Networks in Health Care

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

The Health Care Network (HCN ) related information of a country is one of the most influential fields of data sharing and integrating with disparate data sources of physical world and compatible health care organizations on the exponentially growing World Wide Web (WWW ) for improving and maintaining health related services of mass people. Although these accessible HCN related unstructured or semi-structured data in multiple heterogeneous repositories on the web originate challenges to develop a smarter method in finding specific information using traditional keyword-based search engines. Moreover, it is also a formidable task to harmonize spatial data with our HCN for exploring implicit knowledge that assist people in making their decisions regarding of health services and it is getting researchers' attention at a rapid pace. In this regard, we applied the Physical-Cyber-Social (PCS) computing approach on HCN that demonstrates the feasibility of semantic web technologies to represent domain information in the machine understandable format and we also integrate data from accessible Cyber Space Data Sources (CSDSs) to address these challenges. We published our HCN related data using Resource Description Framework (RDF ) to build a knowledge-base. We call this repository as HCN - BD, which is HCN related machine understandable data source of Bangladesh. This yields a huge knowledge graph with 0.25 million nodes, i.e. RDF triples to facilitate reasoning important information pattern by a graph based query language, SPARQL. Furthermore, we integrate this semantic repository with our generic spatial knowledge-base, Geo - Bangladesh, a machine understandable geographic data source related to the administrative structure of Bangladesh, to examine health care locations using SPARQL and therefore, we achieved the semantic interoperability in our Linked Open Data (LOD) application. Moreover, our research effectively addresses nearest health care centers using real time spatial data from Global Positioning System (GPS) and maps these locality to increase searching ability by mass people.

The FutureS of healthcare

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

ObjectiveTo explore how multidisciplinary inflammatory arthritis (IA) care is accessed from the perspectives of people with IA and their health care network members.MethodsIn this phenomenological study, we used purposive sampling to recruit patients with IA for less than 5 years and age of more than 18 years who spoke English and reported two or more health care network members. We conducted one‐to‐one interviews with patients and their health care network members. Data were analysed using a social network perspective.ResultsWe interviewed 14 patient participants and 19 health care network members comprising health care providers and informal caregivers. An overarching theme of whole person (holistic) IA care was identified, with the following two broad multifaceted subthemes: 1) connected networks and whole person care and 2) network disconnect and disrupted access to care. The first subtheme notes how access to health care providers and social support was fundamental to holistic care and how care was facilitated by communication pathways that promoted care. The second subtheme illustrates impediments to access, including appointment time pressures, inadequacies in communication delivery modes, and family physicians’ unfamiliarity with rheumatology care. Inequities in care were also reported.ConclusionParticipants shared a goal of whole person care. Although health care networks included multiple disciplines, they did not always provide coordinated multidisciplinary care. Communication modes, linkages between network actors, and organizational structures governed the flow of information and resources through networks and influenced access to equitable whole person care. The development of health care system structures to support the flow of information and resource transfer is needed to promote network collaboration and equitable access to resources.

Independent foundations' primary focus is grant making.In general, their assets come from the gift of an individual or family.Community foundations' assets usually come from many donors rather than a single source, and grant making is limited to a particular region.Community foundations are usually classified as private charities under the tax law and are subject to different rules and regulations than are other private foundations. Access To CareAccording to 1988 Census Bureau estimates, over thirty-one million Americans are without health insurance.The demographics of these people are diverse, and their ranks continue to grow as the service industry burgeons and as competition in health care increases.Regional disparities in access also exist.Foundation funding in this area ranges from economic analyses of the problem to direct provision of care.

Primary Health Care Matters.

I found Grace Owen's article 'Support networks in health care’ (Nursing Standard, June 13-19) for health care workers following disasters very interesting and informative. I would, however, like to make one small correction to her text.

