The Sustainability of an Integrated Team-based Chronic Disease Management Program in Primary Care: An In-depth Exploration of Best Care COPD
Notice bibliographique
Résumé
Background: In Canada, a large proportion of health service utilization and death is accounted for by Chronic Obstructive Pulmonary Disease (COPD), a complex chronic disease that is often under-diagnosed and under-treated. The literature identifies that appropriate and beneficial care for patients with COPD includes the use of integrated team-based models of care. While using this model of care is widely supported, there is a gap in evidence on how to support the sustainability of these programs in primary care, post-implementation. The Best Care COPD (BCC) Program has been implemented across Southwestern Ontario, Canada and has been successful in delivering integrated team-based care with a focus on improving patient outcomes, as well as patient and provider satisfaction. Approach: This research study aims to explore the sustainability of an integrated team-based care program, known as BCC. Through this, we will gain a better understanding of the factors that affect and what mechanisms enable sustainability in an integrated team-based care program. A collective case study approach guided by a constructivist paradigm was used to focus on sites in which the BCC program has been implemented for one year or more (post-initial implementation). We used the Program Sustainability Assessment Tool (PSAT) to better understand adaptations that were made over the course of implementation and the way in which these interact to impact sustainability of the BCC program. Additionally, we conducted 2 semi-structured interviews with respiratory therapists, primary care providers, executive leadership, and BCC program leaders. We conducted four focus groups with respiratory therapists (n=20) to gain an understanding of the team dynamic within an integrated team-based model and gain knowledge on the collective experience on adaptation and sustainability of BCC. Moreover, we conducted document analysis to broaden the knowledge base regarding the sustainability of chronic disease management programs. Results: Preliminary findings indicate strategic planning, strong stakeholder partnerships, along with funding stability are necessary factors to support the sustainability of the BCC program within the context of primary care. Furthermore, mechanisms such as program fidelity, establishing collaborative empowerment and practice-based evidence are mechanisms that enabled the BCC program within the context of primary care. Implications: The findings of this study will provide a clearer understanding of strategies to support sustainability for integrated team-based care. Currently, sustainability is recognized as a challenge in translational research; this study can be used as a base for improving implementation processes within integrated team-based models of care ultimately to ensure high quality and sustainable patient care. Future research will include a deeper exploration of patient perspectives on the importance of sustaining integrated team-based care programs as well as implications for scale and spread.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,017 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,007 | 0,007 |
| Communication savante | 0,005 | 0,004 |
| Science ouverte | 0,001 | 0,005 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».