Care coordination for rural residents with chronic disease: Predictors of improved outcomes

2021 ◽  
Author(s):  
Andrew R. Hansen ◽  
Susan F. McLendon ◽  
Haresh Rochani
Keyword(s):  
Chronic Disease ◽  
Care Coordination ◽  
Rural Residents ◽  
Improved Outcomes

scholarly journals Timely Communication Through Telehealth: Added Value for a Caregiver During COVID-19

2021 ◽  
Vol 9 ◽  
Author(s):  
Lauren Hajjar ◽  
Ben Kragen
Keyword(s):  
Chronic Disease ◽  
Pediatric Patient ◽  
Care Coordination ◽  
Informal Caregiver ◽  
Relational Coordination ◽  
Coordination Of Care ◽  
Ehlers Danlos Syndrome ◽  
Coordination Theory ◽  
Provider Payment ◽  
The Impact

Objective: This caregiver case study applies the lens of relational coordination theory (RC) to examine the value of telehealth as a medium of care coordination for a pediatric patient with hypermobile Ehlers-Danlos Syndrome (hEDS) during the COVID-19 pandemic.Background: The COVID-19 pandemic has placed an unprecedented burden on the delivery of healthcare around the globe and has increased the reliance on telehealth services. Delivering telehealth requires a high level of communication and coordination within and across providers as well as between providers, patients and their families. However, it is less clear how telehealth impacts the coordination of care. In this paper, we provide insight into the quality of care coordination between providers and an informal caregiver following policy changes to the provider payment structure in Massachusetts.Methods: This paper employs a single-case, autoethnographic study design where one of the authors uses their experiential insights, as mother of the patient, to inform a wider cultural and political understanding of the shift to remote caregiving for a pediatric patient with hEDS. Data was collected using reflective journaling, interactive interviews, and participant observation and analyzed using content analysis.Results: Findings revealed four interrelating roles of the caregiver including, logistics support, boundary spanner, home health aide, and cultural translator. The adoption of telehealth was associated with improved timeliness and frequency of communication between the caregiver and providers. Findings about the impact of telehealth adoption on accuracy of communication were mixed. Mutual respect between the caregiver and providers remained unchanged during the study period.Conclusions: This paper highlights areas where payer policy may be modified to incentivize timely communication and improve coordination of care through telehealth services. Additional insight from the perspective of an informal caregiver of a patient with a rare chronic disease provides an understudied vantage to the care coordination process. We contribute to relational coordination theory by observing the ways that caregivers function as boundary spanners, and how this process was facilitated by the adoption of telehealth. Insights from this research will inform the development of telehealth workflows to engage caregivers in a way that adds value and strengthens relational coordination in the management of chronic disease.

scholarly journals Health Equity of Rural Residents in Southwest China

2021 ◽  
Vol 9 ◽  
Author(s):  
Xiao-Mei Li ◽  
Jing Kou ◽  
Zhen Yu ◽  
Yuan-Yuan Xiao ◽  
Qiong Meng ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Health Status ◽  
Chronic Diseases ◽  
Ethnic Minorities ◽  
Health Equity ◽  
Yunnan Province ◽  
Hospitalization Rate ◽  
Age Group ◽  
Rural Residents ◽  
Educational Levels

The Chinese government stresses healthcare reform to improve the health of all residents in urban and rural areas. However, much research showed that inequities still existed in health status and health services utilization in China, especially in economically disadvantaged areas. Southwest China's Yunnan Province is an ethnic frontier region with lagging economic development. This study analyzed health equity among rural residents with various socio-economic and demographic statuses in Yunnan Province. Research on this area concerns rural residents. Our study was based on a household study sample consisting of 27,395 participants from six counties in Yunnan. For all participants, data on demographic and socio-economic characteristics, and health status were collected. The chi-square test and logistic regression were used to analyze factors influencing health. The concentration index was used to evaluate health equity. For all respondents, the 2-week prevalence, the prevalence of chronic diseases, and the required hospitalization rate were 7.3, 12.8, and 9.2%, respectively. After adjusting the age proportion of the sixth population census of Yunnan Province, the 2-week prevalence was 7.1%, the prevalence of chronic disease was 10.7%, and the hospitalization rate was 8.4%. The concentration indexes (CIs) reflecting health equity among the respondents with different incomes and educational levels were negative. There was health inequity among respondents with different incomes and educational levels. The respondents with lower incomes and educational levels had worse health. The common influencing factors included gender, age, ethnicity, occupation, marriage status, and the number of family members. Females, the aged, ethnic minorities, farmers, and the divorced or widowed had worse health status than the control groups. Larger numbers of family members correlated with better health. The respondents with lower incomes or educational levels had higher chronic disease prevalences. The associations between the 2-week prevalence, required hospitalization rate, and age were U-shaped; the lowest age group and the highest age group had higher rates. In conclusion, more attention should be paid to females, the aged, ethnic minorities, farmers, the divorced or widowed, residents with low income and low educational level, and those with chronic diseases.

