Sabine Van Houdt

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination

BackgroundCare pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination.The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care.The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary - hospital care continuum.MethodsThis study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results.ResultsThe development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships.ConclusionCare pathways across the primary-hospital care continuum enhance the components of care coordination.

Focus groups to explore healthcare professionals’ experiences of care coordination: towards a theoretical framework for the study of care coordination

BackgroundStrategies to improve care coordination between primary and hospital care do not always have the desired results. This is partly due to incomplete understanding of the key concepts of care coordination. An in-depth analysis of existing theoretical frameworks for the study of care coordination identified 14 interrelated key concepts. In another study, these 14 key concepts were further explored in patients’ experiences. Additionally, “patient characteristics” was identified as a new key concept in patients’ experiences and the previously identified key concept “quality of relationship” between healthcare professionals was extended to “quality of relationship” with the patient. Together, these 15 interrelated key concepts resulted in a new theoretical framework. The present study aimed at improving our understanding of the 15 previously identified key concepts and to explore potentially previous unidentified key concepts and the links between these by exploring how healthcare professionals experience care coordination.MethodsA qualitative design was used. Six focus groups were conducted including primary healthcare professionals involved in the care of patients who had breast cancer surgery at three hospitals in Belgium. Data were analyzed using constant comparative analysis.ResultsAll 15 previously identified key concepts of care coordination were further explored in healthcare professionals’ experiences. Links between these 15 concepts were identified, including 9 newly identified links.The concept “external factors” was linked with all 6 concepts relating to (inter)organizational mechanisms; “task characteristics”, “structure”, “knowledge and information technology”, “administrative operational processes”, “cultural factors” and “need for coordination”. Five of these concepts related to 3 concepts of relational coordination; “roles”, “quality of relationship” and “exchange of information”. The concept of “task characteristics” was only linked with “roles” and “exchange of information”. The concept “patient characteristics” related with the concepts “need for coordination” and “patient outcome”. Outcome was influenced by “roles”, “quality of relationship” and “exchange of information”.ConclusionsExternal factors and the (inter)organizational mechanism should enhance “roles” and “quality of relationship” between healthcare professionals and with the patient as well as “exchange of information”, and setting and sharing of common “goals” to improve care coordination and quality of care.

Multidisciplinary team meetings about a patient in primary care: an explorative study.

Multidisciplinary team meetings (MTM) about a patient are a way to coordinate fragmented care. The Minimal Data Set/Resident Assessment Instrument (MDS/RAI) is a tool to prepare and support these meetings. Methods: An exploratory, qualitative study was used to examine the factors that influence the need for an MTM and to determine the value of MDS/RAI supporting the MTM. Results: Key elements are awareness of the health care professionals that “something is wrong” and the presence of sufficient family caregivers with enough capacity. The MDS/RAI is an aid because registration provides all health care professionals with the same type of preparation, allows possible blind spots to be discovered, and provides structure to the multidisciplinary meeting. Multidisciplinary meetings were found to contribute to sharing of information, knowledge, goals, and mutual respect. Conclusion: The evaluation of the patient’s care needs by MDS/RAI registration, performed by health care professionals involved in the care, and discussion of the results leads to more efficient MTMs.

Patient experiences with care across various types of mental health care: Questionnaire development, measurement invariance, and patients' reports

To describe the development, validation, and findings of a patient experience questionnaire across 7 types of residential and ambulatory mental health care services. Thirty‐five items were hypothesized to cover information, participation, therapeutic relationship, personalized care, organization and collaboration, safety, patient rights, outcomes of care, and discharge preparation and after‐care. Also included were 2 overall rating items (scoring and recommending the organization). This Dutch questionnaire was applied in 79 organizations in Belgium (N patients = 5,168). Exploratory structural equation modelling was conducted on a random split‐half sample to examine dimensionality. Confirmatory factor analysis and multiple group confirmatory factor analyses were conducted on the holdout sample to confirm dimensionality and assess measurement invariance across type of service and patient characteristics. Multilevel logistic regression models linking subscale top box scores to overall rating items were used to assess criterion validity. The hypothesized dimensionality was partly confirmed, and configural and scalar invariance were demonstrated across types of organizations and patient characteristics. Subscale scores were significantly associated with overall ratings. Process evaluation showed that participating organizations strongly support continued use of this questionnaire. This validated patient experience questionnaire supports comparison across organizations from different types of services to improve the quality of mental health care.