Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention
| Autor: | Deborah Wise Harris, Patricia O'Campo, Molyn Leszcz, Agnes Gozdzik, Donald Wasylenki, Vicky Stergiopoulos, Paul Kurdyak, Deborah Kahan, Stephen W. Hwang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Health informatics Health Services Accessibility Health administration 03 medical and health sciences 0302 clinical medicine Nursing Mental health and addictions Health care medicine Humans 030212 general & internal medicine Frequent emergency department users business.industry Health Priorities Health Policy Nursing research Public health Stakeholder Urban Health 030208 emergency & critical care medicine Focus Groups Patient Acceptance of Health Care medicine.disease Mental health Transitions of care Evaluation Studies as Topic Brief intensive case management Medical emergency Brief intervention business Emergency Service Hospital Case Management Research Article |
| Zdroj: | BMC Health Services Research |
| ISSN: | 1472-6963 |
| Popis: | Background Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Methods Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experience with the intervention and factors that helped or hindered successful early implementation. Qualitative data were analyzed using thematic analysis. Results Stakeholders valued the intervention and its potential to support continuity of care for this population. Service delivery system factors, including organizational capacity and a history of collaborative relationships across the healthcare continuum, and support system factors, such as training and supervision, emerged as key facilitators of program implementation. Operational challenges included early low program referral rates, management of a multi-organizational initiative, variable adherence to the model among participating organizations, and scant access to specialty psychiatric resources. Factors contributing to these challenges included lack of dedicated staff in the ED and limited local system capacity to support this population, and insufficient training and technical assistance available to participating organizations. Conclusions A multi-organizational brief intervention is an acceptable model to support integration of hospital, primary and community care for frequent ED users. The study highlights the importance of early implementation evaluation to identify potential solutions to implementation barriers that may be applicable to many jurisdictions. |
| Databáze: | OpenAIRE |
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