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Nursing research provides knowledge that advances nursing science, practice, and health care with the vision to optimize the health and well-being of the population. In a medical center setting or health care organization, nurse scientists are needed to demonstrate new knowledge, innovation, and scholarship. Nursing research in health care organizations or medical centers are led mainly by nurse leaders with a Doctorate in Philosophy (PhD) or a Doctorate in Nursing Practice (DNP). The purpose of this report is to provide examples of the role nurse scientists and nursing research plays nationally in Kaiser Permanente, an integrated health care system. In addition, this report will: (1) define the term "research" in the clinical setting and the role of the nurse research scientist in an integrated health care system and impact on the Magnet® Designation journey, and (2) discuss strategies for a successful role as a nurse research scientist in an integrated healthcare system. [ABSTRACT FROM AUTHOR]

Abstract Background Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation. Methods Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program. Results We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful. Conclusion Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team.

Background: Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation. Methods: Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program. Results: We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful. Conclusion: Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team. [ABSTRACT FROM AUTHOR]

Aims: Diabetes case conferencing is where an endocrinologist visits a general practitioner (GP) to advise on the care of patients with diabetes. Past case conferencing studies have reported improved diabetes management and clinical outcomes in primary care. This study investigated the effectiveness of a diabetes case conferencing program in South Western Sydney, Australia. Methods: Complex diabetes cases were referred by general practitioners to a visiting endocrinologist for review after obtaining patient consent. The patient was not usually present. After the case discussion, a diabetes management plan was developed jointly by the general practice/specialist team. Clinical data were compared at baseline and each year up to three years (2017--2020) after the consultation using paired t-test. The primary outcome was HbA1c. Results: Clinical data were collected for 645/775 patients (mean age 64 ± 15(SD) years; 351 (54.4%) males from 40/43 general practices; 96.4% had type 2 diabetes; 6.5% were insulin treated, 54.3% non-insulin treated, 31.5% both insulin and noninsulin treated and 3.4% diet only. There were reductions in HbA1c by 1.0 ± 1.7% (11 ± 19 mmol/mol) (p < 0.001), systolic blood pressure 8.2 ± 18.1 mmHg (p < 0.001), diastolic blood pressure 2.7 ± 11.6 mmHg (p < 0.001), total cholesterol 0.2 ± 1.7 mmol/l (p = 0.007), low-density lipoprotein 0.2 ± 1.0 mmol/l (p < 0.001), weight 3.3 ± 10.1 kg (p < 0.001) and body mass index (BMI) 1.3 ± 3.5 kg/m2 (p < 0.001). Conclusions: Glycaemia, weight and cardiovascular risk factors improved following case conferencing consultations in a primary care setting. [ABSTRACT FROM AUTHOR]

Aims: Diabetes case conferencing is where an endocrinologist visits a general practitioner (GP) to advise on the care of patients with diabetes. Past case conferencing studies have reported improved diabetes management and clinical outcomes in primary care. This study investigated the effectiveness of a diabetes case conferencing program in South Western Sydney, Australia. Methods: CComplex diabetes cases were referred by general practitioners to a visiting endocrinologist for review after obtaining patient consent. The patient was not usually present. After the case discussion, a diabetes management plan was developed jointly by the general practice/specialist team. Clinical data were compared at baseline and each year up to three years (2017–2020) after the consultation using paired t-test. The primary outcome was HbA1c. Results: Clinical data were collected for 645/775 patients (mean age 64± 15(SD) years; 351 (54.4%) males from 40/43 general practices; 96.4% had type 2 diabetes; 6.5% were insulin treated, 54.3% non-insulin treated, 31.5% both insulin and non-insulin treated and 3.4% diet only. There were reductions in HbA1c by 1.0±1.7% (11±19 mmol/mol) (p

