Literature Collection

BACKGROUND: This study explores the facilitating and inhibiting factors in the design/development, implementation, and applicability/evaluation of value-based payment models of integrated care. The Delphi technique was used to reach consensus among a panel of (inter)national experts on these factors. METHODS: An expert panel of 15 members participated in a three-round Delphi study. Factors from experts and literature were used to compile a list of 40 facilitators and 40 inhibitors. Afterwards, experts were asked to rate the importance of these factors using a 5-point Likert scale. RESULTS: Eight facilitating (e.g., transparency, communication, and trust among involved stakeholders) and seven inhibiting factors (e.g., lack of motivation and engagement among involved stakeholders) achieved full consensus. Timely availability of data and an integrated information technology system for data registration (a facilitator) were the only factors achieving full consensus through a very high agreement. CONCLUSIONS: Adequate outcome measures, targets, benchmarks, and incentives are important in value-based payment models. The less quantifiable items, such as strong leadership, transparency, communication and trust, and motivation and engagement of the involved stakeholders, are also important for successful adoption of these models and promote high-quality care at lower or equal costs.

The opioid epidemic was declared a national public health emergency in 2017. In Georgia, standing orders for the opioid antagonist, naloxone, have been implemented to reduce mortality from opioid overdoses. Service industry workers in the Atlanta, Georgia, inner-city community of Little Five Points (L5P) have access to naloxone, potentially expanding overdose rescue efforts in the community setting. To explore the issues facing L5P, our research brings together qualitative descriptive inquiry, ethnography, community-based research, a community advisory board, and a local artist to maximize community dissemination of research findings through a graphic novel that describes encountering an opioid overdose. This format was chosen due to the ethical responsibility to disseminate in participants' language and for its potential to empower and educate readers. This article describes the process of working on this study with the community and a local artist to create sample pages that will be tested for clarity of the message in a later phase. Working with an artist has revealed that while dissemination and implementation for collaboration begin before findings are ready, cross-collaboration with the artist requires early engagement, substantial funding, artist education in appropriate content, and member checking to establish community acceptability altering illustrations that reinforce negative stereotypes. By sharing the experiences of actions taken during an opioid overdose in L5P through a graphic novel, we can validate service industry workers' experiences, acknowledge their efforts to contribute to harm reduction, and provide much-needed closure to those who encounter opioid overdoses in the community.

Parkinson's Disease (PD) is a progressive neurodegenerative condition that requires timely intervention to manage symptoms and prevent deterioration. This study investigates the essential requirements for a speech-based decision support tool to monitor PD progression in a community-integrated care setting. While still at an early design stage, the envisioned tool may take the form of mobile or desktop software accessible to patients, carers, and professionals in home and clinical settings. A mixed-methods approach, including surveys (n=31), focus groups (n=12), interviews (n=11), and policy document analysis, was used to gather insights from health and social care staff in Wales. Four major themes emerged: essential technical requirements (reliability, ease of use), workforce needs (training, analytic transparency), patient considerations (preferences, privacy), and systemic integration (interoperability, funding). Findings highlight the potential of speech-based AI systems for early, objective detection of PD deterioration. However, clinician trust, digital literacy, and user-centered design remain critical for adoption. Co-design with people with PD (PwPD), carers, and staff is strongly recommended for future development and evaluation. This study contributes to the growing field of intelligent systems in digital health and decision support.

BACKGROUND: Work-integrated learning (WIL) is a core aspect of allied health education. WIL placements typically focus on developing clinical skills, with broader conceptions of work readiness a secondary consideration. Near-peer mentoring (NPM), where senior students mentor junior students, is one WIL placement model that holds promise for developing students' work readiness, along with additional benefits for educators and service users. While there is emerging evidence of the benefits of NPM in allied health, a more comprehensive understanding of the design and outcomes of NPM WIL placements for allied health students, their educators and service users is needed. METHODS: A systematic search of seven electronic databases (CINAHL, ERIC, ProQuest Education, Medline, PsychInfo, EMBASE and Scopus) from 2003 to 2022 was conducted with 4195 records reviewed. Included studies reported on near-peer mentoring between at least one of the identified 11 allied health professionals providing services to real people (i.e. not simulation). Data extracted included pedagogical approaches, type of service model and relationship of peers to each other and educator, objectives for implementing the NPM, and effects for students. Quality appraisal was undertaken using the Standards for Reporting of Qualitative Research (SRQR). RESULTS: Fourteen studies met the inclusion criteria. The majority were North American in origin, from the disciplines of pharmacy, physiotherapy, psychology and occupational therapy, and used a range of research designs. Four types of placement design were observed from incidental co-location of students and observing outcomes through to deliberate preparation of students and/or educators for their roles in a NPM placement. Outcomes for junior students included lowered anxiety leading to increased confidence and motivation to learn and thus enhanced clinical skills. Senior student outcomes included development of educator skills, increased confidence, and enhanced professional reasoning. Service users and educators also benefited from NPM; however, evidence was sparse in these areas. CONCLUSION: The evidence supports near-peer mentoring as a valuable WIL model to support work readiness, and several general pedagogical designs are evident. Future research should design NPM WIL with a greater integration of educational theory and evaluate outcomes beyond satisfaction and self-reported experiences.

BACKGROUND: Team-based models of care are efficacious in improving outcomes for patients with mental and physical illnesses. However, primary care clinics have been slow to adopt these models. We used iterative stakeholder engagement to develop an intervention to improve the implementation of team-based care for this complex population. METHODS: We developed the initial framework for Relational Team Development (RELATED) from a qualitative study of Primary Care Providers' (PCPs') experiences treating mental illness and a literature review of practice facilitation and psychology clinical supervision. Subsequently, we surveyed 900 Colorado PCPs to identify factors associated with PCP self-efficacy in management of mental illness and team-based care. We then conducted two focus groups for feedback on RELATED. Lastly, we convened an expert panel to refine the intervention. RESULTS: We developed RELATED, a two-part intervention delivered by a practice facilitator with a background in clinical psychology. The facilitator observes PCPs during patient visits and provides individualized coaching. Next, the facilitator guides the primary care team through a practice change activity with a focus on relational team dynamics. CONCLUSION: The iterative development of RELATED using stakeholder engagement offers a model for the development of interventions tailored to the needs of these stakeholders. TRIAL REGISTRATION: Not applicable.