The Enthusiasm: Evidence Ratio for Comprehensive Chronic Disease Care?

Kane, Robert L

doi:10.1111/jgs.1_13599

Cited by 6 publications

(12 citation statements)

References 40 publications

(22 reference statements)

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“…GPs in the second cohort are more satisfied about their ability to provide personal care for their patients than those in the first cohort. Other studies have shown that improved clinical outcomes are often absent after the complex, real life implementation of various forms of integrated care[ 12 , 26 ] while providers are often satisfied about the associated changes in care organization [ 26 , 27 ]. Our findings of higher satisfaction with practical aspects and the ability to provide personal care seem consistent with this evidence.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction in Older Persons and General Practitioners during the Implementation of Integrated Care

et al. 2016

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BackgroundIntegrated care for older persons with complex care needs is widely advocated. Particularly professionals and policy makers have positive expectations. Care outcome results are ambiguous. Receiver and provider satisfaction is relevant but still poorly understood.MethodsDuring implementation of integrated care in residential homes (The MOVIT project), we compared general satisfaction and satisfaction with specific aspects of General Practitioner (GP) care in older persons and GPs before (cohort I) and after at least 12 months of implementation (cohort II).ResultsThe general satisfaction score for GP care given by older persons does not change (Cohort I (n = 762) mean score 8.0 (IQR:7.0–9.0) vs. Cohort II (n = 505) mean score 8.0 (IQR:7.0–8.0);P = 0.01). Expressions of general satisfaction in GPs do not show consistent change (Cohort I (n = 87) vs Cohort II (n = 66), percentage satisfied about; role as GP, 56% vs 67%;P = 0.194, ability to provide personal care, 60% vs 67%;P = 0.038, quality of care, 54% vs 62%;P = 0.316). Satisfaction in older persons about some specific aspects of care do show change; GP-patient relationship, points 61.6 vs 63.3;P = 0.001, willingness to talk about mistakes, score 3.47 vs 3.73;P = 0.001, information received about drugs, score 2.79 vs 2.46;P = 0.002. GPs also report changes in specific aspects: percentage satisfied about multidisciplinary meetings; occurrence, 21% vs 53%;P = <0.001, GP presence, 12% vs 41%;P = <0.001, and participation, 29% vs.51%;P = 0.046.ConclusionGeneral satisfaction about care received and provided shows no consistent change in older persons and GPs during the implementation of integrated care. Specific changes in satisfaction are found. These show an emphasis on inter-personal aspects in older persons and organizational aspects in GPs.

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Section: Discussionmentioning

confidence: 99%

Satisfaction in Older Persons and General Practitioners during the Implementation of Integrated Care

et al. 2016

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“…A review of the effectiveness of and economic case for collaborative care models found that “the weight of evidence fails to match the enthusiasm for a solution to the major clinical challenge of the decade. Previous reviews have shown how subjective conclusions about effectiveness of comprehensive care can be.” Because similar reviews have reported uncertain findings from comprehensive care models, decision makers could reasonably conclude that relative advantage is still subjective . We and others have argued that these models have shown proof of concept and that diffusion requires more opportunities to develop the models in real‐world settings .…”

Section: Relative Advantage Of New Models Of Carementioning

confidence: 98%

“…Other reviews have reached similar conclusions that there is high‐quality evidence of the advantage of these models over usual care, but the relative advantage may be difficult to achieve in real‐world healthcare settings . Although new models improve some outcomes, it is less clear that these models improve efficiency and cost of care or other aspects of end‐users' perceptions of relative advantage . If end‐users define relative advantage as better quality and lower cost and no need for practice redesign, then the evidence base for these models is much weaker.…”

Section: Relative Advantage Of New Models Of Carementioning

confidence: 98%

“…The models of care often target persons with specific diseases, such as depression or dementia, but some also target adults with multimorbidity and social stressors. None of the tested models is a panacea, but they offer compelling prototypes and early evidence that remodeling care can overcome some of the challenges in providing excellent care to older adults . Despite the evidence of the models' improvements to quality care, diffusion of these models into routine care is limited.…”

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confidence: 99%

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State of Science: Bridging the Science‐Practice Gap in Aging, Dementia and Mental Health

Callahan

Bateman

Wang

et al. 2018

J American Geriatrics Society

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The workforce available to care for older adults has not kept pace with the need. In response to workforce limitations and the growing complexity of healthcare, scientists have tested new models of care that redesign clinical practice. This article describes why new models of care in aging, dementia, and mental health diffuse inadequately into the healthcare systems and communities where they might benefit older adults. We review a general framework for the diffusion of innovations and highlight the importance of other features of innovations that deter or facilitate diffusion. Although scientists often focus on generating evidence-based innovations, end-users apply their own criteria to determine an innovation's value. In 1962, Rogers suggested six features of an innovation that facilitate or deter diffusion suggested: relative advantage, compatibility with the existing environment, ease or difficulty of implementation, trial-ability or ability to "test drive", adaptability, and observed effectiveness. We describe examples of models of care in aging, dementia and mental health that enjoy a modicum of diffusion into practice and place the features of these models in the context of deterrents and facilitators for diffusion. Developers of models of care in aging, dementia, and mental health typically fail to incorporate the complexities of health systems, the barriers to diffusion, and the role of emotion into design considerations of new models. We describe agile implementation as a strategy to facilitate the speed and scale of diffusion in the setting of complex adaptive systems, social networks, and dynamic macroenvironments.

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“…Academic geriatric medicine can point to a wealth of observational and experimental research that describes the care needs of complex patients and presents data on new models of care, but developing and testing these models is altogether different from implementing and selling them. Although some would urge caution until more‐persuasive evidence of effectiveness is generated, others argue that the overwhelming logic of the solutions and the huge need necessitates action now …”

mentioning

confidence: 99%