Introduction: Integrated care and patient experience are central to the coordination and delivery of high quality health and social care in the UK, but their joint application is poorly understood. This systematic review aimed to gain an understanding of patient experience within current integrated care services in the UK, and specifically, whether they reflect person-centred coordinated care (PCCC). Methods: Following PRISMA, electronic databases (ProQuest, EBSCO and Cochrane Library) were searched from 2012 to 2019 for primary, peer-reviewed literature. Papers were included where patients' or carers' experiences of integrated care were reported. Papers were excluded where they focused on acute integrated care interventions, measured experience via satisfaction scores only, or findings lacked sufficient depth to answer the research question. Quality was assessed using Mixed Methods Appraisal Tool, and findings synthesised using a framework approach, incorporating the Rainbow Model of Integrated Care and Measuring Integrated Care Patient Framework. Results: Sixteen studies were included. Person-centred and shared responsibility experiences were most often discussed. Experiences were not always described as positive and some patients experienced a lack of PCCC. Clinical, professional/organisational and functional integration processes were associated with experiencing domains of PCCC. Discussion: People with complex needs experience a lack of coordination across teams and wider community resources, and limited associations were made between integration processes and patient experience. Further research which gives context to individual experience, provides greater detail of integration processes and utilises validated patient experience measures of PCCC is required to understand the association between integration processes and domains of PCCC. [ABSTRACT FROM AUTHOR]

Background: In recent years, the Chinese government has introduced a new system called the integrated health care system to deepen health care reform and enhance the capacity of the primary health care services.Objective: We aimed to investigate the perceptions and opinions of general practitioners (GPs) on the integrated health care system.Methods: A cross-sectional investigation involving 764 GPs in Hubei province of China was conducted. We used a self-designed questionnaire to collect information on demographics, GPs' knowledge and attitude of the integrated health care system. Data on 749 GPs with completed questionnaires were analysed descriptively. We conducted Spearman rank correlation analysis to test correlation of grade data.Results: 60.92% of the 749 GPs were familiar with the integrated health care system. 88.25% of the GPs were apt to support its development and 70.09% thought it could promote downward referral of patients. The GPs' familiarity with the integrated health care system was significantly related to professional guidance from doctors in higher hospitals (P < 0.05), but not job titles of GPs (P > 0.05). 78.0% of GPs thought that the main benefit of the integrated health care system was the reduction of patients' health care costs; 70.1% believed that the most difficulty was insufficient publicity.Conclusions: The GPs' general cognition of the integrated health care system was general. Most of the GPs supported the integrated health care system and believed that it contributed to decrease the patients' health care costs. Insufficient publicity and the incomplete two-way referral mechanism were regarded to be the main obstacles to its development. [ABSTRACT FROM AUTHOR]

Background: While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system.Methods: To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences.Discussion: This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients.Conclusion: The integrated care system needs collaborative work from different levels of caregivers. So it is extremely important to consider the supplier cooperative behaviour. In this trial, we introduced payment system to help the delivery system integration through providing financial incentives to motivate people to play their roles. Also, the multidisciplinary team, the multi-institutional pathway and system global budget and pay-for-performance payment system could afford as a solution.

Objective To evaluate patient characteristics, treatment patterns, comorbidities, and risk factors associated with the development of acute pancreatitis (AP) in patients with severe hypertriglyceridemia (HTG) in an integrated health care delivery system. Methods We identified a retrospective cohort of severe HTG patients with a fasting triglyceride level ≥ 1000 mg/dL during January 1, 2007 to June 30, 2013 (index date) in an integrated health care delivery system. Patients were aged ≥18 years on index date and had 12 months of continuous membership and drug eligibility before the index date and during postindex including index date. Baseline patient characteristics, comorbidities, and risk factors were evaluated during 12-month preindex. Outcomes such as development of AP, treatment patterns, adherence to index therapy, and change in triglyceride (TG) laboratory levels were evaluated during postindex. Descriptive statistics were used to identify differences between patients developing AP vs no development of AP. A stepwise multivariate logistic regression and backward elimination method were used to assess statistically significant predictive factors associated with development of AP vs no AP. Results We identified 5550 patients with severe HTG, and 5.4% of these patients developed AP during postindex. Patients were mostly male (≥70%) in both groups; however, younger in the AP group (45 years ± 10.6) vs no AP group (50 years ± 11.4) with P value < .0001. The AP group had higher baseline Charslon Comorbidity Index score, alcohol abuse history (42.2%), any pancreatitis history (51.5%), diabetes (47%), and hypertension (55%), vs the no AP group ( P values < .05). Patients in the AP group had higher baseline mean TG levels (2148, SD ± 1578) vs the no AP group (1559, SD ± 861), P value < .0001. Over 50% of the patients were prescribed their index therapy by a primary care provider. Predictive factors associated with the development of AP included younger age, alcohol use, and prior history of any pancreatitis, hypertension, renal disease stage 4, and other prescriber specialty. From parameters estimates, for each 100 mg/dL unit of increase in the TG level above 1000 mg/dL, there was a 3 percent increase in risk of developing AP. Conclusions Patients with severe HTG are at a higher risk of developing AP. A number of comorbidities, risk factors, and baseline TG levels are associated with an increased incidence of AP. Patients with severe HTG are underdiagnosed, undertreated and are nonadherent to their index lipid therapy. There is a need to better define optimal approaches to treating severe HTG so as to reduce the incidence of AP. Economic studies are also needed to evaluate the burden of AP on various health care systems. [ABSTRACT FROM AUTHOR]

