Development of a conceptual framework to scale up co-managed care for older patients with hip fracture in China: a qualitative study

BMC Health Services Research

Research

Jing Zhang¹  Pengpeng Ye²  Minghui Yang³  Xinbao Wu³  Ruth Webster⁴  Rebecca Ivers⁴  Maoyi Tian⁵ 

[1] Clinical Epidemiology Research Centre, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China;National Centre for Orthopaedics, Beijing, China;School of Population Health, University of New South Wales, Sydney, NSW, Australia;National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China;National Centre for Orthopaedics, Beijing, China;Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China;School of Population Health, University of New South Wales, Sydney, NSW, Australia;The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia;The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia;School of Public Health, Harbin Medical University, Harbin, China;

关键词: Hip fracture;    Co-managed care;    Conventional care;    Multidisciplinary management;    Consolidated framework for implementation research;   

DOI  :  10.1186/s12913-023-09910-w

 received in 2022-12-07, accepted in 2023-08-12,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHip fracture creates a major burden on society due to high mortality, loss of independence and excess medical costs for older people. A multidisciplinary co-managed model of care is widely considered as the best practice for the management of older patients with hip fracture. The study aims to develop a conceptual framework to inform the future scale-up of this model of care through the identification of barriers and enablers that may influence successful uptake.MethodsThis qualitative study was conducted within an interventional study, which aimed to test the effectiveness of co-managed model of care for older patients with hip fracture. Health providers and health administrators from three hospitals were purposively selected and interviewed in-depth. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview guides, collect and analyse data. Inductive and deductive approaches were used to generate enablers or barriers, aligned with the CFIR constructs. All barriers or enablers were inductively summarised to a conceptual framework with essential components to guide the implementation of co-managed model of care in other hospitals.ResultsA total of 13 health providers and 3 health administrators were recruited. The main barriers to co-managed care implementation included perceived complexity of implementation, insufficient international collaboration and incentives, the absence of national guideline support and lack of digital health applications for communication between health providers, insufficient number of health providers and beds, and poor understanding about the effectiveness of this care model. A conceptual framework for future scale-up was then developed, consisting of the following essential components: hospital authority support, enabling environment, adequate number of beds, sufficient and skilled health providers, use of digital health technology, regular quality supervision, evaluation and feedback, and external collaborations.ConclusionsDespite the complexity of the intervention, the co-managed model of care has the potential to be implemented and promoted in China and in similar settings, although there is a need to demonstrate feasibility in different settings.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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