Improving chronic illness care: Implementation and evaluation of interdisciplinary and patient-centred care
Bibliographic record
Abstract
The prevalence of chronic diseases and conditions is steadily increasing in Canada and globally. Despite the availability of effective therapies, the management of chronic diseases remains far from optimal. Several reports and practice guidelines recommend that care should be patient-centred and delivered by health care teams as means to empower patients to engage in their own care decisions, enhance coordination of care, and make more efficient use of resources, ultimately leading to improved patient outcomes and safety. However, many challenges remain in implementing these approaches, including assessing and accumulating evidence on their effectiveness. The overall aim of this thesis is to contribute to evidence-informed patient-centred and interdisciplinary team (IDT) care in the context of quality chronic illness care through two interrelated research projects. Using a population-based survey, the first project assessed the level of support for patient-centred care (PCC) amongst the Canadian public and among health professionals. Significant associations were identified between support for PCC and support for both team-based care and the use of health information technology. These associations were identified from both the public and health professionals' perspectives. The second project used a convergent mixed methods design to investigate experiences of primary interdisciplinary care for low back pain. For the qualitative component, I employed a phenomenological approach to better understand the delivery and perceived impact of IDT care. The quantitative component used the Patient Assessment of Chronic Illness Care (PACIC) questionnaire to evaluate change in patient experience and to estimate the impact of patient and process variables on patient experience. The findings from the two components were reviewed for convergence, complementarity and discrepancy. Findings from project 1 suggest that implementation of health care teams supported by information and communication technologies are needed to deliver PCC. From the perspective of the participants in the qualitative inquiry of project 2, IDT care contributed to effective and patient-centred primary care. The quantitative component showed improved experience of care for the majority of the participants but did not demonstrate significant associations between change in experience of care and patient and process outcomes. Overall, implementing an IDT appears to be an appropriate approach to deliver PCC and improve the quality of chronic illness care. Based on these analyses, I propose strategies to help improve the implementation of IDT programs for low back pain. These recommendations can also inform similar primary care programs for other chronic conditions. Directions for future research include further evaluation of the structure and construct validity of the PACIC, and continued investigation of the relationships between PCC, patient experience, patient factors, and outcomes.
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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 | 0.155 | 0.174 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.004 | 0.004 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.004 | 0.008 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 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".