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Faith community nurses (FCNs) are well positioned to serve individuals needing community-based healthcare within local healthcare systems, large church denominations, or through the support and resources of nonprofit faith community nursing organizations. This article briefly outlines development of the specialty of faith community nursing and proposes areas of research needed to grow the impact of this nursing specialty. Examples of FCNs working in and collaborating with healthcare systems, educational institutions, and congregations illustrate the value and diversity of FCN services for impacting community-based care. An exhaustive list of national, denominational, and regional organizations supporting FCN practice is included. [ABSTRACT FROM AUTHOR]

Abstract Objective The accessibility of acute care services is currently under pressure, and one way to improve services is better integration. Adequate methodology will be required to provide for a clear and accessible evaluation of the various intervention initiatives. The aim of this paper is to develop and propose a Population Health Management(PHM) methodology framework for evaluation of transitions in acute care services. Results Our methodological framework is developed from several concepts found in literature, including Triple Aim, integrated care and PHM, and includes continuous monitoring of results at both project and population levels. It is based on a broad view of health rather than focusing on a specific illness and facilitates the evaluation of various intervention initiatives in acute care services in the Netherlands and distinctly explains every step of the evaluation process and can be applied to a heterogeneous group of patients.

Hospital at Home (HaH) is a sustainable, innovative, and next-generation model of healthcare. From the healthcare management point of view, this model provides cost benefits and quality improvement, and from the physicians’ point of view, it helps in providing patient-centered medical care and keeps patients away from hospital admission and its complications. The HaH model was first introduced at John Hopkins in the United States in 1995, which showed very promising results in context to the length of stay, readmission rates, patient satisfaction, and hospital-acquired infections. The HaH model of care provides acute critical care to patients at home and reduces unnecessary hospitalization and related complications. The identified patients for this model of care are elderly patients with chronic conditions and multiple comorbidities. The emergence of technology in today's world and the impact of coronavirus disease 2019 (COVID-19) have increased the demand for the HaH model of care. Although there are many benefits and advantages, the HaH model of care has significant barriers and limitations, such as reimbursement for payment, physician and patient resistance, patient safety, and lack of quantifying research data to support the use of this model. Specific training for the physician, nursing, and other members of the HaH multidisciplinary team is necessary for HaH treatment protocols, along with patient and family caregiver education for those who elect the HaH model of care. HaH is the future of comprehensive healthcare services and helps in achieving the triple aim of access to healthcare, improved quality of care, and reduced cost for healthcare.

Objective: The accessibility of acute care services is currently under pressure, and one way to improve services is better integration. Adequate methodology will be required to provide for a clear and accessible evaluation of the various intervention initiatives. The aim of this paper is to develop and propose a Population Health Management(PHM) methodology framework for evaluation of transitions in acute care services. Results: Our methodological framework is developed from several concepts found in literature, including Triple Aim, integrated care and PHM, and includes continuous monitoring of results at both project and population levels. It is based on a broad view of health rather than focusing on a specific illness and facilitates the evaluation of various intervention initiatives in acute care services in the Netherlands and distinctly explains every step of the evaluation process and can be applied to a heterogeneous group of patients. [ABSTRACT FROM AUTHOR]

Background: Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain).Methods: Prospective cohort study over one year period, 2017-2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data.Results: HaH-HA depicted lower: i) Emergency Room Department (ER) visits (p < .001), ii) Unplanned re-admissions (p = .012); and iii) costs (p < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (p < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified.Conclusions: We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care.Registration: ClinicalTrials.gov (26/04/2017; NCT03130283). [ABSTRACT FROM AUTHOR]

The Hearst Health Prize is the first national annual award for excellence in population health. The prize was established "to discover, support, and showcase the work of an individual, group, organization, or institution that has successfully implemented a population health program or intervention that has made a measurable difference" in health outcomes. Now, 5 years since the award's inception, this article reflects on how submissions for the prize collectively mirror – and may even predict – changes within the field of population health. It examines how the most successful programs demonstrated genuine, measurable improvements in health outcomes and/or health behaviors. In exploring the work of these outstanding programs, the aim of this article is to help disseminate best practices, advance the mission of the prize, and inspire improvements in population health practices. [ABSTRACT FROM AUTHOR]