Progress monitoring implementation in an integrated health care system is a complex process that must address factors such as measurement, technology, delivery system care processes, patient needs and provider requirements. This article will describe how one organization faced these challenges by identifying the key decision points (choice of measure, process for completing rating scale, interface with electronic medical record and clinician engagement) critical to implementation. Qualitative and quantitative data will be presented describing customer and stakeholder satisfaction with the mental health progress monitoring tool (MHPMT) as well as organizational performance with key measurement targets. [ABSTRACT FROM AUTHOR]

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• Taiwan comprises a fast-aging society and care fragmentation in health care services necessitates extensive integration to meet the growing demand of elderly population. • This systematic review demonstrated that the integrated health care systems for multiple morbidities benefit the taiwanese geriatric population in physical and functional outcomes. • Future well-designed studies are needed to provide evidence on integrated medicine during the COVID-19 pandemic. Care fragmentation in the elderly population prompted the need for integrated health care systems. However, evidence regarding the impact of the integrated care system in Taiwan is unclear. We aimed to conduct a systematic review to evaluate the impact of Taiwan's integrated health care programs on geriatric population. We searched bibliographic databases MEDLINE, Embase, Web of Science, and Airiti Library for relevant publications throughout May 2022. Studies investigating the effectiveness of Taiwan's integrated care programs were included. We used the critical appraisal skills programme (CASP) checklist, to assess the risk of bias of included studies. Thirty-four studies, with a total of 838,026 study subjects, were assessed. The systematic review on 11 subthemes (diabetes mellitus, chronic kidney disease, hepatitis C virus, fractures, cancer, dementia, atrial fibrillation, chronic obstructive pulmonary disease, mechanical ventilation, terminal illness, outpatients and community-dwelling patients), demonstrated that the implementation of integrated health care could not only provide benefits on survival, self-care ability, health quality, physical, and functional rehabilitation outcomes, but also significantly reduce medical utilization and expenditures. The integrated health care system for multiple morbidities benefits the Taiwanese geriatric population in physical and functional outcomes. The thematic synthesis provides references for future rigorous clinical trials. [ABSTRACT FROM AUTHOR]

Copyright of Health Policy & Management / Sveikatos Politika ir Valdymas is the property of Mykolas Romeris University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. Methods We used key informant interviews, supplemented by document analysis. Findings The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. Conclusions In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. [ABSTRACT FROM AUTHOR]

The achievements of modern medicine resulted in an increase of number of patients living with chronic diseases that turned out as significant burden for national economics. The oncologic diseases are one of the most widespread ones, determining patient vital prognosis. The modern achievements in medicine determine possibility of optimizing clinical prognosis and chronic course of disease. In modern Russia, the health care system functions in accordance with model of urgent, fragmented medical care that does not meet current needs of patients with chronic diseases. In Russia, actual procedures of medical care of oncologic patients do not consider interdisciplinary continuum scenario. Therefore, the need for its conceptualization. The article proposes model of continuum of oncologic care of patients in the context of an integrated health care system, that presupposes complex interdisciplinary follow-up of patients with chronic disease in situations of disease.