BackgroundThe collaborative care planning study (COCAPP) is a cross-national comparative study of care planning and coordination in community mental healthcare settings. The context and delivery of mental health care is diverging between the countries of England and Wales whilst retaining points of common interest, hence providing a rich geographical comparison for research. Across England the key vehicle for the provision of recovery-focused, personalised, collaborative mental health care is the care programme approach (CPA). The CPA is a form of case management introduced in England in 1991, then revised in 2008. In Wales the CPA was introduced in 2003 but has now been superseded by The Mental Health (Care Co-ordination and Care and Treatment Planning) (CTP) Regulations (Mental Health Measure), a new statutory framework. In both countries, the CPA/CTP requires providers to: comprehensively assess health/social care needs and risks; develop a written care plan (which may incorporate risk assessments, crisis and contingency plans, advanced directives, relapse prevention plans, etc.) in collaboration with the service user and carer(s); allocate a care coordinator; and regularly review care. The overarching aim of this study is to identify and describe the factors that ensure CPA/CTP care planning and coordination is personalised, recovery-focused and conducted collaboratively.Methods/designCOCAPP will employ a concurrent transformative mixed methods approach with embedded case studies. Phase 1 (Macro-level) will consider the national context through a meta-narrative mapping (MNM) review of national policies and the relevant research literature. Phase 2 (Meso-level and Micro-level) will include in-depth micro-level case studies of everyday ‘frontline’ practice and experience with detailed qualitative data from interviews and reviews of individual care plans. This will be nested within larger meso-level survey datasets, senior-level interviews and policy reviews in order to provide potential explanations and understanding.DiscussionCOCAPP will help identify the key components that support and hinder the provision of personalised, recovery-focused care planning and provide an informed rationale for a future planned intervention and evaluation.

BackgroundAn ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level.ObjectivesTo examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care.MethodsMultiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care.ResultsStarting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance.ConclusionsOn balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

ABSTRACTHealthcare reform is currently a hot topic in the United States, and the Chronic Care Model has frequently been cited as the foundation of recent attempts to integrate mental health and physical health care. However, challenges exist to fully integrated care that have delayed adequately meeting the multiple needs of mental health service recipients. This article highlights multiple changes that can be incorporated into mental health care now, derived from the Chronic Care Model, to better meet clients’ physical and mental health needs. These changes include focusing on population-level data and incorporating technology and multidisciplinary teams in treatment and prevention efforts.

Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.