Nurse navigators, in a role that originally focused on a single health condition and improving specified services for an individual patient, have expanded to include care management and care coordination. As the role evolves, nurse navigators are demonstrating proficiency and achieving success transforming care delivery to improve population health while improving quality outcomes, patient satisfaction, and decreasing cost. One innovative health system's clinical nurse specialist team partnered with primary care providers, ancillary care teams, home care, skilled nursing facilities, community agencies, and partners in public health and schools. Clinical nurse specialists, now called "transitional care nurses (TCNs)," have created an accountable community of health for their high-risk population. By following patients from one setting to the next, TCNs identified opportunities for improvement, created innovative programs to bridge gaps, improved teamwork, and integrated care, resulting in lower cost, high-quality care. Results included 50% reduction in hospitalization for patients with chronic disease, pre- and post-TCN partnership. Patients with diabetes were supported with access to diabetes coaches, which resulted in a 12% reduction in AIC, while patients completing pulmonary rehabilitation programs experienced reduced readmission rates from 24% to 2.7%. [ABSTRACT FROM AUTHOR]

In a fragmented healthcare system, the U.S. faces challenges with improving quality, reducing costs, and improving the overall health of the population. With current payment models such as fee-for-service (FFS), negatively impacting care coordination and patient outcomes, healthcare organizations are looking for ways to shift from a volume-based model to a value-based model. This paper will aim to discuss how the FFS model impacts care delivery by reviewing existing literature and providing discussion on current solutions to resolve the problems of the FFS model. Then, a framework will be introduced that organizations can implement to help them adopt a value-based care model including forming a specialized team, identifying healthcare needs, designing and measuring patient outcomes, and evaluating their success. [ABSTRACT FROM AUTHOR]

A descriptive, cross sectional design was used to compare perceptions of compassion and well-being of volunteers with and without a personal history of cancer. Most (79%) were >60 years of age, female (63%), married (75%), White (88%), and Non-Hispanic (79%). Thirteen (54%) had a history of cancer; two were still on treatment. Compassion scores were similar between groups. Volunteers with a history of cancer scored higher (p = 0.04) on General Well-being than those without a history of cancer. Understanding volunteer perceptions of compassion and well-being can guide our support structure and psychoeducation. Future studies could examine patient outcomes related to volunteerism. [ABSTRACT FROM AUTHOR]

Introduction: In student-led healthcare services, health students take responsibility for the management and delivery of health services as part of clinical training. Like all healthcare services, student-led healthcare services need to be evaluated to ensure they provide high quality, safe and cost-effective services. The aim of this literature review was to understand how student-led healthcare services have been evaluated to date and to assess alignment of previous evaluations with the Triple Aim framework. The Triple Aim is a conceptual framework offering a systematic approach to evaluating healthcare services that may be appropriate for evaluation of student-led services. Methods: Electronic databases were searched for articles describing a student-led healthcare service and were screened for studies that evaluated the impact of a studentled healthcare service on patient outcomes. Critical appraisal was informed by Stiefel and Nolan’s (2012) IHI white paper A Guide to Measuring the “Triple Aim”, and each article was appraised against the Triple Aim measurement principles and dimensions of care. Results: Fourteen of 211 identified articles met the inclusion criteria. All 14 studies met the Triple Aim measurement principles of “a defined population”, “gather data over time” and “distinguish between measures”, while only eight of the 14 studies achieved “comparison data”. All 14 studies measured at least one or more of the Triple Aim dimensions. Conclusions: There was little consistency across the evaluations of student-led healthcare services, limiting the extent to which the benefits of student-led healthcare services can be shown to be a valuable resource to the healthcare system. Further investigation is required to determine a suitable evaluation framework for student-led healthcare services. [ABSTRACT FROM AUTHOR]

Abstract Background Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care - public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes. Methods Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims. Results Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building. Conclusions Primary care and public health collaborations can strengthen community-based primary health care while addressing the Quadruple Aims with an emphasis on reducing health inequities but requires attention to collaboration barriers and enablers.

