Avoided Hospitalization Criteria: Validating the Impact of a Community-Based Palliative Care Program.

Objective: This report describes the experiences of a community-based palliative care (CBPC) program's efforts to understand the patterns of hospital utilization, specifically utilization reduction experienced by admitted patients. Efforts to quantify and describe an avoided hospitalization and opportunities to use these data to strengthen partnerships with local insurance payers to assure sustainability of the CBPC will be discussed. Background: Patients with serious chronic illness experience emergency room care and hospitalizations with increasing frequency as their health deteriorates. CBPC programs are well positioned to decrease hospital utilization by early involvement and improved care management. Methods: Arizona Palliative Home Care (AZPHC) program is a free standing CBPC in Maricopa County, Arizona, serving 3300 patients annually. An interdisciplinary team was formed within the CBPC to facilitate the identification of avoided hospital events and communicate these data to community partners in an effective and consistent manner. The processes developed by this team are described. Results: AZPHC has enhanced its hospitalization avoidance strategies by communicating the rate of hospitalization avoidance events in a consistent and strategic manner. Providing instances of avoided hospitalizations with accompanying patient narratives to payers has enabled AZPHC to demonstrate the impact the CBPC has on improving quality of care and reducing overall costs. Discussion: CBPC programs require payment for sustainability; therefore, partnerships with local insurance payers are essential. Presenting data that validate the impact of a program from a clinical and financial perspective will advance the growth of payer-CBPC provider relationships and secure a future for funded CBPC programs.

Collaborative priority setting for human immunodeficiency virus rehabilitation research: A case report.

BACKGROUND: The inclusion of community members and other stakeholders in the establishment of research priorities is vital to ensuring that priorities are congruent with the main concerns of affected communities. PURPOSE: The purpose of this project was to identify priority research topics for addressing the activity and community participation needs of people living with human immunodeficiency virus (HIV) and meaningfully involve multiple stakeholders in the development of those priorities. METHOD: We invited people living with HIV, researchers, service providers, and policy makers to a 2-day forum. Twenty-six people participated in developing priorities through the application of two methodologies, the World Café and Dotmocracy. We evaluated the forum though immediate dialogue and a postproject survey. FINDINGS: Participants identified 10 high-priority research topics. Evaluation findings highlighted positive substantive, instrumental, personal, and normative outcomes of stakeholder involvement. IMPLICATIONS: The identified priority topics can guide future occupational therapy practice and research in this emerging area.

Conceptualising professionalism in occupational therapy through a Western lens.

INTRODUCTION: The term professionalism is embedded within curriculum and occupational therapy documents, yet, explicit discussion of the concept is lacking in the literature. This paper strives for a greater understanding of how professionalism is currently conceptualised within Western occupational therapy literature. METHODS: A broad literature search was conducted and included international peer-reviewed and grey literature from Western cultures including Australia, Canada, New Zealand, the United Kingdom and the United States. To enrich understanding, some documents from medicine were also included. FINDINGS: Professionalism is widely upheld as a core construct of occupational therapy. However, an evidence-based consensus of the specific elements of professionalism guiding occupational therapy practice is lacking. Currently, understanding of professionalism is largely based on multiple, isolated concepts presented in Western professional association documents. RELEVANCE TO CLINICAL PRACTICE: Acknowledging the multifaceted and multicultural nature of professionalism is essential to begin systematically delineating and conceptualising elements of professionalism specific to occupational therapy. LIMITATIONS: This review has been conducted from a solely Western cultural lens. RECOMMENDATIONS FOR FURTHER RESEARCH: Additional work to highlight differences specific to international contexts, cultures, and societal influences is needed to enrich the understanding of professionalism in occupational therapy practice.

Professionalism and occupational therapy: an exploration of faculty and students' perspectives.

BACKGROUND: Professionalism is a complex, multifaceted concept embedded within the curricula of occupational therapy programs and professional documents; yet there is no clear explanation in the literature. PURPOSE: To explore occupational therapy faculty and students' perspectives of the meaning of professionalism. METHODS: This interpretivist qualitative study used convenience sampling to recruit eight second-year occupational therapy master's students and five occupational therapy faculty members to participate in two separate focus groups. Open-coding and constant comparative methods were used to identify themes. FINDINGS: Data analysis yielded the following student focus group themes: uncertainty about professional expectations; searching for answers through concrete concepts; and the context-specific nature of professionalism. Faculty focus group themes were professional responsibility; professional awareness; and the context-specific nature of professionalism. Understanding and enacting professionalism may be a developmental process. IMPLICATIONS: Further exploration of the meaning of professionalism from a variety of other occupational therapy stakeholders is needed.