Implementing structured follow-up of neonatal and paediatric patients: an evaluation of three university hospital case studies using the functional resonance analysis method

BMC Health Services Research

Daniëlle Roorda¹  Dionne Kringos²  Niek Klazinga²  Véronique Bos²  Johannes van Goudoever³  Jaap Oosterlaan³  Menne van Boven⁴  Eleonore de Sonnaville⁵ 

[1] Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit, Amsterdam Reproduction and Development, Amsterdam, Netherlands;Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands;Follow Me Programme and Emma Neuroscience Group, Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development, Amsterdam, Netherlands;Neonatal Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands;Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands;

关键词: Follow-up;    Implementation science;    Quality improvement;    Long-term outcomes;    Functional resonance analysis method (FRAM);    Neonatal intensive care;    Paediatric intensive care;    Paediatric surgery;   

DOI  :  10.1186/s12913-022-07537-x

来源: Springer

【 摘 要 】

BackgroundIn complex critical neonatal and paediatric clinical practice, little is known about long-term patient outcomes and what follow-up care is most valuable for patients. Emma Children’s Hospital, Amsterdam UMC (Netherlands), implemented a follow-up programme called Follow Me for neonatal and paediatric patient groups, to gain more insight into long-term outcomes and to use such outcomes to implement a learning cycle for clinical practice, improve follow-up care and facilitate research. Three departments initiated re-engineering and change processes. Each introduced multidisciplinary approaches to long-term follow-up, including regular standardised check-ups for defined age groups, based on medical indicators, developmental progress, and psychosocial outcomes in patients and their families. This research evaluates the implementation of the three follow-up programmes, comparing predefined procedures (work-as-imagined) with how the programmes were implemented in practice (work-as-done).MethodsThis study was conducted in 2019–2020 in the outpatient settings of the neonatal intensive care, paediatric intensive care and paediatric surgery departments of Emma Children’s Hospital. It focused on the organisational structure of the follow-up care. The functional resonance analysis method (FRAM) was applied, using documentary analysis, semi-structured interviews, observations and feedback sessions.ResultsOne work-as-imagined model and four work-as-done models were described. The results showed vast data collection on medical, developmental and psychosocial indicators in all work-as-done models; however, process indicators for programme effectiveness and performance were missing. In practice there was a diverse allocation of roles and responsibilities and their interrelations to create a multidisciplinary team; there was no one-size-fits-all across the different departments. Although control and feedback loops for long-term outcomes were specified with respect to the follow-up groups within the programmes, they were found to overlap and misalign with other internal and external long-term outcome monitoring practices.ConclusionImplementing structured long-term follow-up may provide insights for improving daily practice and follow-up care, with the precondition of standardised measurements. Lessons learned from practice are (1) to address fragmentation in data collection and storage, (2) to incorporate the diverse ways to create a multidisciplinary team in practice, and (3) to include timely actionable indicators on programme effectiveness and performance, alongside medical, developmental and psychosocial indicators.

【 授权许可】

CC BY