Aims: The electrosurgical technology category is used widely, with a diverse spectrum of devices designed for different surgical needs. Historically, hospitals are supplied with electrosurgical devices from several manufacturers, and those devices are often evaluated separately; it may be more efficient to evaluate the category holistically. This study assessed the health economic impact of adopting an electrosurgical device-category from a single manufacturer. Methods: A budget impact model was developed from a U.S. hospital perspective. The uptake of electrosurgical devices from EES (Ethicon Electrosurgery), including ultrasonic, advanced bipolar, smoke evacuators, and reusable dispersive electrodes were compared with similar MED (Medical Energy Devices) from multiple manufacturers. It was assumed that an average hospital performed 10,000 annual procedures 80% of which involved electrosurgery. Current utilization assumed 100% MED use, including advanced energy, conventional smoke mitigation options (e.g. ventilation, masks), and single-use disposable dispersive electrode devices. Future utilization assumed 100% EES use, including advanced energy devices, smoke evacuators (i.e. 80% uptake), and reusable dispersive electrodes. Surgical specialties included colorectal, bariatric, gynecology, thoracic and general surgery. Systematic reviews, network meta-analyses, and meta-regressions informed operating room (OR) time, hospital stay, and transfusion model inputs. Costs were assigned to model parameters, and price parity was assumed for advanced energy devices. The costs of disposables for dispersive electrodes and smokeevacuators were included. Results: The base-case analysis, which assessed the adoption of EES instead of MED for an average U.S. hospital predicted an annual savings of $824,760 ($101 per procedure). Savings were attributable to associated reductions with EES in OR time, days of hospital stay, and volume of disposable electrodes. Sensitivity analyses were consistent with these base-case findings. Conclusions: Category-wide adoption of electrosurgical devices from a single manufacturer demonstrated economic advantages compared with disaggregated product uptake. Future research should focus on informing comparisons of innovative electrosurgical devices. [ABSTRACT FROM AUTHOR]

The triple aim is defined as the simultaneous pursuit of improvement across three areas: population health outcomes, quality of care and value for the system. Since the triple aim framework was first introduced in 2008, it has been applied in various contexts across several countries. The triple aim has been proposed as a core purpose of the integrated health and care systems in England. However, little has been written about how the systematic application of quality improvement can support the process of achieving the triple aim, despite the increasingly widespread use of quality improvement methods and tools in the quality of care element of the triple aim. This article, the third in a three-part series about applying quality improvement to practice, puts forward a step-by-step guide for healthcare systems to use their existing quality improvement capabilities to help them achieve the triple aim, with examples and learning from the authors' experience at East London NHS Foundation Trust. [ABSTRACT FROM AUTHOR]

Background: Acute care services are currently overstretched in many high income countries. Overcrowding also plays a major role in acute care in the Netherlands. In a region of the Netherlands, the general practice cooperative (GPC) and ambulance service have begun to integrate their care, and the rapid and complete transfer of information between these two care organisations is now the basis for delivering appropriate care. The primary aim of this mixed-methods study is to evaluate the Netherlands Triage System (NTS) merger project and answering the question: What is the added value of implementing a digital NTS merger in terms of healthcare use and healthcare costs? A secondary question is: What are the experiences of patients and care professionals in different acute healthcare organisations following implementation of the digital NTS merger? Methods: Patients who made an acute care request during the 12 months before the NTS merge intervention (control period) were compared with matched patients in the 12 months following the start of the NTS merge. Outcomes included difference in healthcare use 30 days after an acute event and patient’ and care professional’ experiences during the intervention period. To assess healthcare costs, we used reference prices updated to 2021. Results: Compared to patients in the control period, patients in the intervention period were hospitalized less often (52.9% vs 64.4%, p = 0.061) and had fewer emergency department (ED) visits (58.7% vs 69.3%, p = 0.074) in the 30 days following the acute care request. The ED costs were significantly lower during the intervention period compared to the control period (p = 0.042). Furthermore, patients in the intervention period were very satisfied overall with the acute care network (4.63 of 5) and care professionals were fairly satisfied with the cooperation to date (2.73 of 4). Conclusion: The Triple Aim for acute care can be met using relatively simple interventions, but medical data merging is a prerequisite for achieving more robust results covering on the various aspects of the Triple Aim. These successes should be communicated so that a common language can be developed that will support the successful further implementation of larger scale initiatives.

