Assessing readiness to implement patient navigator programs in Toronto, Canada.

People with an intellectual disability and their families experience poorer health care compared with the general population. Living with an intellectual disability is often challenged by coexisting complex and chronic conditions, such as gastrointestinal and respiratory conditions. A literature review was undertaken to document the needs of this vulnerable population, and consultation was undertaken with mothers of children with disabilities and with professionals working within disability services for people with an intellectual disability and their families. Based on this review, there is a need to increase the profile of people with an intellectual disability in the discourse surrounding chronic and complex conditions. Strategies such as guideline and competency development may better prepare health professions to care for people with disabilities and chronic and complex care needs and their families.

ABSTRACTBackgroundOlder adults with multimorbidity present a unique challenge to municipal healthcare due to the complexity of managing multiple health conditions simultaneously. Addressing multimorbidity, especially in older adults, requires an integrated, holistic approach focused on person‐centred healthcare and patient participation. Multidimensional assessments in municipal healthcare, which consider physical, psychological, and social factors, are essential to understanding and managing these complex health conditions. Additionally, trust in the system's reliability and in staff competency is crucial for ensuring quality care.AimThe aim of this study was to explore the experiences and preferences of older adults with assessments in the management of multimorbidity within municipal healthcare.MethodsQualitative data were obtained through semi‐structured individual interviews with 12 home‐dwelling older adults with multimorbidity from three Norwegian municipalities. The participants were aged 67–92, with an average of five chronic conditions. Interviews were conducted face‐to‐face in participants' homes between February 2023 and February 2024. Interviews were transcribed and analysed using reflexive thematic analysis.ResultsWe identified three main themes: nurturing trust and security through professional competence and assessment skills, navigating vulnerability and dependence in healthcare systems, and the impact of patient participation on assessment outcomes. The results emphasise the importance of competence, trust, autonomy, collaboration, and effective communication both in clinical interactions between health professionals and patients and as a system approach in the management of multimorbidity.ConclusionsOlder adults with multimorbidity valued professional competence and effective communication in their healthcare assessments, as these fostered personal and system trust, as well as a sense of security. Participants also highlighted the importance of their involvement in treatment decisions and the need for a coordinated, person‐centred approach to manage their complex health conditions. Our findings underscore the necessity of enhancing healthcare professionals' communication skills, improving information flow, and actively involving patients in assessment and management processes to better support home‐dwelling older adults with multimorbidity in municipal healthcare.Patient and/or Public ContributionThis study builds on a recent James Lind Alliance process, which highlighted improving communication with frail older adults as a key area in the management of multimorbidity and one highly relevant to our aim. A reference group, including a user representative, a healthcare professional, and a professor, contributed to the development of the interview guide and formulation of the study aim and provided input on the results. Additionally, the reference group discussed the implications of the findings, contributed on strategies for dissemination, and promoted the integration of the perspectives and priorities of older adults with multimorbidity throughout the research process.

The study investigated the relationship between organizational readiness to change and the level of professional learning community in Kelantan Residential Schools. A total of 371 teachers representing 15 schools had participated in the study. Random sampling is used to select respondents. The organizational readiness instrument is used to measure the organizational readiness level (Shea, 2014, while the Professional Learning Communities- Revised instrument (Oliver & Hipp, 2010) was used to measure the practices of the PLC. The finding showed a moderately high, positive correlation and significant relationship between organizational readiness and PLC. The result of the study suggested that a readiness to change in an organization positively and significantly affected the PLC implementation. Consequently, organizational readiness to change was found to affect the commitment to change significantly. This research is essential for organizational change management to plan and implement PLC more effectively. The implication of the study was further discussed.

Effective use of business intelligence has become essential for small and medium-sized organizations (SMEs) in the era of digitalization due to the introduction of new technologies. Therefore, this study aims to measure the influence of the Technology Acceptance Model (TAM) and other factors, for example, the quality of information, organization readiness and technology infrastructure, on business intelligence. A quantitative research methodology was used, with a sample size of 281 participants who were owners, managers and information system staff in Iraqi SMEs who had experience using business intelligence. The findings of this study indicated that the quality of information has a significant impact on perceived usefulness (PU) and perceived ease of use (PEOU). Similarly, PU, PEOU, organization readiness and technology infrastructure positively and significantly impact business intelligence adoption. This study offers a comprehensive analysis of the crucial aspects that contribute to the successful deployment of business intelligence, thereby influencing the outcomes of SMEs. The results of this study will help entrepreneurs, SME owners managers, and academics develop a business intelligence system that can enhance overall organizational efficiency in a dynamic economic setting. Putting in place a good business intelligence system will help managers make better decisions, boost economic growth for businesses, support new ideas in businesses, and improve their overall performance and output.