Early Intervention in PsychiatryVolume 7, Issue 2 p. 103-108 Editorial Towards a new paradigm of care: the International Declaration on Youth Mental Health Helen Coughlan, Helen Coughlan Department of Psychiatry, Royal College of Surgeons in IrelandSearch for more papers by this authorMary Cannon, Mary Cannon Department of Psychiatry, Royal College of Surgeons in IrelandSearch for more papers by this authorDavid Shiers, David Shiers Iris InitiativeSearch for more papers by this authorPaddy Power, Paddy Power Young Adult Service, St. Patrick's University HospitalSearch for more papers by this authorClaire Barry, Claire Barry Declaration Youth AdvisorSearch for more papers by this authorTony Bates, Tony Bates Headstrong: the National Centre for Youth Mental HealthSearch for more papers by this authorMax Birchwood, Max Birchwood YouthSpace School of Psychology, University of Birmingham, Birmingham, UKSearch for more papers by this authorSarah Buckley, Sarah Buckley Willow Gove Adolescent Unit, St. Patrick's University HospitalSearch for more papers by this authorDerek Chambers, Derek Chambers Inspire Ireland FoundationSearch for more papers by this authorSimon Davidson, Simon Davidson Provincial Centre of Excellence for Chid and Youth Mental Health, Children's Hospital of Eastern Ontario, Ottawa, CanadaSearch for more papers by this authorMarie Duffy, Marie Duffy Headstrong: the National Centre for Youth Mental Health SpunOutSearch for more papers by this authorBlánaid Gavin, Blánaid Gavin Lucena Clinic, DublinSearch for more papers by this authorCiaran Healy, Ciaran Healy Declaration Youth AdvisorSearch for more papers by this authorColm Healy, Colm Healy Declaration Youth AdvisorSearch for more papers by this authorHelen Keeley, Helen Keeley Inspire Ireland Foundation Health Service Executive, South & North Cork National Suicide Research Foundation, Cork, IrelandSearch for more papers by this authorMichael Maher, Michael Maher Declaration Youth AdvisorSearch for more papers by this authorChris Tanti, Chris Tanti Headspace: the National Youth Mental Health FoundationSearch for more papers by this authorPatrick McGorry, Patrick McGorry Headstrong: the National Centre for Youth Mental Health Headspace: the National Youth Mental Health Foundation Orygen Youth Health Research Centre, Melbourne, AustraliaSearch for more papers by this author Helen Coughlan, Helen Coughlan Department of Psychiatry, Royal College of Surgeons in IrelandSearch for more papers by this authorMary Cannon, Mary Cannon Department of Psychiatry, Royal College of Surgeons in IrelandSearch for more papers by this authorDavid Shiers, David Shiers Iris InitiativeSearch for more papers by this authorPaddy Power, Paddy Power Young Adult Service, St. Patrick's University HospitalSearch for more papers by this authorClaire Barry, Claire Barry Declaration Youth AdvisorSearch for more papers by this authorTony Bates, Tony Bates Headstrong: the National Centre for Youth Mental HealthSearch for more papers by this authorMax Birchwood, Max Birchwood YouthSpace School of Psychology, University of Birmingham, Birmingham, UKSearch for more papers by this authorSarah Buckley, Sarah Buckley Willow Gove Adolescent Unit, St. Patrick's University HospitalSearch for more papers by this authorDerek Chambers, Derek Chambers Inspire Ireland FoundationSearch for more papers by this authorSimon Davidson, Simon Davidson Provincial Centre of Excellence for Chid and Youth Mental Health, Children's Hospital of Eastern Ontario, Ottawa, CanadaSearch for more papers by this authorMarie Duffy, Marie Duffy Headstrong: the National Centre for Youth Mental Health SpunOutSearch for more papers by this authorBlánaid Gavin, Blánaid Gavin Lucena Clinic, DublinSearch for more papers by this authorCiaran Healy, Ciaran Healy Declaration Youth AdvisorSearch for more papers by this authorColm Healy, Colm Healy Declaration Youth AdvisorSearch for more papers by this authorHelen Keeley, Helen Keeley Inspire Ireland Foundation Health Service Executive, South & North Cork National Suicide Research Foundation, Cork, IrelandSearch for more papers by this authorMichael Maher, Michael Maher Declaration Youth AdvisorSearch for more papers by this authorChris Tanti, Chris Tanti Headspace: the National Youth Mental Health FoundationSearch for more papers by this authorPatrick McGorry, Patrick McGorry Headstrong: the National Centre for Youth Mental Health Headspace: the National Youth Mental Health Foundation Orygen Youth Health Research Centre, Melbourne, AustraliaSearch for more papers by this author First published: 26 April 2013 https://doi.org/10.1111/eip.12048Citations: 38 Declaration of Interests: David Shiers: Current member of two Guideline Development Groups (GDG) for the National Institute for Health & Clinical Excellence (NICE): (a) NICE guidance for children and young people affected by psychosis and schizophrenia; and (b) NICE guidance for adults with psychosis and schizophrenia; the views expressed are not those of either GDG, NCCMH or NICE. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume7, Issue2May 2013Pages 103-108 RelatedInformation

Belgium is going through a structural reform of the mental health care system. Key of the reform is is a policy strategy with the ambition to deinstitutionalise the mental health care provision (reduction of beds) through a balanced care approach and by means of establishing regional multisectorial mental health care networks. Each network will cover a range of activities ( 5 functions from prevention over ambulatory care, over housing and social care, over rehabilitation,...) The government program was launched in 2012. This contribution will provide a state of the art process evaluation of the implementation of multisectorial networks. The methodological approach used is grounded in realist evaluation and takes into account knowledge from implementation science. We will report findings of 19 networks. Data were mainly collected through qualitative datacollection techniques. This contribution will highlight the facilitating and hampering factors when implementing interorgansation networks in mental health care: Particular attention will be paid to the governance of these networks and the impact of intsitutional fields in which different sectors operate on the establishment of networks. Based on the empirical analysis we wil present a number of lessons learned, reflections and recommendations on how the organisational and multisectorial intergration of mental health care could become more effective, and we will stress the importance of a context-sensitive approach in order to adress the issue of integration of care.

Previous studies have documented the application of electronic health insurance claim data for health services research purposes. In addition to administrative and billing details of healthcare services, insurance data reveal important information regarding professional interactions and/or links that emerge among healthcare service providers through, for example, informal knowledge sharing. By using details of such professional interactions and social network analysis methods, the aim of the present study was to develop a research framework to explore health care coordination and collaboration. The proposed framework was used to analyse a patient-centric care coordination network and a physician collaboration network. The usefulness of this framework and its applications in exploring collaborative efforts of different healthcare professionals and service providers is discussed.