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Abstract Background As health care strives towards the Triple Aim of improved population health, patient experience, and reduced costs, an organization’s readiness for change may be a key factor. The concept refers to the collective commitment of organizational members to a change and belief in their shared ability to make that change happen (efficacy). This study aims to assess the organizational readiness for implementing large-scale change at a clinical department in pursuit of the Triple Aim and to determine key associated factors. Methods A cross-sectional study at a Danish Obstetrics and Gynecology department faced with external pressure to become more efficient without compromising patient outcomes and experience. The Organisational Readiness for Implementing Change (ORIC) questionnaire was distributed to all employees (n = 403). Descriptive statistics was used to assess overall organizational readiness and single items. The between-group differences in subject characteristics were assessed with independent t-test and non-parametric test. Multiple linear regression was employed to control for potential confounders. Results Response rate was 72%. The level of agreement with the commitment statements was high, and low with the efficacy statements. We did not observe statistically significant differences in the overall score between organizational sections or in relation to gender, age, or profession. Managerial status (B = 3.2, 95% CI = .52, 5.9, P = .02) or interim employment(B = 2.7, 95% CI = .47, 4.9, P = .02) were significant predictors of a high change efficacy score after controlling for potential confounders. Conclusions Changes related to pursuit of the Triple Aim were seen as something that “has to” be done, but left managers, and even more so staff, wondering what “to do” and “how to” do it. Change strategies should therefore address these uncertainties by translating political “have to’s” proposals that resonate with staff, spark engagement, and clarify “how to” deal with the complexity of large-scale change.

Meta-decision as a junction between evidence and its rightful implementation is suggested in this review as a structured framework applied in healthcare, valuable to clinicians and healthcare decision-makers. The process of meta-decision requires optimum measurements to provide data necessary for identifying and developing decision alternatives and explicitly reflect on its value and choose the optimum decision. The location of value in the meta-decision framework is core component. Of equal importance are prerequisites for decision-makers' abilities to make meta-decisions and focus on optimum team environments. As well as improving their decision-making process through reflection and learning.

Background: A guiding principle of a successful integrated health and social care delivery network is to establish a governance approach based on learning, grounded in a data and knowledge infrastructure. The 'Krijtmolen Alliantie' is a network of health and social care providers with the ambition to realize such a performance intelligence driven governance model in line with the Triple Aim. This study seeks to identify what performance intelligence is available and how it can be improved.Methods: This case study was conducted in the district of Amsterdam Noord, the Netherlands, and employed 23 semi-structured interviews with stakeholders in health and social care, a feasibility analysis of available administrative data, and a reflection meeting with board members of the 'Krijtmolen Alliantie'. Information needs for performance intelligence by the stakeholders were mapped and a data landscape of the district covered by the network was drafted. Finally, in the reflection meeting with board members of the 'Krijtmolen Alliantie' the information needs and data landscape were aligned with governing needs, resulting in priority domains around which to strengthen the data infrastructure for governance of the integrated health and social care delivery network.Results: The 'Krijtmolen Alliantie' encompasses a network of providers with a diverse range of catchment areas. There are indicators on population health and welfare, however they have limited actionability for providers due to a misalignment with their respective catchment areas. There is a barrier in data exchange between health and social care providers. It is difficult to construct one indicator for per capita cost in the Dutch health data infrastructure as health and social care are subdivided in financing siloes. Priority domains for improvement of performance intelligence for the 'Krijtmolen Alliantie' are: 1) Per capita and per patient cost data integration that would allow combined accountability through aligning financial incentives to facilitate integrated care, and 2) combined patient experience and outcome measures to reflect network quality of care and patient experience performance.Conclusion: Available performance intelligence lacks actionability for the governance of integrated care networks. Our recommendation is to align performance intelligence with the regional governance responsibilities of stakeholders for health and social care delivery. [ABSTRACT FROM AUTHOR]

