ABSTRACT
1. Label the strategies used in implementing palliative care programs and demonstrate how the various strategies impacted acceptability and adoption. 2. Connect implementation strategies with teaming concepts, both within palliative care teams and between teams (ie, palliative care with oncology, primary care, or other specialty care teams). Implementation strategies are methods or techniques used to improve the adoption of new practices. Team-based health care, or teaming—which is when at least two providers work collaboratively within and across settings to achieve high-quality coordinated patient care—is necessary for successful palliative care. Understanding which strategies are related to teaming and their importance in different settings is essential for achieving desired outcomes in palliative care. Identify and compare implementation strategies related to teaming used by six diverse health systems in expanding palliative care services Sixty-five longitudinal interviews conducted over 2 years with implementers representing academic, large nonprofit, public, and community hospitals. Content analysis using the Expert Recommendations for Implementing Change (ERIC) strategies and strategy domains for categorizing implementation strategies. More than 35 of the 73 ERIC strategies were identified;strategies related to teaming fell primarily into three domains: 1) support clinicians, 2) train and educate stakeholders, and 3) develop stakeholder interrelationships. Creating new clinical teams (support clinicians) where there were previously none was an essential strategy;those unable to fully staff their teams experienced program establishment delays. Ongoing training, specifically in-person group trainings, and educational meetings (train and educate stakeholders) by the palliative care team to promote awareness and competencies within and across teams, were hindered by the COVID-19 pandemic, limiting initial adoption. Developing stakeholder interrelationships, particularly involving executive boards/leadership, was perceived as a necessary ongoing strategy for program establishment, adoption, and sustainability. Strategies related to teaming include creating palliative care teams, training and educating the interdisciplinary team and referring providers, and establishing relationships with providers and leadership, which impact the acceptability and adoption of palliative care services. Strategies promoting within and cross team relationships, education, and clinician support are necessary when expanding palliative care services and should be continuous. [ FROM AUTHOR] Copyright of Journal of Pain & Symptom Management is the property of Elsevier B.V. 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 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 . (Copyright applies to all s.)
ABSTRACT
BACKGROUND: The COVID-19 pandemic led to rapid adaptations among palliative care services, but it is unclear how these adaptations vary in relation to their unique organizational contexts. AIM: Understand how the pandemic impacted the implementation of new and existing palliative care programs in diverse hospital systems using the Dynamic Sustainability Framework. DESIGN: Twelve in-depth interviews with 15 key informants representing palliative care programs from seven hospital systems between April and June 2020. SETTING: Public, not-for-profit private, community, and academic teaching hospitals in the San Francisco Bay Area with existing palliative care programs that were expanding services to new clinical areas (e.g. new outpatient clinic or community-based care). RESULTS: Six themes characterized how palliative care programs were impacted and adapted during the early stages of the COVID-19 pandemic: palliative care involvement in preparing for surge, increased emphasis on advance care planning, advocating for visitors for dying patients, providing emotional support to clinicians, adopting virtual approaches to care, and gaps in chaplaincy support. There was variation in how new and existing programs were able to adapt to early pandemic stresses; systems with new outpatient programs struggled to utilize their programs effectively during the crisis onset. CONCLUSIONS: The fit between palliative care programs and practice setting was critical to program resiliency during the early stages of the pandemic. Reconceptualizing the Dynamic Sustainability Framework to reflect a bidirectional relationship between ecological system, practice setting, and intervention levels might better guide implementers and researchers in understanding how ecological/macro changes can influence interventions on the ground.
ABSTRACT
BACKGROUND: Our goals are to quantify the impact on acute care utilization of a specialized COVID-19 clinic with an integrated remote patient monitoring program in an academic medical center and further examine these data with stakeholder perceptions of clinic effectiveness and acceptability. METHODS: A retrospective cohort was drawn from enrolled and unenrolled ambulatory patients who tested positive in May through September 2020 matched on age, presence of comorbidities and other factors. Qualitative semi-structured interviews with patients, frontline clinician, and administrators were analyzed in an inductive-deductive approach to identify key themes. RESULTS: Enrolled patients were more likely to be hospitalized than unenrolled patients (N = 11/137 in enrolled vs 2/126 unenrolled, p = .02), reflecting a higher admittance rate following emergency department (ED) events among the enrolled vs unenrolled, though this was not a significant difference (46% vs 25%, respectively, p = .32). Thirty-eight qualitative interviews conducted June to October 2020 revealed broad stakeholder belief in the clinic's support of appropriate care escalation. Contrary to beliefs the clinic reduced inappropriate care utilization, no difference was seen between enrolled and unenrolled patients who presented to the ED and were not admitted (N = 10/137 in enrolled vs 8/126 unenrolled, p = .76). Administrators and providers described the clinic's integral role in allowing health services to resume in other areas of the health system following an initial lockdown. CONCLUSIONS: Acute care utilization and multi-stakeholder interviews suggest heightened outpatient observation through a specialized COVID-19 clinic and remote patient monitoring program may have contributed to an increase in appropriate acute care utilization. The clinic's role securing safe reopening of health services systemwide was endorsed as a primary, if unmeasured, benefit.
Subject(s)
COVID-19 , Ambulatory Care Facilities , COVID-19/epidemiology , Communicable Disease Control , Humans , Monitoring, Physiologic/methods , Retrospective StudiesABSTRACT
PURPOSE: Pre-visit planning (PVP) is believed to improve effectiveness, efficiency, and experience of care, yet numerous implementation barriers exist. There are opportunities for technology-enabled and artificial intelligence (AI) support to augment existing human-driven PVP processes-from appointment reminders and pre-visit questionnaires to pre-visit order sets and care gap closures. This study aimed to explore the current state of PVP, barriers to implementation, evidence of impact, and potential use of non-AI and AI tools to support PVP. METHODS: We used an environmental scan approach involving: (1) literature review; (2) key informant interviews with PVP experts in ambulatory care; and (3) a search of the public domain for technology-enabled and AI solutions that support PVP. We then synthesized the findings using a qualitative matrix analysis. RESULTS: We found 26 unique PVP implementations in the literature and conducted 16 key informant interviews. Demonstration of impact is typically limited to process outcomes, with improved patient outcomes remaining elusive. Our key informants reported that many PVP barriers are human effort-related and see potential for non-AI and AI technologies to support certain aspects of PVP. We identified 8 examples of commercially available technology-enabled tools that support PVP, some with AI capabilities; however, few of these have been independently evaluated. CONCLUSIONS: As health systems transition toward value-based payment models in a world where the coronavirus disease 2019 pandemic has shifted patient care into the virtual space, PVP activities-driven by humans and supported by technology-may become more important and powerful and should be rigorously evaluated.