Abstract
There has been a lot of conversation about the new normal in terms of what healthcare will look like and how providers will deliver care as we move past the second COVID-19 surge. Care coordination challenges are magnified during COVID-19, and the pandemic has highlighted the interdependence of providers across the continuum. Moreover, COVID-19 has highlighted the need for interoperability and communication between providers to ensure the best possible care for patients. For example, care providers in hospitals and post-acute providers have needed to communicate in near real-time on a variety of time-sensitive issues to ensure the safety of patients and staff, including the ability to accept COVID-19 positive patients, bed availability and patient test results. Because of this, it is likely we will continue to see the need for increased communication and transparency. Healthcare will be much more virtual than it was at the beginning of 2020. To survive and thrive in the new world, healthcare providers need to go where the customer is headed. To put it different: healthcare needs to be delivered when, where, and how patients want it.
The Discussion & Opinion paper by Gill nicely describes the need for a shift in control and power from the health professional to the patient to determine the best approach to dealing with the condition at hand. Moreover, by explaining the concept of patient centricity and illustrating it with personal examples, Gill points out the importance of utilising the large, experienced and skilled resource that is better known as the community of patients. 1
Kumari et al. conducted a qualitative study in Northern India to gain insight into how heart failure is managed by patients, their family caregivers, cardiologists and nurses. From their findings it was concluded that both patients and their caregivers were inadequately trained to manage the heart failure symptoms by themselves in their home settings. Moreover, the lack of a protocolised approach by healthcare providers in addition to other barriers, made the hospital management of heart failure very challenging. 2
However, having care pathways for predictable trajectories of care is no guarantee for success, as researched by Olsson. Moreover, the complexity surrounding the implementation of care pathways may result in ‘crowding out’: situations when patients with lower priority are provided treatment before patients with higher priority. This issue becomes problematic when associated with waiting times and/or associated adverse outcomes. By looking into the data from a hospital in southern Sweden, Olsson investigated whether the implementation of cancer care pathways is associated with longer waiting times for surgery, radiology scans and pathology analyses for patients. Since crowding out effects have not been previously researched, this article fills a gap by providing a more detailed understanding of such effects and helps to see whether actions need to be taken to prevent patients from (too long) waiting times. 3
In their multiple case study of coordinated care for children with inflammatory bowel disease (IBD), deJong et al. have explored perspectives of coordinated care following emergency department visits, because these visits may indicate deficiencies. They identified three major themes: perceptions of appropriate expertise, desire for integration of information and services, and making assumptions instead of engaging. Equally important is that this study shows the relevance of lived experience to inform the development of more effective care coordination tools and models. 4
The final article in this issue of the International Journal of Care Coordination addresses the cost, burden and quality of life of primary caregivers of children with lymphoma in a tertiary hospital in Ghana. The findings of this study have led authors to recommended policymakers in Ghana to develop a national programme to reduce the cost of cancer medication and treatment while improving the quality of life of both the caregiver and the care recipient. It will be interesting to see, when such a programme gets implemented, the programme’s return on investment (ROI) for Ghana as well as similar countries in the world. 5
For care coordination to be effective, patients indeed need to be engaged. As from what can already be learned from the COVID-19 pandemic in 2020, the new normal is likely to enable robust analytics platforms to take in multiple data sources, leverage real-time information, support patient engagement capabilities, and empower stakeholders to build and refine healthcare programmes that improve patient care and control costs. The International Journal of Care Coordination welcomes authors to share their opinions about the new normal as well as to submit original research presenting evidence on whether the new normal of healthcare lives up to its high expectations.