Circle of care modeling: improving continuity of care for end of life patients.




Price, Morgan Thomas Mayhew

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Objective: This study sought to answer the question “What feasible changes can be made to care processes and clinical information systems to improve Continuity of Care for end of life patients?” Methods: This study adapted Genre Theory and Soft Systems Methodology into a new systems approach, the Circle of Care Modeling Approach. Thirty-four healthcare providers and health IT professionals were interviewed in two communities in British Columbia, Canada. The interviews sought to discover the nature of care provided for end of life patients and how clinical information systems supported care. Interviews were centered on two simulated end of life patients. The patient centric healthcare system, or Circle of Care, was described for each of these patients in each community. Rich Pictures and Conceptual Models were developed based on interview findings. These diagrams were used with participants to discuss gaps in continuity and to seek improvements during a series of structured discussion groups. Results and Discussion: The Circle of Care for end of life patients was found to be large and complex in both communities. Potentially dozens of providers would have been involved in each patient’s care over their last year of life. No provider knew all members of the Circle of Care. All communication activities that were described by participants could be described within the Circle of Care with ten Abstracted Genres. Patient information was housed in many disparate repositories (both paper and electronic) and access to these repositories was limited. The participants described several aspects of Continuity of Care. A new model to describe Continuity of Care was developed based on the findings and taking into account the systems orientation of this study. Six suggested improvements were generated with the study participants to better support Continuity of Care within the communities in this study. These are described in the dissertation. The suggested improvements were compared to existing functionality of clinical information systems. This novel approach to exploring and visualizing the healthcare system from a patient-centric lens, the Circle of Care Modeling Approach, provided a new way of describing and reasoning about the complexities associated with Continuity of Care.



end of life, continuity of care, soft systems methodology, genre theory