The information requirements in both situations are similar, but the organization of participants either facilitates or impedes information flow.
Instead, several key concepts offer important lessons to consider in designing and evaluating new approaches to care coordination. Self-management support takes the form of an operational process of standardization in the case of a tool kit with tracking forms and action plans.
Such application of the frameworks presented in this chapter Frameworks of care assessments applied to childcare provide a useful way for systems level decisionmakers to characterize and assess specific approaches embedded in demonstration projects and used within health care delivery organizations.
Protective Capacities and Protective Factors: Another take-home point from this framework is that the positioning of care coordination implies that it is one of many important care processes, and therefore does not act in a vacuum even at the level of service delivery.
The choices of appropriate interventions to improve coordination are likely to be more self-evident by breaking the analysis up into discrete coordination problems. The coordinating process would be teamwork, and the outcomes would be the same as in the first case. When the collaborative scores of all clinician groups were evaluated simultaneously, however, the relationship between collaboration and mortality failed to reach statistical significance.
In other words, the designs of structures for information-processing affect the ability of the participants to get the information they need to carry out their respective patient care activities.
Thus, application of this model involves potentially focusing on discrete elements of care coordination e. Regulating all child-care operations and child-placing agencies to protect the health, safety, and well-being of children in care.
Similarly, the practice team must be prepared through receiving adequate information. These tools are considered to be most effective when they are directly connected to service planning and monitoring ongoing progress of the case.
Many studies outside of and within health care have focused on the effects of factors associated with organizational decisions on coordination and organizational effectiveness. Classification of predisposing characteristics and enabling resources is a function of point of view.
Decision support occurs as an operational process of adjustment in the case of a system that generates regular feedback for clinical teams on guideline compliance from registry data, or simply an organizational support to help facilitate other coordination mechanisms.
Risk assessment is the collection and analysis of information to determine the degree to which key factors are present in a family situation that increase the likelihood of future maltreatment to a child or adolescent.
However, the leader of the same system may make a choice about whether to invest in information systems, making the same factor an enabling resource.
For those decisionmakers who have a span of control within one organization that provides integrated care to patients, the organizational design framework could readily apply, and offer a way to generate potential solutions appropriate to the particular demands of a care coordination problem.
The organizational theory literature describes the relationships among organizations that together produce a good or a service; however, a detailed review of this information is outside the scope of this report. The idea behind predisposing characteristics is that they are not easily altered.
To present these concepts as accessibly as possible, we anchor our discussion using a framework of formal coordinating mechanisms from organizational design research.
For example, a patient diagnosed with prostate cancer might be rapidly seen by his primary care physician, a urologist, and a radiation oncologist to determine the best course of treatment. The subsequent sections highlight some of the important methodological challenges in measuring concepts specifically related to care coordination.
By system-level policymakers e. The patient, of course, offers another key perspective to consider as we explore and apply specific frameworks. The general organizational design framework shown in Figure 5 characterizes organizations as information-processing systems, where the flow of information among participants is a function of the demands of the situation and the capabilities of the organization to move information to where it is needed.
Coordinating care better is only beneficial if other aspects of care delivery are optimized as well. Practice guidelines, care maps and protocols are examples of standardization Table In particular, variability in outcomes from different interventions to improve care coordination may be due in part to differences in the effectiveness of these interventions in improving relationships among interdependent clinicians.
Methodological Approach Similar to the methods described in detail in Chapter 3, we used iterative searches to identify literature describing conceptual frameworks and associated empirical evidence related to care coordination. Interventions to improve care coordination typically involve changes to enabling resources e.
A focus group of hospitalized patients found that patients perceived that clear communication reflected good care coordination, and had varying opinions about who has responsibility for coordination e. Examples of these mechanisms that operate mostly at the service delivery level include designating participants as liaisons e.
Grouping involves putting participants together or separating them into units.
Assessing these outcomes is important in all evaluations of care coordination interventions. Delivery system re-design could reflect structural linking when telemedicine for rural patients is implemented, or grouping when nurse educator is included in a planned diabetes visit, or the operational process of monitoring with group visits.
First, different situations produce variable information requirements, as shown on the left side of Figure 5. Depending upon the particular local environment, they make decisions related to care coordination to maximize health care outcomes and profit.
Table 18 Summary of relationship of concepts across frameworks.
Thus, the service-level decisionmaker and the systems-level decisionmaker will have different views of predisposing characteristics versus enabling resources. This latter concept is well-known as the outcomes of medical care.Sep 16, · Forum for students doing their Certificate 3 in Childcare Studies.
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