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Objective: To examine frontline providers' experiences implementing home‐based palliative care (HBPC) covered by a private health insurer in partnership with community‐based hospice, home health, and Accountable Care Organizations. Study setting: Primary data collection at three community‐based hospice and home health organizations in Northern and Southern California at the outset of the new private payer‐contracted HBPC. Study design: Qualitative focus groups with frontline HBPC providers. Data collection: Focus groups were guided by a nine‐item, semi‐structured research protocol, audio‐recorded, transcribed verbatim, and analyzed by two independent coders using a grounded theory approach. Principal findings: Participants (n = 24) were mostly White (79.2%) female (91.7%) aged 39 years or less (62.5%), and from diverse disciplines. Three major themes were identified: (1) patient referrals, (2) organizational factors, and (3) HBPC reimbursement. Findings highlight barriers and facilitators to implementing HBPC covered by an insurer including the organization's community reputation, the dynamic/"teaminess" of the HBPC team, having a site champion/"quarterback," and issues from a siloed medical system. Participants also discussed challenges with patient referrals, specifically, lack of palliative care knowledge (both providers and patients/families) and poor communication with patients referred to HBPC. Conclusions: This study found that despite a favorable perception of payer‐contracted HBPC by frontline providers, barriers and facilitators persist, with patient accrual/referral paramount. [ABSTRACT FROM AUTHOR]

Specialized, fragmented acute care is not aligned optimally to serve older adults. Person-centered care ( PCC) has emerged as an evidence-based solution that involves enlisting patients as partners in treatment planning. Although several efforts have captured person-centered voices in outpatient care, more information is needed at the organizational and provider level to better understand the feasibility, challenges, and effect of PCC in community-based and social services settings. To assess themes and emerging trends, researchers conducted telephone interviews with leaders at nine organizations providing PCC for older adults. Questions were focused on the legacy of PCC services, whether and how PCC was connected to better quality care, and what tools were used for measuring PCC. Three themes on PCC for older adults emerged. (1) Each organization ascribed to a unique definition and operational structure for PCC. (2) Despite these differences, all organizations specified a strong commitment to PCC. Most noted financial resources and staffing as challenges and opportunities affecting feasibility. (3) Terms such as 'patient-centered' care and other PCC synonyms may warrant greater clarification, because ideological differences set these classifications apart. Results from this analysis indicate the lack of a single, established definition for PCC. As interest in and support for PCC mounts, organizations in outpatient medical and community-based settings clearly have undertaken individual efforts to interpret what PCC is and how to provide it. Interview responses reflect this inconsistency, highlighting how staff and financing in particular can bolster or burden the PCC paradigm and what a consensus definition could do for the field. [ABSTRACT FROM AUTHOR]

People experiencing homelessness are at increased risk for serious burn injuries and face additional barriers to care such as inability to perform wound care and difficulty with follow-up. Although not burn-specific, street medicine programs provide direct medical care to people experiencing unsheltered homelessness in their own environment and may be well positioned to bridge this gap in burn care for this population. We conducted a cross-sectional survey to characterize the burn care experience of street medicine teams with providing burn care for people experiencing homelessness. The 60 respondents included 18 (30%) physicians, 15 (25%) nurse practitioners or physician assistants, 15 (25%) registered nurses, and 6 (10%) medical students, and 6 (10%) other team members. The most common reported barriers to care were prior negative experiences with emergency departments, and transportation to burn centers. There was regional variability in frequency of providing burn care, which was reflected in respondent comfort with assessing and treating burns. Burns were most often dressed with daily dressings such as a non-adherent dressing over silver sulfadiazine or bacitracin. Silver-based contact dressings were rarely used. Street medicine teams in the United States are treating burn injuries among people experiencing homelessness, though management practices and experience treating burns was variable. As street medicine programs continue to grow, burn-related education, training, and connections to local burn centers for team members is important. Through strengthened partnerships between burn centers and street medicine teams, these programs may be well positioned to bridge the gap in burn care for people experiencing homelessness., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Before the Affordable Care Act (ACA), the financing landscape for fee-for-service health care lacked broad structure and incentives to provide palliative care outside hospitals. Since the ACA, several payers have taken the opportunity to offer home-based palliative care (HBPC) to their members. Objective: To evaluate the impact of outreach efforts by a physician champion among a cohort of primary care physicians (PCPs) to introduce a new HBPC program and benefit, obtain buy-in, and motivate referrals for Blue Shield patients. Design: Secondary qualitative analysis of detailed field notes from a HBPC physician champion from in-person meetings with a cohort of PCPs and their office staff. Subjects: PCPs were from a physicians group in northern California that met with the physician champion during a 12-month study period. Results: During the 12-month study period, the physician champion met with clinicians at 27 distinct primary care offices. Qualitative analyses revealed three independent themes relating to receptivity and perception of the new HBPC program: (1) physician-level factors (overburdened, lack of palliative care knowledge, misconceptions around palliative care, and patient control), (2) practice-level factors (practice structure and role/integration of advance practice providers), and (3) first impression of the HBPC program (receptivity, "dirty data," and communication). Conclusion: Results hold important implications for practice and new approaches to engaging PCPs in HBPC, obtaining buy-in, and generating patient referrals. PCPs need better support in caring for patients with serious illness and HBPC can likely fill that role if PCPs are willing to refer and HBPC programs adapt., Competing Interests: No competing financial interests exist., (© Alexis Coulourides Kogan et al., 2020; Published by Mary Ann Liebert, Inc.)

Objectives: To identify characteristics and readmission risks associated with opting out of a social work-driven transition intervention., Study Design: Secondary data analysis of a randomized controlled pilot study at a large nonprofit urban community hospital., Methods: Hospitalized English-speaking, cognitively intact adults 65 years or older with expected discharge back to the community were eligible for enrollment. Additionally, patients met at least 1 of the 3 criteria: 1) 75 years or older, 2) taking 5 or more medications, or 3) had 1 or more prior inpatient stays or emergency department visits in the previous 6 months. The transition intervention consisted of up to 2 in-home visits (the first occurring within 48 hours after discharge) and up to 4 telephone follow-up calls (for a maximum of 6 total contacts) by a transition social worker. This study analyzed participants randomized to the intervention arm on measures including demographics, medical diagnoses, presence of advance directive, and all-cause 30-day hospital readmissions., Results: Of the 90 patients randomized to the Social Work Intervention Focused on Transitions intervention group, 10% were readmitted within 30 days and nearly one-third refused (ie, opted out of) the home visit component of the intervention. Multivariate analyses revealed that those opting out of the intervention had 3 times greater odds of having a respiratory condition compared with intervention recipients (odds ratio [OR], 3.10; 95% CI, 1.09-8.80; P = .034). Additionally, opting out of the intervention (OR, 6.75; 95% CI, 1.05-43.52; P = .045) and having a diagnosis of cancer (OR, 29.59; 95% CI, 2.01-435.45; P = .014) significantly predicted readmission., Conclusions: Findings suggest that some at-risk patients may not be receptive to services and programs aimed at improving care transitions, resulting in a higher risk for readmission.