Centrality and compatibility of institutional logics when introducing value-based reimbursement

PurposeUsing financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands.Design/methodology/approach41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory.FindingsAfter the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride.Originality/valueInterviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.

Exploring Effectiveness of Online Nutrition-Related Diabetes Education Training for Interdisciplinary Healthcare Students at a Student-Run Free Clinic

Objectives The objective of this project was to explore the effectiveness of online nutrition-related diabetes education training for interdisciplinary healthcare students volunteering at a student-run free clinic (SRFC). Providing online nutrition-related diabetes education training to interdisciplinary healthcare students at a student-run free clinic may increase participants’ familiarity with and confidence in providing nutrition-related diabetes education to patients. Methods Student volunteers (n = 16) at a SRFC watched an online training video on nutrition-related diabetes education. Topics covered in the training video included the relationship between diet and type 2 diabetes, and the use of motivational interviewing and SMART goals to counsel patients with type 2 diabetes. Using a pre-test/post-test design with eight Likert-scaled (strongly disagree to strongly agree) items, students rated statements indicating familiarity with and confidence in providing nutrition-related diabetes education to patients. Wilcoxon signed-rank tests were conducted to test for statistically significant shifts in each Likert-scaled item pre- to post-test. Statistical significance was set at P ≤ 0.05. Results Results showed an overall positive shift in response ratings from the pre- to post-test for all Likert-scaled items. Seven of the eight sets of results had a statistically significant positive shift in response rating (P values < 0.05). Conclusions Findings indicate that providing online nutrition-related diabetes education to interdisciplinary students volunteering at a SRFC has potential to increase their familiarity with and confidence in providing nutrition-related diabetes education to their patients with diabetes. Funding Sources No funding was received.

Empowering Public Health Pharmacy Practice—Moving from Collaborative Practice Agreements to Provider Status in the U.S.

This article describes the history and evolution of pharmacist-physician collaborative practice agreements (CPAs) in the United States with future directions to support pharmacists’ provider status as the profession continues to evolve from product-oriented to patient-centered care and population health. The pharmacy profession has a long history of dispensing and compounding, with the addition of clinical roles in the late 20th century. These clinical roles have continued to expand into diverse arenas such as communicable and non-communicable diseases, antimicrobial stewardship, emergency preparedness and response, public health education and health promotion, and critical and emergency care. Pharmacists continue to serve as integral members of interprofessional and interdisciplinary healthcare teams. In this context, CPAs allow pharmacists to expand their roles in patient care and may be considered as a step towards securing provider status. Moving beyond CPAs to a provider status would enable pharmacists to be reimbursed for cognitive services and promote integrated public health delivery models.

Autism Spectrum Disorder from the Womb to Adulthood: Suggestions for a Paradigm Shift

The wide spectrum of unique needs and strengths of Autism Spectrum Disorders (ASD) is a challenge for the worldwide healthcare system. With the plethora of information from research, a common thread is required to conceptualize an exhaustive pathogenetic paradigm. The epidemiological and clinical findings in ASD cannot be explained by the traditional linear genetic model, hence the need to move towards a more fluid conception, integrating genetics, environment, and epigenetics as a whole. The embryo-fetal period and the first two years of life (the so-called ‘First 1000 Days’) are the crucial time window for neurodevelopment. In particular, the interplay and the vicious loop between immune activation, gut dysbiosis, and mitochondrial impairment/oxidative stress significantly affects neurodevelopment during pregnancy and undermines the health of ASD people throughout life. Consequently, the most effective intervention in ASD is expected by primary prevention aimed at pregnancy and at early control of the main effector molecular pathways. We will reason here on a comprehensive and exhaustive pathogenetic paradigm in ASD, viewed not just as a theoretical issue, but as a tool to provide suggestions for effective preventive strategies and personalized, dynamic (from womb to adulthood), systemic, and interdisciplinary healthcare approach.