Purpose To understand the impact vertical integration between primary and secondary care providers has on the patient journey regarding access to and overall experience of care. Design/methodology/approach Cross-comparative case study qualitative evaluation comprising: (1) focus groups and one-to-one interviews with key service managers and clinicians from acute hospitals and GP practices; and (2) one-to-one interviews with patients from integrated GP practices, to understand their experiences of vertical integration models. We used the SELFIE (Sustainable intEgrated care modeLs for multimorbidity: delivery, FInancing and performancE) framework as a lens to guide our qualitative study. Findings Vertical integration between acute trusts and general practices is supported by the introduction of novel ways of clinically integrating care across primary, community and secondary healthcare organisations to meet the needs of all patients locally, but specifically those at risk, with complex, and/or multiple long-term conditions. Health service improvements are driven by local acute trusts, in collaboration with clinicians in general practice, and focus on health service changes that can improve population health for all patients locally. Vertically integrated practices are used to test services before encouraging wider local roll-out to non-vertically integrated practices. Originality/value For vertical integration to be implemented successfully, there is a need for an initial period of trust and relationship building between staff (clinicians and other staff) in primary care and in secondary care. Patients undertake significant “navigation work” concerned with choosing and accessing health provision; however, this holds true for both vertically integrated and non-vertically integrated general practices nationally.

In 2013/2014 Southern Melbourne Primary Care Partnership facilitated Assessment of Chronic Illness Care (ACIC) audits in the four Community Health Services in its region. This sparked a discussion of progress in implementing Chronic Disease Management approaches in community health. As a result in 2015, the Southern Melbourne Primary Care Partnership established a co-design process to further develop, imbed and sustain a model of care for community health to support people with chronic and complex conditions.Through a series of facilitated workshops and using consensus decision making, clinicians, managers and primary care partnership representatives worked together with consumers to develop a common model of care. Activities included:• Listening to client experience of care• Mapping the client journey• Discussing the challenges and barriers facing practitioners in delivering care• Examining existing person centred care models• Using client experience to design the modelThe resultant Model of Care provides care options for clients when they are self-managing and when they need comprehensive assistance and care coordination. It has ‘built in’ fluidity enabling the client to move through care options dependent on their changing health status. The implementation of the Model will provide consumers with a consistent community health experience across the region. While partial implementation of the model has already occurred, formal implementation in all four (4) Community Health Services will occur from August.Our presentation will include:• evaluation of the co-design process• proposed post-implementation evaluation frameworkAcknowledgement: The authors acknowledge contributions from members of the Community Health Integrated Chronic Disease Collaborative: Gary Streker, Mark Crawford: Inner South Community Health Prahran Vic.; Jean Magar, Gabrielle Nott: Bentleigh Bayside Community Health East Bentleigh Vic.; Belinda Brookes, Carly Bertram, Kerryn Woolley: Caulfield Community Health Service Caulfield Vic., Debra Starr, Rosemary McGrann: Central Bayside Community Health Parkdale Vic. and their respective participating consumers; Linda Betts Co-Design Facilitator: Linda Betts and Associates

To define and validate the role of the community nurse in a multidisciplinary team caring for clients with chronic and complex needs. A key factor in optimising care for clients with chronic and complex conditions in the community is the use of multidisciplinary teams. A team approach is more effective as it enables better integration of services. The role of the community nurse in the multidisciplinary team has as yet not been delineated. A modified Delphi technique was used in this study. A group of 17 volunteer registered nurses who were experienced in the care of clients with chronic conditions and complex care needs in the community formed a panel of experts. Experts were emailed a series of three questionnaires. Main findings show that the role of the community nurse in a multidisciplinary team for clients with chronic conditions has six main domains - advocate, supporter, coordinator, educator, team member and assessor. A consensus on the role of the community nurse in the multidisciplinary team is described. The six key role domains reaffirm the generic role of the nurse and the validation of the role clarifies and reinforces the centrality of the community nurse in the team. Further refinement of the community nurse role is indicated to increase comprehensiveness of role descriptors particularly for the role domain, advocate. Community nurses working in multidisciplinary teams caring for clients with chronic conditions can define their role as a team member. The working relationship of the community nurse with other health professionals in the multidisciplinary team as a key approach to more integrated care for clients and carers enables the use of this approach to be better understood by all team members. With this increased understanding, community nurses are in a position to build stronger and more effective care teams.

