Development and Implementation of a Nurse-Led Model of Care Coordination to Provide Health-Sector Continuity of Care for People With Multimorbidity: Protocol for a Mixed Methods Study

Abstract

BackgroundInnovative strategies are required to reduce care fragmentation for people with multimorbidity. Coordinated models of health care delivery need to be adopted to deliver consumer-centered continuity of care. Nurse-led services have emerged over the past 20 years as evidence-based structured models of care delivery, providing a range of positive and coordinated health care outcomes. Although nurse-led services are effective in a range of clinical settings, strategies to improve continuity of care across the secondary and primary health care sectors for people with multimorbidity have not been examined.ObjectiveTo implement a nurse-led model of care coordination from a multidisciplinary outpatient setting and provide continuity of care between the secondary and primary health care sectors for people with multimorbidity.MethodsThis action research mixed methods study will have two phases. Phase 1 includes a systematic review, stakeholder forums, and validation workshop to collaboratively develop a model of care for a nurse-led care coordination service. Phase 2, through a series of iterative action research cycles, will implement a nurse-led model of care coordination in a multidisciplinary outpatient setting. Three to five iterative action research cycles will allow the model to be refined and further developed with multiple data collection points throughout.ResultsPilot implementation of the model of care coordination commenced in October 2018. Formal study recruitment commenced in May 2019 and the intervention and follow-up phases are ongoing. The results of the data analysis are expected to be available by March 2020.ConclusionsNursing, clinician, and patient outcomes and experiences with the nurse-led model of care coordination will provide a template to improve continuity of care between the secondary and primary health care systems. The model template may provide a future pathway for implementation of nurse-led services both nationally and internationally.International Registered Report Identifier (IRRID)DERR1-10.2196/15006

Continuity of care for people with multimorbidity: the development of a model for a nurse-led care coordination service

“…The broader study used recognised and validated instruments to collect data in relation to continuity of care, patient-centredness, workplace culture and the nurses' practice role. 1 A concurrent approach to data collection using quantitative and qualitative methods within cycles allowed both sets of data to be interpreted together, providing a richer and more comprehensive response to research questions. 1,52 This study, (Phase 1) focusing on stakeholder consultation and validation, adapted Braun and Clarke's methodology of thematic analysis, 53 to categorise and synthesise data into a workable model that could later guide the implementation of the nurse-led service.…”

“…1 A concurrent approach to data collection using quantitative and qualitative methods within cycles allowed both sets of data to be interpreted together, providing a richer and more comprehensive response to research questions. 1,52 This study, (Phase 1) focusing on stakeholder consultation and validation, adapted Braun and Clarke's methodology of thematic analysis, 53 to categorise and synthesise data into a workable model that could later guide the implementation of the nurse-led service. Finally, the consultation data and model domains were aligned with literature evidence and preliminary results of the systematic review (PROSPERO registration number: CRD42018095780, submitted).…”

“…Reporting on the stakeholder engagement process aimed to capture stakeholder knowledge and experience by combining pragmatism and idealism into a workable model that addressed patient care delivered across the secondary and primary health care sectors. 1 Phase 2 (to be reported in a subsequent paper) included further action research cycles, with a mixed methods approach and multiple data collection points with validated data collection tools. 1 Phase 2 focused firstly on operationalising the model with implementation of service protocols, procedures, clinical guidelines, and the lead nurse care coordinator role, and secondly on evaluation of the nurses', multidisciplinary staff and patients' experiences of the nurse-led care coordination service and model.…”

“…1 Phase 2 (to be reported in a subsequent paper) included further action research cycles, with a mixed methods approach and multiple data collection points with validated data collection tools. 1 Phase 2 focused firstly on operationalising the model with implementation of service protocols, procedures, clinical guidelines, and the lead nurse care coordinator role, and secondly on evaluation of the nurses', multidisciplinary staff and patients' experiences of the nurse-led care coordination service and model.…”

“…This article, the first in a series of two, is part of a broader action research study to evaluate the feasibility of a nurseled care coordination service to improve continuity of care for people with multimorbidity. 1 This paper reports on the development of a model for nurse-led care coordination using stakeholder consultation and validation processes as part of the first action research cycle within a broader study. The second paper in the series reports on an implementation study and evaluates the model as part of subsequent action research cycles.…”