Implementing models of care for musculoskeletal conditions in health systems to support value-based care

Abstract

Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems.

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

“…KIs advocated for a strategy that targeted function through the adoption of high-value care and de-adoption of low-value care with reform priorities that are adaptable to local contexts in recognition of variability in economic development and health priorities across countries. These attributes align with the principles of developing system-level models of care and transformations needed to deliver high-value care in health systems [ 39 , 58 , 59 ].…”

“…Further, we purposively sampled across clinical disciplines and from peak global and regional organisations. Valuable perspectives from consumer advocates and people with lived experience highlight the critical importance of person-centred viewpoints [ 58 ]. The logic model provides a data-driven and contemporary framework upon which a global strategy can be formulated.…”

Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare

“…The most common reasons for excluding papers at full-text review were because they did not discuss a formal change management method explicitly (144), were not in a healthcare setting, 16 were commentary, protocol or editorial pieces, 11 or were not in health service delivery. 6 Many studies alluded to common concepts or techniques identified in change management methodologies but were excluded if no explicit model or framework was utilised. The distinct and expansive literature employing the Model for Improvement as a methodology was excluded because, whilst the model intersects with change management methodologies, the focus is determining the nature of changes and adaptations to introduce through incremental introduction and analysis of changes rather than the process of managing the change.…”

“…The most common reasons for excluding papers at full-text review were because they did not discuss a formal change management method explicitly (144), were not in a healthcare setting, 16 were commentary, protocol or editorial pieces, 11 or were not in health service delivery. 6 Many studies alluded to common concepts or techniques identified in change management methodologies but were excluded if no explicit model or framework was utilised.…”

“… 3–5 Strategies implemented centrally and locally across health systems to enhance efficiency and patient-reported experiences and outcomes require individuals, teams and organisations to quickly adopt, integrate and renew their behaviours, activities and approach to service planning. 6 , 7 Likewise, achieving patient-centred care requires a revitalisation of the system as a whole, with holistic changes to ways of working to enable and integrate patient contributions, preferences, experiences and outcomes to inform care delivery. 8 , 9 Realisation of healthcare organisations as intelligent systems that consider even everyday clinical work as learning and improvement opportunities have further integrated continuous quality improvement as business as usual for healthcare.…”