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Collaboration and Coordination Challenges in Patient-Centered Care: Models and Informaion Services
Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis reports on research focuses on how to deal with the fact that the organization and processesof today’s health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. The overall research goal is to suggest ways in which IT-based solutions can enable and leverage collaboration and coordination insituations where a co-morbid patient is subject to care delivered simultaneously by several different professionals and organizations.

Patient-centered care is defined as quality health and social care achieved through a partnership between informed and respected patients, their families, and coordinated health and social care teams who conduct care activities according to jointly determined care plans.

Against a background of several years of research on patient-centered collaborative care using adesign science approach, using techniques such as focus groups, interviews, and document studies, the author of the thesis has further pursued the work in a project named CoCare. Results show that the care required in aging societies is both a social and a technical challenge. Meeting this challenge will require a redesign of today's health and social care processes in order to focus more clearly on patient needs and values, and poses demands on information services allowing to share knowledge of the patient’s health and social situation among involved care providers. An important aspect of the increased complexity is that a single patient may need care from several autonomous care providers in parallel, particularly patients with co-morbidities. This clearly requires effective coordination of care activities, which poses further demands on information services to support this task.

A set of issues involving patient-centered collaborative care is identified and analyzed. The thesis introduces the notions of the Patient-Centered Care Process (PCCP) and a conglomeration of suchprocesses. A conglomeration comprises a set of PCCPs that concern the same patient, that are overlapping in time, and that share the overall goal of improving and maintaining the health and socialwell-being of the patient. The PCCP is inspired by the well-known PDCA cycle and comprises the four phases of assessing the patient situation (ASSESS), planning care activities (PLAN), performingcare activities (DO) and following up care (CHECK) for the patient. Based on a number of key standards, such as HL7, HISA and CONTsys, the thesis introduces a Patient-Centered Information Model (PCIM). A set of information services, together constituting a Coordination Hub, is proposed. The information services aim to help formal as well as informal carers (including the patient) inconducting care according to the PCCP

The thesis contributes to a deeper understanding of care processes and suggests ways to achieve patient-centered collaborative care that better contributes to creating value for the patient as an individual.

Place, publisher, year, edition, pages
Stockholm: Department of Computer and Systems Sciences, Stockholm University , 2016. , 141 p.
Series
Report Series / Department of Computer & Systems Sciences, ISSN 1101-8526 ; 16:010
Keyword [en]
patient-centered care, healthcare, social care, home care, collaboration, coordination, care processes, processes coordination, multi-sectoral collaboration, communication, information models, information services, management
National Category
Computer and Information Science
Research subject
Computer and Systems Sciences
Identifiers
URN: urn:nbn:se:su:diva-132693ISBN: 978-91-7649-471-4OAI: oai:DiVA.org:su-132693DiVA: diva2:954368
Public defence
2016-10-07, Lilla hörsalen, NOD-huset, Borgarfjordsgatan 12, Kista, 14:00 (Swedish)
Opponent
Supervisors
Available from: 2016-09-14 Created: 2016-08-18 Last updated: 2016-09-05Bibliographically approved
List of papers
1. Scenario for a patient at home in health and social care
Open this publication in new window or tab >>Scenario for a patient at home in health and social care
2014 (English)In: Journal of Healthcare Leadership, ISSN 1179-3201, E-ISSN 1179-3201, no 6, 51-66 p.Article in journal (Refereed) Published
Abstract [en]

This paper describes and discusses the situation for a typical patient with multiple illnesses and how his case would benefit from improved coordination, communication, and collaboration among all involved care providers. The paper is built around a patient case presented in a current scenario. The authors identified that for a single patient with several problems and diagnoses and the involvement of several care actors, the common issues concern lack of collaboration, lack of coordination, and awareness of what others have done to assess, plan, perform, and evaluate care. This presumably leads to a lack of care quality and a lack of effective use of care resources. The scenario and the findings are based on a patient-oriented perspective, on an analysis expressed in focus groups, and on interviews with key actors in health and social care. The paper also discusses the fact that an increasing number of patients are treated in their homes by a variety of organizations, and how this fact raises new and more intense demands on the various stakeholders forming the care staff to collaborate and coordinate care. We point to the need for managers in and between organizations to agree on the ways of collaborating at the operational level. Most importantly, by taking a basic set of issues as the starting point for reasoning, we derived a set of related problems and suggest solutions to deal with these. The literature currently lacks scenario descriptions that put the patient's situation into focus with respect to collaboration between health and social care. Finally, the paper presents a future case for collaboration including support by new e-services.