Value-based healthcare (VBHC) is a widely approved logic for financing services, using innovative care models and evaluating healthcare outcomes. It is consistent with the Triple Aim framework of simultaneously improving population health, patient experience and the costs of care. In Nordic countries, VBHC has been mainly implemented as a strategic concept in developing hospitals. Despite the evident interest in VBHC as a management trend in healthcare organisations, the studies concerning the implications of VBHC logics on health policies have been scant. This study aimed to fill this gap by building a conceptual bridge between national health policy and value-based care. Through the Triple Aim framework, we explored how VBHC goals have evolved in Finnish Government Programmes from 1995 to 2015 by using qualitative document analysis and interviews. The study addresses the evolution and national impacts of VBHC. Our results show that the goals of Triple Aim gradually become evident at the Finnish health policies. All three Triple Aim goals were present, though the equal prioritisation of these goals only emerged in 2015, also highlighting patient experience. We argue that VBHC logics have indeed affected Nordic welfare policies, not only at the organisational level but also concerning performance measurement and care delivery. This may imply that the diffusion of VBHC logics evolves from healthcare organisations to policymaking instead of top-down. Particularly in publicly financed systems, VBHC indicates a transformation to a new public governance ideology, accelerating policy goals that promote customer responsiveness and value creation for citizens. [ABSTRACT FROM AUTHOR]

Abstract Background Evaluation of integrated care programmes for individuals with multi-morbidity requires a broader evaluation framework and a broader definition of added value than is common in cost-utility analysis. This is possible through the use of Multi-Criteria Decision Analysis (MCDA). Methods and results This paper presents the seven steps of an MCDA to evaluate 17 different integrated care programmes for individuals with multi-morbidity in 8 European countries participating in the 4-year, EU-funded SELFIE project. In step one, qualitative research was undertaken to better understand the decision-context of these programmes. The programmes faced decisions related to their sustainability in terms of reimbursement, continuation, extension, and/or wider implementation. In step two, a uniform set of decision criteria was defined in terms of outcomes measured across the 17 programmes: physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centeredness, continuity of care, and total health and social care costs. These were supplemented by programme-type specific outcomes. Step three presents the quasi-experimental studies designed to measure the performance of the programmes on the decision criteria. Step four gives details of the methods (Discrete Choice Experiment, Swing Weighting) to determine the relative importance of the decision criteria among five stakeholder groups per country. An example in step five illustrates the value-based method of MCDA by which the performance of the programmes on each decision criterion is combined with the weight of the respective criterion to derive an overall value score. Step six describes how we deal with uncertainty and introduces the Conditional Multi-Attribute Acceptability Curve. Step seven addresses the interpretation of results in stakeholder workshops. Discussion By discussing our solutions to the challenges involved in creating a uniform MCDA approach for the evaluation of different programmes, this paper provides guidance to future evaluations and stimulates debate on how to evaluate integrated care for multi-morbidity.

Since their inception in 2012, accountable care organizations (ACOs) have yielded inconsistent and unpredictable financial results. These outcomes may be related to an individual ACO's participant mix of primary care physicians (PCPs) and specialists. We analyzed ACO performance data to better understand the cooperative roles of PCPs and specialists in financially successful ACOs. The dataset included several variables reflecting different quantitative and qualitative characteristics of ACO performance. The analyses of variance and covariance (ANOVA and ANCOVA) were used as the primary statistical tool. The obtained results provided the evidence that a larger number of PCPs in an ACO can help to achieve quantitative goals related to immediate financial effect. In contrast, ACOs with a higher relative share of specialists tend to improve the healthcare quality and profitability in the longer term. The results provide a solid basis for further investigation that may help future ACOs to design the strategies resulting in efficient quality care and sustainable profitability. [ABSTRACT FROM AUTHOR]

NPs piloted a family-centered goal-planning tool with a medically complex pediatric population during outpatient clinic visits. The tool was an effective reminder to discuss goals after trust and rapport are established between provider and family. [ABSTRACT FROM AUTHOR]

