A clinical process redesign project to improve outcomes and reduce care variance for people with Parkinson's disease

Harris, M. Jackuelyn; Fry, Margaret; Fitzpatrick, Lesley

doi:10.1016/j.auec.2019.02.001

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…All the other care models were generic in terms of the health care needs of persons with PD. One study reported an inpatient care coordination model specific to PD patients presenting to the emergency department . Strategies for care coordination varied — a majority of the models involved a point of contact for the patient or caregiver who functioned as a manager to coordinate communication and consultations among the patient and other providers.…”

Section: Resultsmentioning

confidence: 99%

“…Strategies for care coordination varied — a majority of the models involved a point of contact for the patient or caregiver who functioned as a manager to coordinate communication and consultations among the patient and other providers. The primary coordinator role was taken up by specialist nurses, movement disorders neurologists, or others such as the social worker . This eliminated the need for the entire care team to be present at a single site at the same time.…”

Section: Resultsmentioning

confidence: 99%

“…We included 48 records in the qualitative review, from which 37 studies met the inclusion and exclusion criteria. The study characteristics of 8 randomized, controlled trials (RCTs) included in the quantitative meta‐analysis and 19 other experimental studies included in the systematic review are presented in Table . The remaining 10 articles included in our systematic review were nonexperimental (ie, review articles or descriptions of care models) and are detailed separately in Supplementary Table 1 …”

Section: Resultsmentioning

confidence: 99%

“…2 for geographical map), although large parts of the world remained underrepresented. Table presents the characteristics and results of all studies, including the RCTs included in the meta‐analysis, as well as other studies included in the systematic review (nonrandomized, controlled trials, pretest/posttest designs, observational cohort studies, and retrospective chart reviews) . In the online supplementary materials, Supplementary Table 1 presents articles with detailed descriptions of proposed care models and other related reviews of care models specific to integrated care in PD .…”

Section: Resultsmentioning

confidence: 99%

“…The majority of care models incorporated elements from 2 broad themes with overlapping features. Many studies (n = 26) focused on the process of care coordination including medical and surgical management, consultations, and allied health care . The other major theme was delivery of multidisciplinary rehabilitation in various settings (n = 11) .…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

et al. 2020

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Background Quality of life in Parkinson's disease (PD) is affected by motor and nonmotor symptoms, necessitating an integrated care approach. Existing care models vary considerably in numerous domains. The objectives of this study were to perform a systematic review and meta‐analysis of PD integrated care models and develop recommendations for a representative model. Methods We conducted a systematic review of published integrated care models and a meta‐analysis of randomized, controlled trials examining integrated care versus standard care. The primary outcome was health‐related quality of life using a validated PD scale. We evaluated levels of care integration using the Rainbow Model of Integrated Care. Results Forty‐eight publications were identified, including 8 randomized, controlled trials with health‐related quality of life data (n = 1,149 total PD patients). Qualitative evaluation of individual care model integration guided by the Rainbow Model of Integrated Care revealed frequent clinical and professional integration, but infrequent organizational and population‐based integration elements. Meta‐analysis of randomized, controlled trials revealed significant heterogeneity (I2 = 90%, P < 0.0001). Subgroup analysis including only outpatient care models (n = 5) indicated homogeneity of effects (I2 = 0%, P = 0.52) and improved health‐related quality of life favoring integrated care, with a small effect size (standardized mean difference [SMD], −0.17; 95% CI, −0.31 to −0.03; P = 0.02). Conclusions Outpatient integrated PD care models may improve patient‐reported health‐related quality of life compared with standard care; however, because of variable methodological approaches and a high risk of bias related to inherent difficulties in study design (eg, blinding of participants and interventionists), generalizability of these results are difficult to establish. The Rainbow Model of Integrated Care is a promising method of evaluating elements and levels of integration from individual patient care to population health in a PD context. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, LLC. on behalf of International Parkinson and Movement Disorder Society.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

et al. 2020

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Quality Improvement in Parkinson’s Disease: A Successful Program to Enhance Timely Administration of Levodopa in the Hospital

Nance¹,

Boettcher

Edinger

et al. 2020

JPD

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Background: Patients hospitalized with Parkinson’s disease (PD) require timely delivery of carbidopa-levodopa (C/L) medication. Ill-timed administration of C/L doses is associated with greater morbidity and longer lengths of stay. Objective: To understand the barriers to timely C/L administration, and implement strategies to improve the administration of the drug to hospitalized PD patients. Methods: Several key strategies were employed in 2015 to improve the timely delivery of C/L doses: 1. three kinds of nursing alert in the electronic medical record (EMR); 2. staff in-service education; 3. stocking immediate-release C/L into automated medication dispensing machines on key hospital units; 4. reports to nurse unit managers on timeliness of C/L administration; and 5. reconciliation of inpatient and outpatient levodopa orders by the hospital pharmacist upon admission. The primary outcome was the percent of C/L doses administered within 60, 30, and 15 minutes of scheduled time. Results: Our urban hospital, affiliated with a Parkinson’s Foundation Center of Excellence, had 5,939 C/L administrations in 2018. There was sustained improvement in timely delivery of doses, from 89.3% in 2012 to 96.5% in 2018 (within 60 minutes of the scheduled time), 65.5% to 86.4% (30 minutes), and 42.3% to 71.1% (15 minutes) (all p < 0.001). Conclusions: With multifaceted but relatively simple measures, we were able to “change the culture” so that hospitalized patients with Parkinson’s disease receive levodopa on time.

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Improvement in Medication Adherence Using TV Programmes as Reminders

Saha

Adhikary

Jha

et al. 2021

International Journal of Asian Business and Information Management

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According to WHO, only 50% of patients adhere to chronic therapy. The problem of non-adherence has persisted over decades. Over 197 million Indian households have TV sets, and on average Indians spend 3 hours, 44 minutes watching television. A TV programme is used as intervention by patients to improve medication adherence rates. The objective of the research is to find the effect of TV programmes as a form of reminder in improving medication adherence. With the help of a structured questionnaire, the information about medication adherence behaviour was obtained from patients suffering from different types of diseases in the state of Sikkim, India. It has been found that when patients use TV programmes as a form of reminder, the odds of missing the medication consciously reduces by 45.9%. At a personal level, the probability that a person will not miss the time of medication is 42.3% higher compared to when it is not used, and if the total population is considered, 15.6% fewer people would not be missing the medication at all when the reminder is used.

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A clinical process redesign project to improve outcomes and reduce care variance for people with Parkinson's disease

Cited by 5 publications

References 20 publications

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

Quality Improvement in Parkinson’s Disease: A Successful Program to Enhance Timely Administration of Levodopa in the Hospital

Improvement in Medication Adherence Using TV Programmes as Reminders

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