Keyword
multisectorial collaboration, coordination, communication, patient-centered care, home care, health and social care
National Category
Information Systems Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Computer and Systems Sciences
Identifiers
urn:nbn:se:su:diva-132870 (URN)10.2147/JHL.S68167 (DOI)
External cooperation:
Available from: 2016-08-25 Created: 2016-08-25 Last updated: 2016-08-25Bibliographically approved
2. Need for a New Care Model - Getting to Grips with Collaborative Home Care
Open this publication in new window or tab >>Need for a New Care Model - Getting to Grips with Collaborative Home Care
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2010 (English)In: MEDINFO 2010: Proceedings of the 13th World Congress on Medical Informatics / [ed] C. Safran et al., IOS Press, 2010, 8-12 p.Conference paper (Refereed)
Abstract [en]

In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership, and how this fact places new and severe demands on health care and home service staff to communicate and collaborate. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level and how this aspect needs to be considered during procurement of home care services. Most importantly, by reasoning around a set of problematic areas, we derive a set of related problems and suggest solutions for dealing with them. The solutions are a mix of organizational/administrative measures and IT support for communication and coordination.

Place, publisher, year, edition, pages
IOS Press, 2010
Series
, Studies in Health Technology and Informatics, ISSN 0926-9630 ; 160
Keyword
Collaboration, Home care, Home health care, Home service
National Category
Information Systems Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Computer and Systems Sciences
Identifiers
urn:nbn:se:su:diva-132851 (URN)10.3233/978-1-60750-588-4-8 (DOI)978-1-60750-587-7 (ISBN)978-1-60750-588-4 (ISBN)
External cooperation:
Conference
13th World Congress on Medical and Health Informatics, 12-15 September, Cape Town, South Africa
Available from: 2016-08-25 Created: 2016-08-25 Last updated: 2016-08-25Bibliographically approved
3. CO-CARE - Collaborative Health and Social Care
Open this publication in new window or tab >>CO-CARE - Collaborative Health and Social Care
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2008 (English)In: Proceedings of 13th International Symposium for Health Information Management Research / [ed] P. S. Bath, K. Day, T. Norris, Massey University, New Zealand , 2008, 113-124 p.Conference paper (Refereed)
Abstract [en]

In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership. We explore how this poses new and stronger demands on health care and home service staff, as well as on different managerial and operational levels, to improve their communication and collaboration. We emphasize the need for managers in different organizations to agree on ways and forms of communication and collaboration between the operational levels, and the particular importance of this during procurement of home care services. As a result a number of methodological measures, strategies and IT solutions to support organizational development, coordination and collaboration are suggested.

Place, publisher, year, edition, pages
Massey University, New Zealand, 2008
Keyword
Collaboration, home health care, social care, IT support, management
National Category
Information Systems Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Computer and Systems Sciences
Identifiers
urn:nbn:se:su:diva-132827 (URN)978-0-473-14173-8 (ISBN)
External cooperation:
Conference
13th International Symposium for Health Information Management Research, Auckland, New Zealand, October, 2008
Available from: 2016-08-25 Created: 2016-08-25 Last updated: 2016-08-25Bibliographically approved
4. Needs, Requirements, and e-Services for Collaborative and Patient-Centered Care
Open this publication in new window or tab >>Needs, Requirements, and e-Services for Collaborative and Patient-Centered Care
2013 (English)In: BIR 2012. Emerging Topics in Business Informatics Research 2012: Proceedings of the 11th International Conference on perspectives in business informatics research / [ed] Natalia Aseeva, Eduard Babkin, Oleg Kozyrev, 2013, 75-91 p.Conference paper (Refereed)
Abstract [en]

This paper discusses the fact that more and more patients are treated in their homes by a whole set of organizations, and how this fact places new and more intense demands on health and social care staff to communicate and collaborate. The aim of the paper is to further explore the detailed needs for collaboration between different care units, individuals and professions, and to outline organizational and/or IT-based solutions. The suggested solutions are based on a patient and process oriented perspective and on an analysis of needs and issues expressed in interviews with key actors in a number of research projects focused on collaboration in care. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level over sectors and units and how this aspect has to be taken into account already during procurement of care services. Most importantly, by reasoning from a basic set of issues, we derive a set of related problems and suggest solutions for how to deal with these. The solutions include suggestions for various e-services aimed at improving coordination and collaboration among care personnel.