Objective: Population health management (PHM) refers to large-scale transformation efforts by collaborative adaptive health networks that reorganize and integrate services across public health, health care, social care and wider public services in order to improve population health and quality of care while at the same time reducing cost growth. However, a theory-based framework that can guide place-based approaches towards a comprehensive understanding of how and why strategies contribute to the development of PHM is lacking, and this review aims to contribute to closing this gap by identifying the key components considered to be key to successful PHM development. Methods: We carried out a scoping realist review to identify configurations of strategies (S), their outcomes (O), and the contextual factors (C) and mechanisms (M) that explain how and why these outcomes were achieved. We extracted theories put forward in included studies and that underpinned the formulated strategy-context-mechanism-outcome (SCMO) configurations. Iterative axial coding of the SCMOs and the theories that underpin these configurations revealed PHM themes. Results: Forty-one studies were included. Eight components were identified: social forces, resources, finance, relations, regulations, market, leadership, and accountability. Each component consists of three or more subcomponents, providing insight into (1) the (sub)component-specific strategies that accelerate PHM development, (2) the necessary contextual factors and mechanisms for these strategies to be successful and (3) the extracted theories that underlie the (sub)component-specific SCMO configurations. These theories originate from a wide variety of scientific disciplines. We bring these (sub)components together into what we call the Collabroative Adaptive Health Network (CAHN) framework. Conclusions: This review presents the strategies that are required for the successful development of PHM. Future research should study the applicability of the CAHN framework in practice to refine and enrich identified relationships and identify PHM guiding principles. [ABSTRACT FROM AUTHOR]

Background: Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care - public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes.Methods: Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims.Results: Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building.Conclusions: Primary care and public health collaborations can strengthen community-based primary health care while addressing the Quadruple Aims with an emphasis on reducing health inequities but requires attention to collaboration barriers and enablers. [ABSTRACT FROM AUTHOR]

Abstract Background In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed. This study focuses on a cardiology primary care plus intervention. Primary care plus (PC+) is a new health-care delivery model focused on substitution of specialist care in the hospital setting with specialist care in the primary care setting. The intervention consists of a cardiology PC+ centre in which cardiologists, supported by other health-care professionals, provide consultations in a primary care setting. The PC+ centre aims to improve the health of the population and quality of care as experienced by patients, and reduce the number of referrals to hospital-based outpatient specialist care in order to reduce health-care costs. These aims reflect the Triple Aim principle. Hence, the objectives of the study are to evaluate the cardiology PC+ centre in terms of the Triple Aim outcomes and to evaluate the process of the introduction of PC+. Methods/Design The study is a practice-based, quantitative study with a longitudinal observational design, and an additional qualitative study to supplement, interpret and improve the quantitative study. The study population of the quantitative part will consist of adult patients (≥18 years) with non-acute and low-complexity cardiology-related health complaints, who will be referred to the cardiology PC+ centre (intervention group) or hospital-based outpatient cardiology care (control group). All eligible patients will be asked to complete questionnaires at three different time points consisting of questions about their demographics, health status and experience of care. Additionally, quantitative data will be collected about health-care utilization and related health-care costs at the PC+ centre and the hospital. The qualitative part, consisting of semi-structured interviews, focus groups, and observations, is designed to evaluate the process as well as to amplify, clarify and explain quantitative results. Conclusions This study will evaluate a cardiology PC+ centre using quantitative and supplementary qualitative methods. The findings of both sub-studies will fill a gap in knowledge about the effects of PC+ and in particular whether PC+ is able to pursue the Triple Aim outcomes. Trial registration NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

