Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jun 12, 2019
Open Peer Review Period: Jun 12, 2019 - Jun 20, 2019
Date Accepted: Aug 21, 2019
(closed for review but you can still tweet)
Development and Implementation of a Nurse-Led Model of Care Coordination to Provide Health-Sector Continuity of Care for People with Multimorbidity: Protocol for a Mixed Methods Study
ABSTRACT
Background:
Innovative strategies are required to reduce care fragmentation for people with multimorbidity. In response, coordinated models of health care delivery need to be adopted to deliver consumer-centred continuity of care. Nurse-led services have emerged over the past 20 years as evidence-based structured models of care delivery, providing a range of positive and coordinated healthcare outcomes. Although Nurse-led services are effective in a range of clinical settings, strategies to improve continuity of care across the secondary and primary health care sectors for people with multimorbidity have not been examined.
Objective:
To implement a nurse-led model of care coordination from a multi-disciplinary outpatient setting and provide continuity of care between the secondary and primary health care sectors for people with multimorbidity.
Methods:
This action research mixed methods study will have two phases. Phase one includes a systematic review, stakeholder forums and validation workshop to collaboratively develop a model of care for a nurse-led care coordination service. The second phase, through a series of iterative action research cycles, will implement a nurse-led model of care coordination in a multidisciplinary outpatient setting. Three to five iterative action research cycles will allow the model to be refined and further developed with multiple data collection points throughout.
Results:
Pilot implementation of the model of care coordination commenced in October 2018. Formal study recruitment commenced in May 2019 and the intervention and follow-up phases are ongoing. The results of the data analysis are expected to be available by March 2020
Conclusions:
Nursing, clinician and patient outcomes and experiences with the nurse-led model of care coordination will provide a template to improve continuity of care between the secondary and primary healthcare systems. The model template may provide a future pathway for implementation of nurse-led services both nationally and internationally.
Citation
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Copyright
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