<> "The repository administrator has not yet configured an RDF license."^^ . <> . . "Continuity of care at the interface of primary\r\ncare and other healthcare providers"^^ . "This dissertation aimed to provide insight into continuity of care between care providers at the interface\r\nbetween primary and other care providers. More specifically, it explored the impact of continuity\r\nof care as a characteristic of strong primary care and its impact on hospital readmissions. For this purpose,\r\nthree overarching themes were considered in more detail: The current state of communication\r\nand information flow between primary care and hospitals, the current state of provider connectedness\r\nbetween primary care physicians and other ambulatory physicians and the development, implementation\r\nand evaluation of a care programme (the VESPEERA programme) to improve communication\r\nand cooperation between general practices and hospitals. Four studies were conducted to explore the\r\nunderlying research questions. This includes a qualitative interview study with staff from hospitals and\r\ngeneral practices, a claims-based social network study in patients with chronic obstructive pulmonary\r\ndisease, a quasi-experimental trial evaluating the effectiveness of the VESPEERA programme as well as\r\na quantitative questionnaire survey.\r\nOverall, 49 persons from different groups participated in the qualitative interview study. The result of\r\nthe qualitative analysis was 16 subthemes across five main themes, which were current cooperation,\r\noptimal cooperation, determinants of cooperation and personal emotional and social determinants.\r\nThe participants described that communication is mostly written and synchronous communication via\r\ntelephone is rather rare and takes place predominantly to obtain missing information. For the future,\r\nthe participants wished for better communication and especially cooperation. This includes standardised\r\nand electronic information transfer between care providers. Personal emotional and social determinants,\r\nsuch as reciprocal appreciation and understanding of roles and responsibilities were described\r\nto impact information flow and communication. Furthermore, especially personal professional\r\nrelationships, i.e. knowing each other, were mentioned to positively influence information flow.\r\nFor the social network analysis, a network between 7,876 general practitioners, pneumologists and\r\ncardiologists with 121,750 connections was considered. In the final analysis, 7,294 patients who were\r\nnested in 3,673 general practitioners were included. Regarding the impact of network characteristics\r\non continuity of care, closeness centrality and the EI-index showed a significant effect on the SECON\r\nin the year after discharge. Beyond that, degree centrality and the EI-index impacted readmission rates\r\nwithin 30 days after discharge from hospital. Additionally, density affected readmission rates within\r\n90 days after discharge. No significant effect of network characteristics on readmission rates between\r\n91 days and one year after discharge was found.\r\nIn the VESPEERA trial, 371 patients fulfilled the eligibility criteria. Including the control group, which\r\nwas matched from claims data, 742 patients were considered in the analysis. Regarding the primary\r\nSummary |\r\n120\r\noutcome, readmissions within 90 days after hospital discharge due to the same indication, the rate\r\nafter the intervention period was almost the same in both groups. In the control group, the readmission\r\nrate increased, in the intervention group, a decrease was observed. Altogether, a difference of\r\n6 % regarding readmission rates between the intervention and control groups was thus observed. The\r\nprimary analysis did not show a significant effect, although the intervention patients showed a slightly\r\nbetter outcome. Therefore, no significance tests were performed for any secondary outcomes.\r\nThe questionnaire survey, in which a total of 68 care providers participated, showed that the participants\r\nwere rather indecisive when asked to rate the benefit over the expenses to use the intervention\r\ncomponents with a tendency to a positive balance. The responses of the participants showed several\r\nfactors affected the implementation of the VESPEERA programme. This includes insufficient resources\r\nsuch as financial compensation and the availability of staff and workplaces. Furthermore, legal regulations\r\nrelevant at the time hindered implementation and participants saw the implementation as unwieldy,\r\ntoo comprehensive and too complex. However, as a result of working with the VESPEERA programme,\r\nalmost half of the participants agreed that their awareness of the importance of cross-sectoral\r\ncooperation increased.\r\nEven in times of increasing use of modern information technology, social and emotional factors such\r\nas personally knowing each other were perceived to be crucially important for information flow and\r\neffective collaboration, allowing to improve informational and management continuity of care. A quantitative\r\nconfirmation of this statement could not be achieved in the social network analysis as the effects\r\nof provider connectedness were small, did not improve the overall predictive power of explanatory\r\nand were not congruent across outcomes. Furthermore, due to several contextual factors, no statistically\r\nsignificant effect of the VESPEERA programme on patients’ hospital readmission rates was\r\nfound. However, the results of the primary analysis as well as the analyses of secondary outcomes and\r\nthe subgroups showed trends that patients might have benefitted from the intervention. For most\r\noutcomes, the odds ratios are in favour of the intervention group.\r\nThe results of this dissertation raise the question of whether continuity of care is and will still be relevant\r\nin highly specialised and fragmented healthcare systems that take care of patients with complex\r\nhealth needs. Furthermore, it is unclear whether current measures of continuity of care do justice to\r\nthe complexity of the matter. The overall results of this dissertation do, however, emphasise the relevance\r\nof having a single point of coordination. This is typically the general practitioner, in the future\r\nideally in the form of a primary care team, who thus fulfils the pillars of primary care which include\r\ncontinuity and coordination of care."^^ . "2024" . . . . . . . "Johanna Maria"^^ . "Forstner"^^ . "Johanna Maria Forstner"^^ . . . . . . "Continuity of care at the interface of primary\r\ncare and other healthcare providers (PDF)"^^ . . . "Forstner_Johanna_17_08_1991_Dissertation_PDFA.pdf"^^ . . . "Continuity of care at the interface of primary\r\ncare and other healthcare providers (Other)"^^ . . . . . . "lightbox.jpg"^^ . . . "Continuity of care at the interface of primary\r\ncare and other healthcare providers (Other)"^^ . . . . . . "preview.jpg"^^ . . . "Continuity of care at the interface of primary\r\ncare and other healthcare providers (Other)"^^ . . . . . . "medium.jpg"^^ . . . "Continuity of care at the interface of primary\r\ncare and other healthcare providers (Other)"^^ . . . . . . "small.jpg"^^ . . . "Continuity of care at the interface of primary\r\ncare and other healthcare providers (Other)"^^ . . . . . . "indexcodes.txt"^^ . . "HTML Summary of #34846 \n\nContinuity of care at the interface of primary \ncare and other healthcare providers\n\n" . 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