IntroductionAn increasing number of individuals are living with multiple chronic conditions, often combined with psychosocial complexities. For these patients with complex conditions, an integrated primary care model that provides care coordination and a team-based approach can help manage their multiple needs. Information and communication technologies (ICTs) are recognized as a critical enabler of integrated primary care. A better understanding of the use of ICTs in an integrated care setting and how ICTs are being leveraged would be beneficial to identify knowledge gaps and could lead to successful implementation for ICT-based interventions.ObjectiveThis study will systematically scope the literature on the topic of ICT-enabled integrated healthcare delivery models for patients with complex care needs to identify which technologies have been used in integrated primary care settings.MethodThis study protocol outlines a scoping review of the peer-reviewed literature, using Arksey and O’Malley’s (enhanced by Levac et al.) scoping review methodology. Peer-reviewed literature will be identified using a multi-database search strategy. The results of the search will be screened, abstracted, and charted in duplicate by six research team members.DiscussionThe key findings of the study will be thematically analyzed to describe the implemented ICTs aimed for complex patients within the integrated primary care model. The finding will highlight what types of ICTs are being put in place to support these models, and how these ICTs are enabling care integration. This review will be the first step to formally identify how ICT is used to support integrated primary health care models. The results will be disseminated through peer-reviewed publications, conference presentations, and special interest groups.

This study examines the readiness of Camarines Norte State College (CNSC) Main Campus for a digital payment system, aiming to identify its level of readiness along with technological, organizational, and environmental context, and proposed business strategy plan for its implementation. The research involved a descriptive survey method with 62 selected personnel, using frequency count, five-point Likert Scale, weighted mean, ranking technique, and Kendall’s Coefficient of Concordance statistical instruments. The findings revealed that the campus was ready in terms of experienced IT professionals and current systems capable of integrating with digital payment platforms. However, the technological infrastructure was neither ready nor unready. Organizational readiness was high, with employees willing to embrace technological innovations but needing digital training and skills development. Environmental readiness was positive with clients supporting digital payment systems but unable to adjust to changing market trends. The study concluded that CNSC’s technological infrastructure may not adequately support digital payments, and more digitally aligned trainings are needed. The financial capability to invest in a digital payment system was not prioritized due to budget constraints. The UCaN strategy plan addresses key issues in the CNSC Main Campus business process for digital payment system implementation, ensuring long-term success and sustainability.

APhA advances provider status initiative

This study aimed to investigate the impact of emerging digital health technologies on the sustainability of primary healthcare systems in Tanzania, focusing on operational, institutional, social and environmental dimensions. A convergent mixed-methods design was employed in Tanzania. Quantitative data were collected from 240 healthcare workers across 204 primary healthcare facilities using a structured questionnaire. Regression analysis identified predictors of sustainability outcomes based on the technology-organisation-environment (TOE) framework. In parallel, qualitative data were gathered through 25 semi-structured interviews with health professionals and administrators. Thematic analysis was employed to explore perceptions, experiences and institutional challenges associated with digital health implementation. Usability, system reliability and staff capacity were significant predictors of operational sustainability (R2=0.760), while training availability, leadership support and policy support were strong predictors of institutional sustainability (R2=0.844). Environmental sustainability received the lowest overall rating (mean=2.41, SD=0.78), reflecting constraints such as unstable electricity, limited funding and a lack of maintenance planning. Qualitative findings reinforced these patterns, with participants reporting improved workflow and data visibility but raising concerns about digital exclusion, weak governance and inequities between urban and rural facilities. The integration of findings highlighted the need for coordinated investments beyond infrastructure, including sustained training, policy coherence and targeted support for under-resourced health centres. This study extends the TOE framework to a multi-dimensional sustainability context, integrating operational, institutional, social and environmental perspectives in a low-resource primary healthcare setting. It provides evidence that sustainable digital health implementation requires not only technological functionality but also organisational readiness, inclusive policies and attention to environmental resilience.