Sidney P Norton,1 Evan M Dickerson,1 Charles G Kulwin,2 Mitesh V Shah2 1Financial Planning and Analysis, Indiana University Health, Indianapolis, IN, USA; 2Adult Neurosurgery, Goodman Campbell Brain and Spine, Indianapolis, IN, USA Background: The Triple Aim is defined as: improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. The purpose of this analysis was to evaluate the economic value of a new neurosurgical technique, the BrainPath™ approach, for use in patients with subcortical tumors and intracerebral hemorrhage (ICH). Methods: Inpatient length of stay (LOS) data were collected for ICH and brain tumor surgical patient cases between August 2013 and November 2015. Patient cases were separated into two groups; BrainPath approach (n = 28) and conventional techniques, such as craniotomy, (n = 208). The average intensive care unit (ICU) LOS was calculated for each group by diagnosis-related group and compared between groups. Results: The new surgical technology resulted in surgical intervention in 14 ICH cases which otherwise would have been medically managed due to the hemorrhage location or size of the ICH. A reduction in ICU LOS was seen in this group. Based on the variable direct cost per day in the neuro critical care unit at this academic medical center, 14 patient cases incurred ~ US$210,000 less in direct ICU costs. Surgical resection was possible in two tumor patient cases which would have been biopsied, rather than surgically resected, also due to location of the abnormalities. A total net value of > US$329,000 is attributable to the analyzed approach over a 28-month period. Conclusion: This analysis shows positive economic value for the new technology group when ICU LOS and reimbursement are considered against equipment costs, thus achieving Triple Aim objectives. Keywords: brain tumor, intracranial hemorrhage, intracerebral hemorrhage, intensive care unit length of stay, Triple Aim, economic value

The purpose of this report is to describe and discuss the development and implementation of an interprofessional educational (IPE) program for students on a regional medical campus. IPE is important in training the next generation of health care professionals. Regional medical campuses often have reduced IPE activities due to limited resources and their distance from their main campuses. However, regional campuses can also provide opportunities for innovative solutions to provide IPE learning experiences. This article demonstrated how one regional campus created innovative opportunities to meet student needs.

Background: The sustainability of many healthcare systems in Western countries is of serious concern due to rising expenditures. In the Netherlands for example, the expenditures on medical specialist care increased with more than 55% during the past decade to more than 27 billion euros in 2016. Therefore, redesigning healthcare delivery models is high on the Dutch political agenda. In two Dutch pioneer sites, various stakeholders started experimenting with a new healthcare delivery model called Primary Care Plus (PC+). In PC+, various medical specialists perform consultations in the primary care setting in order to achieve substitution of specialised hospital care with less expensive primary care to control for rising costs. Additionally, stakeholders aim to achieve better integration between primary care and specialised hospital care by enhancing collaboration and communication between GPs and medical specialists. This should ultimately prevent unnecessary referrals to (outpatient) hospital care and consequently improve Quadruple aim outcomes. Aims and Objectives: The aim is to present and discuss the evaluation and results of the PC+ interventions in two Dutch pioneer sites measured according to the Quadruple Aim outcomes (experiences of patients and healthcare providers, population health and costs). The results are based on the evaluation, which started in 2013 and will be finished in 2018. At the ICIC 2016 in Barcelona, results of a PC+ pilot and preliminary results of the implementation of the PC+ centres were presented and during this workshop we will present the final results and lessons learned. Format: The workshop, which will be chaired by professor Dirk Ruwaard as leader of the Living Lab on Sustainable Care at Maastricht UMC+/Maastricht University, will be structured according to the Quadruple Aim outcomes in the pioneer sites for PC+ and will end with the lessons learned including recommendations for policy, practice and research. Several researchers of the Living Lab will present their work and there will be ample time to discuss the outcomes and share thoughts and experiences. Speakers: Dirk Ruwaard, Tessa Quanjel, Esther van den Bogaart, Daan Westra, Niels Hameleers and Mariëlle Kroese. Timing: 65 minutes presentation and 25 minutes discussion Proposed Structure 10 min: Opening: Integrated care through Primary Care Plus by Dirk Ruwaard 45 min: Quadruple aim outcomes: 10 min: Quality of care as experienced by patients by Tessa Quanjel 10 min: Experiences and satisfaction of healthcare providers by Esther van den Bogaart 10 min: Health of the population measured with health related quality of life outcomes by Mariëlle Kroese 15 min: Effects of PC+ on the healthcare costs by Niels Hameleers 10 min: Lessons learned by Daan Westra 25 min: Discussion (led by Dirk Ruwaard) Target audience: researchers, healthcare providers, healthcare insurers and policy makers Learnings/Take away: We will share our experiences with the audience regarding the evaluation of PC+ on Quadruple Aim outcomes and the do’s and don’ts for all stakeholders on how to start and implement new healthcare delivery models, such as PC+.