The Feasibility and Acceptability of Training Dietitians to Hand Feed People Living With Dementia

The purpose of this study was to evaluate the feasibility and acceptability of a training program using the interactive Positive Approach to Care□ dementia care curriculum to Registered Dietitians (RDs). To recruit RDs, the Alabama Dietetic Association emailed its member twice about the training opportunity, and a maximum of 25 potential participants could register online. Of those who registered, 80% (20/25) attended the training, and all attendees agreed to the informed consent. The total cost for the two training sessions, including travel, supplies, and labor hours, was approximately $800. The primary challenge for the facilitator was accurately following the script due to time constraints. Two weeks after completing the training, participants answered open ended questions, and many shared how they enjoyed the hands-on activities and watching videos of people living with dementia being fed using the Hand-Under-Hand□ technique. Some participants would have preferred a longer workshop at a location that was more convenient for them. All participants shared how this training may impact their professional practice, such as how it changed the way they approach and communicate with people living with dementia. Since receiving the training, many shared how they have either already started or are interested in sharing the information with interdisciplinary healthcare professionals and/or caregivers. Overall, the training session is considered a feasible, acceptable, and low-cost approach to training RDs on providing hands-on care to people living with dementia. Lengthening the training may improve the replicability of the script in addition to providing opportunities for more hands-on activities.

Quality of Life in Romanian Children with Type 1 Diabetes: A Cross-Sectional Survey Using an Interdisciplinary Healthcare Intervention

Background: The purpose of this study was to assess the quality of life in Romanian type 1 diabetes mellitus (T1DM) children attending an early interdisciplinary healthcare intervention. Hypothesis: engaging T1DM children in leisure sports leads to a better quality of life. Methods: This research embeds a cross-sectional observational study, incorporating some clinical characteristics relevant for diabetes management. The Kidscreen 27 questionnaire was issued to 100 T1DM children aged between 7 and 17 years. Parents completed the questionnaire. All subjects received interdisciplinary healthcare in the previous year. Statistics were performed using SPSS, v20. The required sample size of 100 subjects was obtained with a confidence interval of 95% and a sampling error of 0.009. The tests were two-sided, with a type I error set at 0.05. Results: Subjects reached an increased level of physical well-being, psychological well-being, autonomy, parent relationships, peer and social support, and school inclusion. There was a significant difference (p < 0.05) between children who practice leisure activities and children who only participated in physical education (PE) classes, regarding their physical well-being (t = 2.123). ANOVA demonstrated significant differences between age groups regarding physical well-being. Conclusion: The interdisciplinary healthcare intervention increased the efficiency of T1DM management with positive effects on life quality.

UK consensus guidelines for the delivery of unexpected news in obstetric ultrasound: The ASCKS framework

Background Studies indicate there is a need to improve the delivery of unexpected news via obstetric ultrasound, but there have been few advances in this area. One factor preventing improvement has been a lack of consensus regarding the appropriate phrases and behaviours which sonographers and ultrasound practitioners should use in these situations. Aims To develop consensus guidelines for unexpected news delivery in Early Pregnancy Unit and Fetal Anomaly Screening Programme NHS settings. Methods A workshop was conducted to identify priorities and reach consensus on areas of contention. Contributors included interdisciplinary healthcare professionals, policy experts, representatives from third-sector organisations, lay experts and academic researchers ( n = 28). Written and verbal feedback was used to draft initial guidance which was then circulated amongst the wider writing group ( n = 39). Revisions were undertaken until consensus was reached. Results Consensus guidelines were developed outlining the behaviours and phrases which should be used during scans where unexpected findings are identified. Specific recommendations included that: honest and clear communication should be prioritised, even with uncertain findings; technical terms should be used, but these should be written down together with their lay interpretations; unless expectant parents use other terminology (e.g. ‘foetus’), the term ‘baby’ should be used as a default, even in early pregnancy; at the initial news disclosure, communication should focus on information provision. Expectant parents should not be asked to make decisions during the scan. Conclusions These recommendations can be used to develop and improve news delivery interventions in obstetric ultrasound settings. The full guidelines can be accessed online as supplemental material and at https://doi.org/10.5518/100/24 .