Once again, approaches to health care financing and access in the United States are being publicly debated, and once again, children’s health care is taking a back seat. On the plus side, some of the shortcomings of our current system are coming into greater focus, and fundamental questions about people’s right to health care and how to control health care costs are being voiced. On the other hand, the consideration of the social determinants of health, the social consequences of ill health, and the resulting health disparities (which are issues of special concern for vulnerable populations, especially developing children and children with special health care needs) have not entered the debate.Among the approaches to controlling costs is a focus on the small group of individuals whose medical care accounts for a large portion of health care costs. This group, excluding older adults in their final years of life, tends to have complex medical and social conditions. Perhaps because most children seem to be in good health or because those who do not are few in number (and thus, cost relatively little), insufficient attention is paid to children with complex needs. Yet within the pediatric population, these children (who are characterized as having multiple, significant health problems that affect multiple organ systems; functional limitations; high health care use; and sometimes technology dependence) are most likely to manifest adverse outcomes when health and/or social services systems fail. The health and well-being of these most vulnerable of children are sentinel indicators of the effectiveness of the systems on which they depend.By reputation, although absent much evidence, hospital and subspecialty care for children in the United States is world class. Ironically, the availability of technology and advanced care processes is contributing to the increased number of children with chronic and complex health conditions. Yet even among tertiary- and quaternary-care settings, there is substantial variation in who receives what care, how much it costs, and the outcomes achieved. Outside those settings, shortcomings in services for children with special health care needs are even more apparent; access to comprehensive, coordinated, and family-centered care is the exception rather than the rule.Most of the problems in gaining access to quality health care are systemic, reflecting the additional time, skills, staffing, support, and payment that these children’s team-based care requires. Equally troubling is that many other problems arise from the longstanding fragmentation of services for children and families among physical and mental health, education, developmental disability and social services, and the failure to coordinate among them. Any family with a child with special health care needs can articulate the burden this places on their ability to care for their child.In this supplement, we build on presentations and discussion from a symposium held in December 2015 at the National Academy of Sciences called “Designing Systems That Work for Children with Complex Health Care Needs.” The symposium, which was sponsored by the Lucile Packard Foundation for Children’s Health, was brought together in an effort to contribute to addressing some of the longstanding, systemic issues that affect the care of children with complex health conditions.The goal of the Lucile Packard Foundation for Children’s Health is to improve the US system of care for children with chronic and complex health care needs. Our work is intended to ensure that all children have access to high-quality, culturally competent, family-centered health care when and where they need it, provided through a delivery system that recognizes their unique physical and developmental needs and potential. Our hope is that in the articles in this supplement, we can help clarify some of the difficult, systemic issues and challenges that affect health care for these children and point the way toward their resolution.Throughout 2018 we will be hosting online discussions between the authors of articles in this supplement and key stakeholders in the field. Join us for the conversations or access the archived material at lpfch.org/aapsupplement.

Assessing Health Care Needs and Clinical Outcome With Urological Case Complexity: A Study Using INTERMED

This study offers novel empirical insights into how Tanzanian manufacturing firms are navigating the transition to Industry 4.0 amid infrastructural and capacity limitations. While global adoption of technologies such as IoT, automation, and AI has surged, little is known about their implementation in sub-Saharan African industries, where digital readiness remains uneven. Using a qualitative design, the study conducted semi-structured interviews with managers from seven leading manufacturing companies across diverse sectors in Tanzania. Thematic analysis revealed sector-specific patterns in the adoption and integration of advanced technologies, with some firms, such as Yara Tanzania and Melt Industries, demonstrating high-level implementation in areas like predictive maintenance, real-time supply chain visibility, and energy optimisation. The study’s novelty lies in its grounded exploration of the interplay between organisational readiness, infrastructural constraints, and policy gaps, offering a first-of-its-kind, context-specific assessment for Tanzania. Findings emphasise the urgent need for targeted digital infrastructure investments, fiscal incentives, and workforce upskilling to enable scalable and inclusive adoption of Industry 4.0 technologies across the manufacturing sector.

The objective of this study was to develop a context-sensitive decision-making framework for evaluating outsourcing strategies in industrial projects, based on insights from industry professionals. This qualitative study employed a thematic approach to explore how outsourcing decisions are made within industrial project environments. Data were collected through in-depth, semi-structured interviews with 21 professionals involved in project management, procurement, and strategic planning in Tehran-based industrial companies. Participants were selected through purposive sampling, and interviews continued until theoretical saturation was reached. The interview transcripts were analyzed using NVivo software through an inductive thematic analysis process to extract key themes and patterns. The analysis revealed four major thematic categories influencing outsourcing decisions: (1) Strategic Evaluation Criteria (e.g., cost-benefit analysis, risk assessment, competitive positioning), (2) Organizational Readiness and Internal Capabilities (e.g., technological infrastructure, process maturity, decision-making structures), (3) Stakeholder Involvement and Communication (e.g., intra-organizational coordination, relationship management, risk communication), and (4) Post-Outsourcing Performance Management (e.g., KPI tracking, SLAs, knowledge retention). Participants emphasized the importance of aligning outsourcing strategies with business goals, ensuring internal capacity for integration, and maintaining relational continuity through performance monitoring and feedback loops. The study provides an empirically grounded framework for evaluating outsourcing strategies in industrial projects, highlighting the necessity of a systemic and multidimensional approach. The results suggest that effective outsourcing decisions depend not only on economic and operational logic but also on organizational maturity, stakeholder alignment, and adaptive performance management. These insights offer both theoretical advancement and practical guidance for organizations seeking to implement outsourcing strategically within complex industrial settings.