Managing Care Pathways For Patients With Complex Care Needs

One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.

This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

This book examines the nature of service design and service thinking in healthcare and hospital management. By adopting both a service-based provider perspective and a consumer-oriented perspective, the book highlights various healthcare services, methods and tools that are desirable for customers and effective for healthcare providers. In addition, readers will learn about new research directions, as well as strategies and innovations to develop service solutions that are affordable, sustainable, and consumer-oriented. Lastly, the book discusses policy options to improve the service delivery process and customer satisfaction in the healthcare and hospital sector. The contributors cover various aspects and fields of application of service design and service thinking, including service design processes, tools and methods; service blueprints and service delivery; creation and implementation of services; interaction design and user experience; design of service touchpoints and service interfaces; service excellence and service innovation. The book will appeal to all scholars and practitioners in the hospital and healthcare sector who are interested in organizational development, service business model innovation, customer involvement and perceptions, and service experience.

This title provides professionals who care for the dying with a user-friendly guide on how to render the best possible treatment.

Comprehensive and in-depth guide provides the expertise of more than 100 of the nation's top professionals.

The first-ever step-by-step guide to the full continuum of care! Includes 30 pathways, each covering prehospital admission, acute care, and home care; multidisciplinary care interventions; medical, surgical, and psychosocial problems; and patient outcomes, patient teaching, and nursing research. Contents include contributors, consultants, and reviewers; preface; overview; respiratory problems; cardiovascular problems; metabolic function problems; cancer; renal disorders; musculoskeletal problems; neurologic problems; bowel elimination problems; pressure ulcers; psychiatric disorders; appendices, including NANDA-approved nursing diagnoses and national resources; selected references; and index.

This issue covers topics central to the management of the patient with a chronic disease by taking a comprehenisve look at: Successful/Innovative Models in Chronic Disease Management, The Patient-Centered Medical Home, Self-Management Education and Support, Major Pharmacologic Issues in Chronic Disease Management, Health Information Technology, Community-Based Partnerships for Improving Chronic Disease Management, and Effective Strategies for Behavioral Change, Diabetes Management, CHF Management, Asthma Management, and Depression Management.

This volume provides integral knowledge of all aspects of stroke care and rehabilitation after stroke, and is therefore highly relevant for nurses who work in rehabilitation centers. It outlines the several phases after stroke, for example the type of care patients may receive in the chronically phase at home. Nurses will obtain knowledge about treatment, importance of observation and caring with a special focus on communication problems, swallowing problems, activities of daily living, urinary and defecation problems, shoulder and hand issues. Thanks to photographs, nurses will learn to transfer patients in the adequate positions. Several chapters provide nurses with examples of effective and efficient collaboration with multidisciplinary professionals, informal caregivers and patients themselves. There is also an emphasis on behavior and cognitive functioning. And lastly, in the final chapters authors highlight the organization of rehabilitation and integrated care issues. Nurses play a very important role in rehabilitation, education, counseling, prevention, and caring for patients with cerebrovascular accident (CVA). In caring for stroke patients, nurses need specific competences and abilities that go beyond the general neurologic knowledge and experience. Nurses need to collaborate in an efficient and effective manner with multidisciplinary team members in their organization and across organizations. This book discusses medical aspects and specific symptoms of a stroke, as well as the limitations that patients experience, and which interventions are indicated for recovery.