Series
, CEUR Workshop Proceedings, ISSN 1613-0073 ; 963
Keyword
Multi-sectorial collaboration, home care, home health care, social care
National Category
Information Systems
Research subject
Computer and Systems Sciences
Identifiers
urn:nbn:se:su:diva-97739 (URN)
Conference
BIR 2012, Nizhny Novgorod, Russia, September 24-26, 2012
Available from: 2013-12-17 Created: 2013-12-17 Last updated: 2016-08-22Bibliographically approved
5. The coordination hub: Toward patient-centered and collaborative care processes
Open this publication in new window or tab >>The coordination hub: Toward patient-centered and collaborative care processes
2015 (English)In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 21, no 4, 284-305 p.Article in journal (Refereed) Published
Abstract [en]

The organization and processes of today's health and social care are becoming ever more complex as a consequence of societal trends, including an aging population and an increased reliance on care at home. One aspect of the increased complexity is that a single patient may receive care from several care providers, which easily results in situations with potentially incoherent, uncoordinated, and interfering care processes. In order to describe and analyze such situations, the article introduces the notion of a process conglomeration. This is defined as a set of patient-care processes that all concern the same patient, that are overlapping in time, and that all are sharing the overall goal of improving or maintaining the health and social well-being of the patient. Problems and challenges of process conglomerations are investigated using coordination theory and models for continuous process improvement. In order to address the challenges, a solution is proposed in the form of a Coordination Hub, being an integrated software service that offers a number of information services for coordinating the activities of the processes in a process conglomeration.

Keyword
Care processes, health care, home care, processes coordination, social care
National Category
Information Systems
Research subject
Computer and Systems Sciences
Identifiers
urn:nbn:se:su:diva-111108 (URN)10.1177/1460458214528822 (DOI)000364641500003 ()
Available from: 2014-12-22 Created: 2014-12-22 Last updated: 2016-08-22Bibliographically approved
6. Understanding Care Work and the Coordination of Care Process Conglomerations
Open this publication in new window or tab >>Understanding Care Work and the Coordination of Care Process Conglomerations
2015 (English)In: Advances in Conceptual Modeling: ER 2015 Workshops AHA, CMS, EMoV, MoBID, MORE-BI, MReBA, QMMQ, and SCME, Stockholm, Sweden, October 19-22, 2015, Proceedings / [ed] Manfred A. Jeusfeld, Kamalakar Karlapalem, Springer, 2015, 26-37 p.Conference paper (Refereed)
Abstract [en]

Health and social care is becoming ever more complex as a consequence of societal trends, including an aging population and increased reliance on care at home. One aspect of the increased complexity is that a single patient may receive care from several care providers, which easily results in situations with potentially incoherent, uncoordinated, and interfering care processes. In order to describe and analyze such situations, the article introduces the notions of patient-centered care process and a conglomeration of such. The latter is defined as a set of patient care processes that all concern the same patient, are overlapping in time, and are all sharing the overall goal of improving or maintaining the health and social well-being of the patient. The processes are based on a PDCA-cycle comprising phases for assessing, planning, performing and following up the care for the patient independently of health and social care organizations.

Place, publisher, year, edition, pages
Springer, 2015
Series
, Lecture Notes in Computer Science, ISSN 0302-9743 ; 9382
Keyword
Care process, Processes coordination, Health care, Social care, Home care, Patient-centered care, Collaboration, Coordination
National Category
Information Systems
Research subject
Computer and Systems Sciences
Identifiers
urn:nbn:se:su:diva-123980 (URN)10.1007/978-3-319-25747-1_3 (DOI)978-3-319-25746-4 (ISBN)978-3-319-25747-1 (ISBN)
Conference
ER 2015 Workshops AHA, CMS, EMoV, MoBID, MORE-BI, MReBA, QMMQ, and SCME, Stockholm, Sweden, October 19-22, 2015
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2016-08-22Bibliographically approved

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