The Spoke-Hub-and-Node Model of Integrated Heart Failure Care |
| |
Authors: | Ashlay A. Huitema Karen Harkness George A. Heckman Robert S. McKelvie |
| |
Affiliation: | 1. Western University, London, Ontario, Canada;2. McMaster University, Hamilton, Ontario, Canada;3. University of Waterloo/Schlegel UW Research Institute for Aging, Canadian Integrated Heart Failure Care, Waterloo, Ontario, Canada |
| |
Abstract: | Heart failure (HF) is a significant public health concern. Specialized HF clinics provide the optimal environment to address the complex needs of these patients and improve outcomes. The current and growing population of patients with HF outstrips the ability of these clinics to deliver care. Integrated care is defined as health services that are managed and delivered so that people receive a seamless continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services. This approach requires coordination across different levels and sites of care within and beyond the health sector, according to changing patient needs throughout their lives. The spoke-hub-and-node (SHN) model represents an organization of care that works collaboratively with the primary care sector and is highly integrated with community-based multidisciplinary teams of health care professionals and specialty care. The purpose of this article is to analyze the requirements for successful implementation of SHN models. We consider the respective roles of HF clinics, HF nurse specialists, pharmacists, palliative care teams, telemonitoring, and solo practitioners. We also discuss levels of care delivery and the importance of patient stratification and patient flow. The SHN approach has the potential to build on and improve the chronic care model (CCM) to deliver centralized services to preserve high-quality patient-centred care at affordable costs. |
| |
Keywords: | Corresponding author: Dr Robert S. McKelvie St Joseph’s Health Care Center Room B3-628 268 Grosvenor Street London Ontario N6A 4V2 Canada. Tel.: +1-519-646-6175. |
本文献已被 ScienceDirect 等数据库收录! |
|