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BMC Health Services Research

, 16:546

Organization, structure and delivery of healthcare


BackgroundMany health system and health Information and Communication Technology ICT projects do not achieve their expected benefits. This paper presents an approach to exploring changes in the healthcare system to better understand the expected improvements and other changes by using a patient-centric modelling approach. Circle of care modeling CCM was designed to assist stakeholders in considering healthcare system changes using a patient centric approach.

MethodsThe CCM approach is described. It includes four steps, based on soft systems methodology: finding out, conceptual modelling, structured discussion, and describing potential improvements. There are four visualizations that are used though this process: patient-persona based rich pictures of care flows as part of finding out, and three models: provider view, communication view, and information repository view as part of conceptual modelling.

ResultsThree case studies are presented where CCM was applied to different real-world healthcare problems: 1. Seeking improvements in continuity of care for end of life patients. 2. Exploring current practices for medication communication for ambulatory patients prior to an update of a jurisdictional drug information system. 3. Deciding how to improve attachment of patients to primary care. The cases illustrate how CCM helped stakeholders reason from a patient centered approach about gaps and improvements in care such as: data fragmentation in 1, coordination efforts of medication management in 2, and deciding to support a community health centre for unattached patients in 3.

DiscussionThe circle of care modelling approach has proved to be a useful tool in assisting stakeholders explore health system change in a patient centric approach. It is one way to instantiate the important principle of being patient centered into practice when considering health system changes.

KeywordsCircle of care Quality improvement Modeling Clinical informatics AbbreviationsCCMCircle of care modelling

ICTInformation and communication technology

MDMedical doctor

PHPPatient health portal

PHRPersonal health record

RNRegistered nurse

SysMLSystems modeling language

UMLUnified modelling language

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Autor: Morgan Price


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