Introduction of Network-Based Healthcare at Kaiser Permanente

Abstract

Background: Early 2014, Kaiser Permanente decided to adopt an innovative model for network-based allied healthcare for persons with Parkinson's disease (PD), based on the principles of the Dutch ParkinsonNet. Objective: We present the interventions that were performed to implement this method at Kaiser Permanente and we show the first outcomes based on these interventions. Methods: In this study, 57 physical therapists, 18 speech therapists and 20 occupational therapists, as well as 13 medical centers across the state of California were included. Nine interventions were performed more or less simultaneously, including training and education of healthcare providers and patients, a train the trainer curriculum, organizing IT, streamlining referral processes and building networks. Results: At the start, less than 30% of the patients within the Southern California Region received specialized allied health treatment (consisting of, i.e., gait training, voice training or guidance in activities of daily life). After one year, almost 55% of patients received specialized allied health treatment. In the second year, this number increased to just under 67%, suggesting a sustained concentration of care (the second core component of networked care). This can be seen as a first indicator for successful implementation of the ParkinsonNet network at Kaiser Permanente. Conclusions: The importance of these findings lies in the fact that a healthcare innovation that proved effective in one country can be transferred successfully to another country and to another healthcare system.

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

“…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 …”

“…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 .…”

“…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) .…”

“…The other major theme was delivery of multidisciplinary rehabilitation in various settings (n = 11) . Among the care coordination models, 24 were primarily based in the outpatient setting with or without care coverage extending to home or community . Two models were specifically tailored for perioperative evaluation of patients for deep brain stimulation, and another targeted neuropsychiatric symptoms in a comprehensive manner .…”

Patient-centred management of Parkinson's disease – Authors' reply

“…We were encouraged to note that specialised allied health-care programmes, which were originally developed in the Netherlands, could be transferred successfully to a different health-care setting in another country with modifications dictated by the regional availability of resources. 2 …”