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The informal caregivers reported that the hospital services were concerned with examining the patients, diagnosing them and returning them back home as rapidly as possible. Despite decades of attention to the principles of activating, empowering and engaging the patients in their own healthcare [9,[53][54][55] as part of securing patientcenteredness as a cornerstone of healthcare service quality [54,56], the informal caregivers reported a health service that did not appear to be responsive to the patients' or the informal caregivers' preferences or needs. Instead, the informal caregivers we interviewed found the health services in the municipality to be focused on short visits from healthcare personnel and the delivery of health services rather than helping with practical tasks.…”

Section: Discussionmentioning

confidence: 99%

Informal caregivers’ views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge

2020

View full text Add to dashboard Cite

Background: In the European Union (EU), informal caregivers provide 60% of all care. Informal caregiving ranges from assistance with daily activities and provision of direct care to helping care recipients to navigate within complex healthcare and social services systems. While recent caregiver surveys document the impact of informal caregivers, systematic reviews show that they have unmet needs. Because of the political desire to reduce the length of hospital stays, older patients are discharged from the hospital 'quicker and sicker' than before. The transition between different levels of the healthcare system and the period after hospital discharge is critical for elderly patients. Caregivers' perspectives on the quality of older patients' care journeys between levels of the healthcare system may provide valuable information for healthcare providers and policymakers. This study aims to explore older patient's informal caregivers' views on healthcare quality in the hospital and in the first 30 days after hospitalisation. Method: We conducted semi-structured individual interviews with 12 participants to explore and describe informal caregivers' subjective experiences of providing care to older relatives. The interviews were then transcribed and analysed thematically. Results: The analysis yielded the overarching theme 'Informal caregiversa health service alliancequality contributor', which was divided into four main themes: 'Fast in, fast out', 'Scant information', 'Disclaimer of responsibility' and 'A struggle to secure professional care'. The healthcare system seemed to pay little attention to ensuring mutual understandings between those involved in discharge, treatment and coordination. The participants experienced that the healthcare providers' main focus was on the patients' diseases, although the health services are supposed to view patients holistically.

show abstract

Section: Discussionmentioning

confidence: 99%

Informal caregivers’ views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge

2020

View full text Add to dashboard Cite

show abstract

“…The informal caregivers reported that the hospital services were concerned with examining the patients, diagnosing them and returning them back home as rapidly as possible. Despite decades of attention to the principles of activating, empowering and engaging the patients in their own healthcare [9,[53][54][55] as part of securing patient-centeredness as a cornerstone of healthcare service quality [54,56], the informal caregivers reported a health service that did not appear to be responsive to the patients' or the informal caregivers' preferences or needs. Instead, the informal caregivers we interviewed found the health services in the municipality to be focused on short visits from healthcare personnel and the delivery of health services rather than helping with practical tasks.…”

Section: Discussionmentioning

confidence: 99%

Informal caregivers’ views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge

Lilleheie

Bye

Bergland

2020

Preprint

View full text Add to dashboard Cite

Background: In the European Union (EU), informal caregivers provide 60% of all care. Informal caregiving ranges from assistance with daily activities and provision of direct care to helping care recipients to navigate within complex healthcare and social services systems. While recent caregiver surveys document the impact of informal caregivers, systematic reviews show that they have unmet needs. Because of the political desire to reduce the length of hospital stays, older patients are discharged from the hospital ‘quicker and sicker’ than before. The transition between different levels of the healthcare system and the period after hospital discharge is critical for elderly patients.Caregivers’ perspectives on the quality of older patients’ care journeys between levels of the healthcare system may provide valuable information for healthcare providers and policymakers. This study aims to explore older patient’s informal caregivers’ views on healthcare quality in the hospital and in the first 30 days after hospitalisation. Method: We conducted semi-structured individual interviews with 12 participants to explore and describe informal caregivers’ subjective experiences of providing care to older relatives. The interviews were then transcribed and analysed thematically.Results: The analysis yielded the overarching theme ‘Informal caregivers – a health service alliance – quality contributor’, which was divided into four main themes: ‘Fast in, fast out’, ‘Scant information’, ‘Disclaimer of responsibility’ and ‘A struggle to secure professional care’. The healthcare system seemed to pay little attention to ensuring mutual understandings between those involved in discharge, treatment and coordination. The participants experienced that the healthcare providers’ main focus was on the patients’ diseases, although the health services are supposed to view patients holistically.Conclusion: Based on the information given by informal caregivers, health services must take into account each person’s needs and preferences. To deliver quality healthcare, better coordination between inter-professional care teams and the persons they serve is necessary. Health professionals must strengthen the involvement of caregivers in transitions between care and healthcare. Future work should evaluate targeted strategies for formal caregivers to cooperate, support and empower family members as informal caregivers.

show abstract

“…Some of our participants even reported that they were not asked or allowed to have an opinion about their own healthcare. Despite decades of attention to principles of activating, empowering and engaging the patients in their own healthcare [9,[47][48][49] as part of securing patient centeredness as a cornerstone of healthcare service quality [48,50], the service did not appear to be responsive to older patients' preferences or needs.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study of old patients’ experiences of the quality of the health services in hospital and 30 days after hospitalization

Lilleheie

Bye²,

Bergland

2020

Preprint

View full text Add to dashboard Cite

Background: The number of people aged 80 years and above is projected to triple over the next 30 years. People in this age group normally have at least two chronic conditions. The impact of multimorbidity is often significantly greater than expected from the sum of the effects of each condition. The World Health Organization has indicated that healthcare systems must prepare for a change in the focus of clinical care for older people. The World Health Organization (WHO) defines healthcare quality as care that is effective, efficient, integrated, patient centered, equitable and safe. The degree to which healthcare quality can be defined as acceptable is determined by services’ ability to meet the needs of users and adapt to patients’ expectations and perceptions.Method: We took a phenomenological perspective to explore older patients’ subjective experiences and conducted semistructured individual interviews. Eighteen patients (aged from 82 to 100 years) were interviewed twice after discharge from hospital. The interview transcriptions were analyzed thematically.Results: The patients found their meetings with the health service to be complex and demanding. They reported attempting to restore a sense of security and meaning in everyday life, balancing their own needs against external requirements. Five overarching themes emerged from the interviews: hospital stay and the person behind the diagnosis, poor communication and coordination, life after discharge, relationship with their next of kin, and organizational and systemic determinants.Conclusion: According to the WHO, to deliver quality healthcare, services must include all six of the dimensions listed above. Our findings show that they do not. Healthcare focused on measurable values and biomedical inquiries. Few opportunities for participation, scant information and suboptimal care coordination left the patients with a feeling of being in limbo, where they struggled to find balance in their everyday life. Further work must be done to ensure that integrated services are provided without a financial burden, centered on the needs and rights of older people.

show abstract

Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care

Cited by 23 publications

References 26 publications

Informal caregivers’ views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge

Informal caregivers’ views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge

Informal caregivers’ views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge

A qualitative study of old patients’ experiences of the quality of the health services in hospital and 30 days after hospitalization

Contact Info

Product

Resources

About