scholarly journals Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease

2019 ◽  
Vol 2 (10) ◽  
pp. e1912604 ◽  
Author(s):  
Rachel Caskey ◽  
Kellyn Moran ◽  
Daniel Touchette ◽  
Molly Martin ◽  
Garret Munoz ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Usual Care ◽  
Care Coordination ◽  
Comprehensive Care ◽  
Children And Youth

scholarly journals The Morbidity Rate of Chronic Disease among Chinese Rural Residents: Results from Liuyang Cohort

2013 ◽  
Vol 22 (4) ◽  
pp. 362-367 ◽  
Author(s):  
Xin Huang ◽  
Mengshi Chen ◽  
Hongzhuan Tan ◽  
Shuiyuan Xiao ◽  
Jing Deng
Keyword(s):  
Chronic Disease ◽  
Morbidity Rate ◽  
Rural Residents

Chronic disease prevalence and influencing factors among rural residents in Jiangxi, China

2014 ◽  
Vol 6 (2) ◽  
pp. 106-111 ◽  
Author(s):  
L. Zhang ◽  
Z. Yuan ◽  
J. E. Maddock ◽  
J. Zou ◽  
Z. Zheng ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Influencing Factors ◽  
Disease Prevalence ◽  
Rural Residents ◽  
Chronic Disease Prevalence

scholarly journals Willingness of patients with chronic disease in rural China to contract with family doctors: implication for targeting characteristics

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jie Li ◽  
Jie Li ◽  
Peipei Fu ◽  
Yan Chen ◽  
Xue Tang ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Chronic Conditions ◽  
Chronic Disease Management ◽  
Family Doctor ◽  
Chronic Patients ◽  
Rural Residents ◽  
Cross Sectional ◽  
Family Doctors ◽  
The Government

Abstract Background Rural residents with chronic conditions have a stronger need for health services, which should make using family doctor contract services a priority. This study aimed to evaluate the rate of willingness among rural residents with chronic conditions to contract with family doctors and examine its determinants. Methods A cross-sectional study was conducted from May, 2018 to June, 2018 in Shandong Province in China. A total of 769 rural unsigned residents with chronic conditions were included in the analysis. Using the Andersen model as the theoretical framework, logistic regression models were chosen to analyse the factors associated with willingness to contract with family doctors. Results This study found that the rate of willingness to contract with family doctors among chronic patients in rural Shandong was 46.7%. A higher willingness was observed in those living a further distance from the village clinic (more than 600 m: OR = 1.85, 95%CI =1.17–2.93), having received publicity for family doctor contract services (OR = 1.71, 95% CI = 1.06–2.76), reporting need for utilizing a chronic disease management program (OR = 3.36, 95% CI = 2.20–5.23), and reporting need for higher medical insurance reimbursement (OR = 1.91, 95% CI = 1.28–2.83). Conclusions The prevalence of contract willingness was relatively low among unsigned rural residents with chronic conditions in rural Shandong, China. The need factors were powerful factors affecting their willingness to contract with family doctors. The government should therefore strengthen targeted publicity and education to rural residents with chronic conditions and provide targeted healthcare services, such as chronic disease management programs and medical services with higher reimbursement rates, to promote their willingness to contract with family doctors.

scholarly journals The Role of Caregiver-Reported Risks in Predicting Adverse Pediatric Outcomes

2020 ◽  
Vol 45 (8) ◽  
pp. 957-970
Author(s):  
Louise E Vaz ◽  
David V Wagner ◽  
Rebecca M Jungbauer ◽  
Katrina L Ramsey ◽  
Celeste Jenisch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Disease ◽  
Care Coordination ◽  
Demographic Data ◽  
Disease Status ◽  
Emergency Department Visits ◽  
Inpatient Admission ◽  
Social Risk ◽  
Social Risk Factors ◽  
Future Health

Abstract Objective Certain social risk factors (e.g., housing instability, food insecurity) have been shown to directly and indirectly influence pediatric health outcomes; however, there is limited understanding of which social factors are most salient for children admitted to the hospital. This study examines how caregiver-reported social and medical characteristics of children experiencing an inpatient admission are associated with the presence of future health complications. Methods Caregivers of children experiencing an inpatient admission (N = 249) completed a predischarge questionnaire designed to capture medical and social risk factors across systems (e.g., patient, caregiver, family, community, healthcare environment). Electronic health record (EHR) data were reviewed for child demographic data, chronic disease status, and subsequent emergency department visits or readmissions (i.e., acute events) 90 days postindex hospitalization. Associations between risk factors and event presence were estimated using odds ratios (ORs) and confidence intervals (CI), both unadjusted and adjusted OR (aOR) for chronic disease and age. Results Thirty-three percent (N = 82) of children experienced at least one event. After accounting for child age and chronic disease status, caregiver perceptions of child’s health being generally “poor” or “not good” prior to discharge (aOR = 4.7, 95% CI = 2.3, 9.7), having high care coordination needs (aOR = 3.2, 95% CI = 1.6, 6.1), and experiencing difficulty accessing care coordination (aOR = 2.5, 95% CI = 1.4, 4.7) were significantly associated with return events. Conclusions Caregiver report of risks may provide valuable information above and beyond EHR records to both determine risk of future health problems and inform intervention development.

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