Implementation of integration strategies between primary care units and a regional general hospital in Brazil to update and connect health care professionals: a quasi-experimental study protocol

Abstract

BackgroundBetter communication among field health care teams and points of care, together with investments focused on improving teamwork, individual management, and clinical skills, are strategies for achieving better outcomes in patient-oriented care. This research aims to implement and evaluate interventions focused on improving communication and knowledge among health teams based on points of care in a regional public health outreach network, assessing the following hypotheses: 1) A better-working communication process between hospitals and primary health care providers can improve the sharing of information on patients as well as patients’ outcomes. 2) A skill-upgrading education tool offered to health providers at their work sites can improve patients’ care and outcomes.Methods/DesignA quasi-experimental study protocol with a mixed-methods approach (quantitative and qualitative) was developed to evaluate communication tools for health care professionals based in primary care units and in a general hospital in the southern region of São Paulo City, Brazil. The usefulness and implementation processes of the integration strategies will be evaluated, considering: 1) An Internet-based communication platform that facilitates continuity and integrality of care to patients, and 2) A tailored updating distance-learning course on ambulatory care sensitive conditions for clinical skills improvements.The observational study will evaluate a non-randomized cohort of adult patients, with historical controls. Hospitalized patients diagnosed with an ambulatory care sensitive condition will be selected and followed for 1 year after hospital discharge. Data will be collected using validated questionnaires and from patients’ medical records. Health care professionals will be evaluated related to their use of education and communication tools and their demographic and psychological profiles. The primary outcome measured will be the patients’ 30-day hospital readmission rates. A sample size of 560 patients was calculated to fit a valid logistic model. In addition, qualitative approaches will be used to identify subjective perceptions of providers about the implementation process and of patients about health system use.DiscussionThis research project will gather relevant information about implementation processes for education and communication tools and their impact on human resources training, rates of readmission, and patient-related outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1626-9) contains supplementary material, which is available to authorized users.

Discussion on the Application Value of Doctor-nurse Integrated Mode to the Nursing in the Cardiothoracic Surgery

“…Moreover, in the report on the implementation of doctor-nurse integrated mode in primary hospitals written by Hu Qu'er, Feng Lulu et al, this mode can speed up recovery effectively and reduce medical costs to further reduce treatment costs for patients, to realize real win-win. Therefore, the application scope and development space of this mode are wide [10].…”

A prospective evaluation of inter-rater agreement of routine medical records audits at a large general hospital in São Paulo, Brazil

“…HMMD is a large public general hospital (300 beds) located in the southern zone of the city of São Paulo, Brazil-an impoverished region encompassing approximately 600,000 inhabitants. The present study was part of a larger intervention aimed at improving the quality of patient care through a tailored integration strategy among health facilities in its Regional Health Care Network [15].…”

“…The planned intervention used the Lean Six Sigma methodology, which is widely utilized to aggregate values in several HMMD quality improvement processes already a part of the work culture among the professionals [15].…”

A Roadmap on the Prevention of Cardiovascular Disease Among People Living With Diabetes

“…Evidence based solutions and an example of integrated patient care with improved outcomes. An integrated approach to health care delivery is not new to health care systems and evidence clearly links this to improved patient outcomes [104,105]. Yet interprofessional practice remains among the greatest reported barriers to patient care [106].…”