liu.seSök publikationer i DiVA
Ändra sökning
Avgränsa sökresultatet
1 - 5 av 5
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 1.
    Smeds, Magdalena
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Managing care pathways for patients with complex care needs2019Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient.

    Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs.

    The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care.

    The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions.

    Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways.

    This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway.

    Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation.

    This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.

    Delarbeten
    1. The management of cancer care pathways in a coordination centre
    Öppna denna publikation i ny flik eller fönster >>The management of cancer care pathways in a coordination centre
    2018 (Engelska)Konferensbidrag, Publicerat paper (Refereegranskat)
    Abstract [en]

    PurposeCoordination, patient centeredness and accessibility of care are important aspects for patients with complex care needs. Variations in symptoms, morbidity, care needs, and individual prerequisites are large within these patient groups which complicates diagnostics and treatment. New ways of organising health care is needed to handle these challenges and the use of solutions as multidisciplinary cancer centres and coordination centres are becoming more common.The purpose of this paper is to study how health care can be organised to care for patients with complex care needs. This is done by describing how one coordination centre works with management and coordination of care pathways in cancer care.

    Design/methodology/approachThis paper is based on a qualitative single case study where the implementation of CCPs was studied in the Region of Östergötland. Three main data collection methods were used: semi-structured interviews, observations and document studies. Sixteen interviews were held with three physicians, seven nurses, two care unit managers, two general practitioners and the coordination centres two project leaders. Ten observational studies in the form of participative and non-participative observations in meetings were conducted. A retrospective document study was also conducted where internal public documents were systematically reviewed. Pilot study reports and implementation reports, during the period 2014 to 2018 were read and analysed by conducting content analysis.

    FindingsThe UCCD was designed to take care of all potential cancer patients under ‘one roof’. This implied the need to find routines for handling a large amount of patients, with several different cancer diagnoses, and widely diverse care needs. The organisational design resulted in two diagnostic pathways: a standardised and a customised. The standardised diagnostic pathway works well for patients with clear symptoms and care needs with low complexity where the care can be standardised to follow rules and guidelines. The customised diagnostic pathway works well for patients with ambiguous symptoms care needs with high complexity where the care pathway need to be tailored and diagnostics are done by problem solving based on intuition and experience.

    Originality/Value of paperThis paper contributes with knowledge on how coordination centres can work with care pathways to improve health care coordination and quality for patients with complex care needs.

    Nyckelord
    Health care, cancer care pathways, coordination centre, patient centeredness, standardisation
    Nationell ämneskategori
    Tillförlitlighets- och kvalitetsteknik
    Identifikatorer
    urn:nbn:se:liu:diva-155094 (URN)
    Konferens
    21st QMOD conference, Cardiff UK, 22-24 August, 2018
    Tillgänglig från: 2019-03-18 Skapad: 2019-03-18 Senast uppdaterad: 2019-05-14
    2. The effects of cancer care pathways on waiting times
    Öppna denna publikation i ny flik eller fönster >>The effects of cancer care pathways on waiting times
    2019 (Engelska)Ingår i: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 11, nr 2, s. 204-216Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose

    The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation.

    Design/methodology/approach

    A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation.

    Findings

    Three effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times.

    Originality/value

    “Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.

    Ort, förlag, år, upplaga, sidor
    Emerald Group Publishing Limited, 2019
    Nyckelord
    Health care, Standardisation, Patient care, Quality management, Health care management, Quality of health care
    Nationell ämneskategori
    Tillförlitlighets- och kvalitetsteknik Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
    Identifikatorer
    urn:nbn:se:liu:diva-154049 (URN)10.1108/IJQSS-04-2018-0041 (DOI)000479227600004 ()2-s2.0-85058658565 (Scopus ID)
    Tillgänglig från: 2019-01-24 Skapad: 2019-01-24 Senast uppdaterad: 2019-08-27Bibliografiskt granskad
  • 2.
    Smeds, Magdalena
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Poksinska, Bozena Bonnie
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    The effects of cancer care pathways on waiting times2019Ingår i: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 11, nr 2, s. 204-216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation.

    Design/methodology/approach

    A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation.

    Findings

    Three effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times.

    Originality/value

    “Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.

  • 3.
    Smeds, Magdalena
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Poksińska, Bozena
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    The implementation and improvement science perspective on interventions in health care2018Konferensbidrag (Övrigt vetenskapligt)
  • 4.
    Smeds, Magdalena
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    The management of cancer care pathways in a coordination centre2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    PurposeCoordination, patient centeredness and accessibility of care are important aspects for patients with complex care needs. Variations in symptoms, morbidity, care needs, and individual prerequisites are large within these patient groups which complicates diagnostics and treatment. New ways of organising health care is needed to handle these challenges and the use of solutions as multidisciplinary cancer centres and coordination centres are becoming more common.The purpose of this paper is to study how health care can be organised to care for patients with complex care needs. This is done by describing how one coordination centre works with management and coordination of care pathways in cancer care.

    Design/methodology/approachThis paper is based on a qualitative single case study where the implementation of CCPs was studied in the Region of Östergötland. Three main data collection methods were used: semi-structured interviews, observations and document studies. Sixteen interviews were held with three physicians, seven nurses, two care unit managers, two general practitioners and the coordination centres two project leaders. Ten observational studies in the form of participative and non-participative observations in meetings were conducted. A retrospective document study was also conducted where internal public documents were systematically reviewed. Pilot study reports and implementation reports, during the period 2014 to 2018 were read and analysed by conducting content analysis.

    FindingsThe UCCD was designed to take care of all potential cancer patients under ‘one roof’. This implied the need to find routines for handling a large amount of patients, with several different cancer diagnoses, and widely diverse care needs. The organisational design resulted in two diagnostic pathways: a standardised and a customised. The standardised diagnostic pathway works well for patients with clear symptoms and care needs with low complexity where the care can be standardised to follow rules and guidelines. The customised diagnostic pathway works well for patients with ambiguous symptoms care needs with high complexity where the care pathway need to be tailored and diagnostics are done by problem solving based on intuition and experience.

    Originality/Value of paperThis paper contributes with knowledge on how coordination centres can work with care pathways to improve health care coordination and quality for patients with complex care needs.

  • 5.
    Smeds, Magdalena
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Poksińska, Bozena
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Push out, inclusion or exclusion? What are actually the effects of implementing cancer patient pathways in Sweden?2017Konferensbidrag (Refereegranskat)
1 - 5 av 5
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf