RESUMEN
BACKGROUND: Health system fragmentation directly contributes to poor health and social outcomes for older adults with multiple chronic conditions and their care partners. Older adults often require support from primary care, multiple specialists, home care, community support services, and other health-care sectors and communication between these providers is unstructured and not standardized. Integrated and interprofessional team-based models of care are a recommended strategy to improve health service delivery to older adults with complex needs. Standardized assessment instruments deployed on digital platforms are considered a necessary component of integrated care. The aim of this study was to develop strategies to leverage an electronic wellness instrument, interRAI Check Up Self Report, to support integrated health and social care for older adults and their care partners in a community in Southern Ontario, Canada. METHODS: Group concept mapping, a participatory mixed-methods approach, was conducted. Participants included older adults, care partners, and representatives from: home care, community support services, specialized geriatric services, primary care, and health informatics. In a series of virtual meetings, participants generated ideas to implement the interRAI Check Up and rated the relative importance of these ideas. Hierarchical cluster analysis was used to map the ideas into clusters of similar statements. Participants reviewed the map to co-create an action plan. RESULTS: Forty-one participants contributed to a cluster map of ten action areas (e.g., engagement of older adults and care partners, instrument's ease of use, accessibility of the assessment process, person-centred process, training and education for providers, provider coordination, health information integration, health system decision support and quality improvement, and privacy and confidentiality). The health system decision support cluster was rated as the lowest relative importance and the health information integration was cluster rated as the highest relative importance. CONCLUSIONS: Many person-, provider-, and system-level factors need to be considered when implementing and using an electronic wellness instrument across health- and social-care providers. These factors are highly relevant to the integration of other standardized instruments into interprofessional team care to ensure a compassionate care approach as technology is introduced.
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Prestación Integrada de Atención de Salud , Salud Digital , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , OntarioRESUMEN
This paper explains the benefits model developed and deployed by the connecting South West Ontario (cSWO) program. The cSWO approach is founded on the principles of enabling clinical and organizational value and the recognition that enabling requires a collaborative approach that can include several perspectives. We describe our approach which is aimed at creating a four-part harmony between change management and adoption, best practice research and quality indicators, data analytics and clinical value production.
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Registros Electrónicos de Salud/organización & administración , Difusión de la Información/métodos , Humanos , Ontario , Guías de Práctica Clínica como Asunto , Garantía de la Calidad de Atención de Salud , Telemedicina/organización & administraciónRESUMEN
This paper outlines a quality assurance (QA) process and a multiple case, explorative, electronic medical records (EMRs) project in Ontario. The project, dedicated to Advancing and Leveraging the Investment Value of EMRs (ALIVE) was an eight-month investigation of improvements to EMRs in terms of the technical elements of patient records that could be optimized through data standardization and the social elements needed to integrate value into the everyday functioning of primary care (PC) organizations. We argue that standardized and structured data offer substantial clinical value in PC insofar as it enables more proactive chronic disease prevention and management (CDPM). While PC clinicians may have had the opportunity to look the other way with respect to enabling technologies in the past, imminent health system reforms demand more meaningful use of EMRs moving forward.
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Enfermedad Crónica/terapia , Registros Electrónicos de Salud/organización & administración , Modelos Organizacionales , Atención Primaria de Salud/organización & administración , Garantía de la Calidad de Atención de Salud/organización & administración , Enfermedad Crónica/epidemiología , Eficiencia Organizacional , Humanos , Ontario/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVE: Aboriginal people in Canada have poorer health than the rest of the population. Reasons for health disparities are many and include problems in communication between doctor and patient. The objective of this study was to understand doctor-patient communication in Aboriginal communities in order to design educational interventions for medical students based on the needs and experiences of patients. METHODS: Experiences of good and poor communication were studied by semi-structured interviews or focus groups with 22 Aboriginal community members, 2 community health representatives and 2 Aboriginal trainee physicians. Transcribed data were coded and subjected to thematic analysis. RESULTS: Positive and negative experiences of communicating with physicians fell into three broad and interrelated themes: their histories as First Nations citizens; the extent to which the physician was trusted; time in the medical interview. CONCLUSION: Aboriginal peoples' history affects their communication with physicians; barriers may be overcome when patients feel they have a voice and the time for it to be heard. PRACTICE IMPLICATIONS: Physicians can improve communication with Aboriginal patients by learning about their history, building trust and giving time.