The Sustainability of an Integrated Team-based Chronic Disease Management Program in Primary Care: An In-depth Exploration of Best Care COPD
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.007 | 0.007 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.001 | 0.005 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".