Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada.
Postdoctoral Fellow, Engineering and Applied Science, Memorial University, Newfoundland and Labrador, Canada.
Health Res Policy Syst. 2024 Aug 12;22(1):103. doi: 10.1186/s12961-024-01196-6.
Healthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery.
The functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting.
Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care.
A transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.
医疗保健系统的可持续性受到了几个关键问题的挑战；其中最紧迫的问题之一是人口老龄化。传统的、阶段性的医疗服务模式并不是为那些身体复杂、脆弱的老年人设计的。这些人将受益于更全面、协调、以患者为中心、在他们居住的社区中更容易获得的医疗和社会保健。提供这种服务是一项具有挑战性的工作。社区卫生和社会保健专业人员是孤立的，分散在各个地点和部门，每个专业人员都有自己的思维模式、电子健康信息系统和沟通方式。为了摆脱零散的医疗服务模式，走向更综合的医疗服务方法，在加拿大大西洋地区的一个城市社区进行了社区综合老年评估过程的分析。这项研究的目的是确定在社区综合老年评估过程中，存在哪些挑战和机遇，可以向更综合的医疗服务模式转变。
使用功能共振分析方法（FRAM）和动态 FRAM（DynaFRAM）建模来对社区卫生和社会保健系统进行建模，并创建一个假设的患者就诊情景。为建模提供信息的数据包括文件审查、焦点小组以及对在社区环境中为老年人提供护理和服务的卫生和社会保健专业人员的半结构化访谈。
确定了在当地实施综合护理的挑战和机遇。FRAM 和 DynaFRAM 分析的结果为多层面的流程改进建议提供了信息，旨在推动当地社区综合老年评估流程向更综合的护理模式转变。
在当地对社区卫生和社会保健进行变革性的重新设计是必要的，但如果不了解卫生和社会保健专业人员的工作方式以及老年人在动态条件下如何获得护理，就无法实现这一目标。FRAM 和 DynaFRAM 建模提供了对系统操作和功能的更深入理解，并展示了决策者在努力实施更综合的护理模式时不应忽视的关键步骤。