Background: When compared with conventional weight loss strategies, bariatric surgery results in substantially greater durable weight loss and rates of disease remission., Objective: The ENGAGE CVD (Effectiveness of Gastric Bypass versus Gastric Sleeve for Cardiovascular Disease) cohort study aimed to provide population-based, comprehensive, rigorous evidence for clinical and policy decision making regarding the choice between gastric bypass and gastric sleeve for overall cardiovascular disease (CVD) risk reduction, risk factor remission, and safety., Methods: The cohort had 22,095 weight loss surgery patients from a large integrated health care system in Southern California assembled from 2009 to 2016 who were followed up through 2018. Bariatric surgery patients were followed up for the length of their membership in the health care system. Of the patients who had at least five years of follow-up (surgery between 2009 and 2013), 85.86% (13,774/16,043) could contribute to the outcome analyses for the ENGAGE CVD cohort., Results: Patients in the ENGAGE CVD cohort were 44.6 (SD 11.4) years old, mostly women (17,718/22,095; 80.19%), with 18.94% (4185/22,095) non-Hispanic black and 41.80% (9235/22,095) Hispanic, and had an average BMI of 44.3 (SD 6.9) kg/m 2 at the time of surgery. When compared with patients who did not contribute data to the 5-year outcome analysis for the ENGAGE CVD cohort (2269/16,043; 14.14%), patients who contributed data (13,774/16,043; 85.86%) were older (P=.002), more likely to be women (P=.02), more likely to be non-Hispanic white (P<.001), more likely to have had an emergency department visit in the year before surgery (P=.006), less likely to have a mental illness before surgery (P<.001), and more likely to have had a CVD event at any time before surgery (P<.001)., Conclusions: This study had one of the largest populations of gastric sleeve patients (n=13,459). The 5-year follow-up for those patients who had surgery between 2009 and 2013 was excellent for a retrospective cohort study at 85.86% (13,774/16,043). Unlike almost any study in the literature, the majority of the ENGAGE CVD cohort was racial and ethnic minority, providing a rare opportunity to study the effects of bariatric surgery for different racial and ethnic groups, some of whom have the highest rates of severe obesity in the United States. Finally, it also used state-of-the-art statistical and econometric comparative effectiveness methods to mimic the effect of random assignment and control for sources of confounding inherent in large observational studies., International Registered Report Identifier (irrid): RR1-10.2196/14936., (©Karen J Coleman, Heidi Fischer, David E Arterburn, Douglas Barthold, Lee J Barton, Anirban Basu, Anita Courcoulas, Cecelia L Crawford, Peter Fedorka, Benjamin Kim, Edward Mun, Sameer Murali, Kristi Reynolds, Kangho Suh, Rong Wei, Tae K Yoon, Robert Zane. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 06.04.2020.)

Objective: To explore the content and mode of extended specialized outpatient nursing care (SONC) in assisted reproduction clinics in the joint efforts of the level-Ⅲ grade-A hospital and lower-level hospitals., Methods: We enrolled 300 infertility patients for this study, 150 from the hospitals of our Integrated Healthcare System (IHCS) and the other 150 from other local hospitals, the former receiving extended SONC based on wisdom medicine of the IHCS (the experimental group), and the latter conventional SONC (the control group). At the end of the treatment cycle, we compared the frequency of clinic visits, knowledge of relevant requirements (such as the procedure of consultation, timely completion of examinations, timely initiation of the treatment cycle, and correct execution of doctor's advice), and scores on the Medical Coping Modes Questionnaire and quality of life (QOL) between the two groups of patients., Results: Compared with the control group, the experimental group showed a significantly lower frequency of clinic visits (P < 0.05), better knowledge of relevant requirements (P < 0.05), higher confrontation score (P < 0.05), lower resignation score (P < 0.05), and higher QOL score (P < 0.05)., Conclusions: SONC based on wisdom medicine of IHCS in the assisted reproduction clinic is conducive to synchronization of thinking, sharing of knowledge and information, seamless connection between upper- and lower-level hospitals, and hence the provision of homogenous nursing care.

Just as the "New Deal" aimed to elevate the "forgotten man" of the Great Depression through governmental relief and reform, so does the Department of Veterans Affairs (VA) health care system aim to improve the health of veterans with the invisible illness of chronic kidney disease through a concerted series of health care delivery reforms. Augmenting its primary care platform with advances in informatics and health service delivery initiatives targeting kidney disease, the VA is changing how nephrology care is provided to veterans with the goal of optimized population kidney health. As the largest provider of kidney health services in the country, the VA offers an instructive case study of the value of comprehensive health care coverage for people with chronic kidney disease. Recent reports of kidney health outcomes among veterans support the benefit of the VA's integrated health care delivery system. Suggestions to optimize veterans' kidney health further may be equally applicable to other health systems caring for people afflicted with kidney disease., (Published by Elsevier Inc.)