2.2 Framework for healthcare delivery models
In this chapter we explore a framework of six major healthcare delivery models:
- Methods of delivery
- Time of delivery
- Place of delivery
- Healthcare workforce of delivery
- Coordination of care delivery
- Technology-assisted delivery
This framework is based on the Effective Practice and Organisation of Care (EPOC) taxonomy of health systems interventions. The EPOC taxonomy includes four main domains of interventions:
- Delivery arrangements
- Financial arrangements
- Governance arrangements
- Implementation strategies
The taxonomy was first developed in 2002 and has been revised several times to include updates of health system interventions as they become available (EPOC, 2016). One of the drawbacks of using this framework is its potential overlap of interventions that can be classified across more than one domain. Nevertheless, this framework is relevant as it focuses on the function of the intervention within a particular context.
Methods of delivery
This model of healthcare delivery includes specialised outpatient clinics such as chronic disease management clinics to reduce waiting time for elective surgeries, maternal and child health clinics, and group versus individualised care. Examples of interventions include community-based health worker led interventions on cancer control, such as breast cancer for women, cardiovascular risk reductions for better control of blood pressure and cholesterol levels, and weight loss programs (Kim et al., 2016).
Time of delivery
Time of delivery models include triage clinics to improve patient management and admission clinics to reduce the administration burden on ward staff during hospital admissions. Examples of interventions include programs on emergency department (ED) visit reduction, improving patient flow and quality of care in ED and patient-centred clinics for patients with chronic conditions managed in outpatients. Other examples in this category include interventions administered by community paramedicine and mobile-integrated healthcare. These have been associated with high levels of patient satisfaction and reducing healthcare service use (Gingold et al., 2021; Gregg et al., 2019).
Place of delivery
This model of care delivery focuses on shifting care away from hospital settings and moving it to home settings or community health organisations. Examples include school-based clinics, outreach services and helicopter emergency medical services. Examples of interventions delivered in these places include using the ED for managing alcohol abuse, family violence and palliative care, home-based prevention and rehabilitation, waiting room interventions for sexually transmitted diseases, school-based health centres for mental health and home visits for child health and maltreatment and pregnancy (Gregg et al., 2019).
Mobile health clinics have been increasingly used as an novel model of healthcare delivery that is accessible to disadvantaged populations and individuals with chronic disease. These types of clinics offer a variety of services, such as primary care, dental care, prevention screenings, ophthalmology checks and mammographs (Gregg et al., 2019; Labeit et al., 2013).
Healthcare workforce of delivery
This model of delivery includes extending the scope of healthcare professionals, such as pharmacists, nurse practitioners and paramedics. This strategy has been successful in addressing workforce issues for medical practitioners in some areas. Examples of interventions include carer involvement in cognition-based interventions for people with dementia, nurse–physician substitution, pharmacist involvement in care for patients with chronic conditions, radiographers in advanced roles, interventions to increase breastfeeding, and advanced life support training for healthcare professionals at hospitals and ambulance teams (Yu et al., 2017).
Coordination of care delivery
This model includes transition care arrangements from hospital to home settings, integrated care models for a range of chronic diseases such as obstructive pulmonary disease, collaborative care for mental illness and case management for heart failure patients. The spread of care coordination activities aims at ensuring patients experience less fragmentation, inconsistency and unplanned care. Lack of coordinated care can result in unnecessary emergency room visits, hospital admissions, avoidable readmissions and unnecessary expenses on hospital resources that have been estimated at US$25 billion to US$45 billion annually (Swan et al., 2019).
Technology-assisted delivery
This model of delivery focuses mainly on telehealth interventions, such as telephone counselling, mobile applications and internet-based programs. A recent scoping review addressing digital health innovations for non-communicable diseases during the COVID-19 pandemic highlighted the importance of technology-assisted delivery for mental health and neurological disease during the pandemic (Abd-Alrazaq et al., 2021). Their use has also been valuable in improving access issues in rural and remote areas (Murthy et al., 2023). More specifically, technology use enhanced patients’ communication and personal health tracking. Other conditions where these interventions were implemented were in cancer management, cardiovascular diseases for prescriptions management, and diabetes management for client management and communications (Gudi et al., 2023).
Summary
A recent Australian study found strong agreement among various stakeholders about the potential of alternative healthcare models to enhance the sustainability of Australia’s health system. It identified improving medical services in residential care, offering single-point-access multidisciplinary care for complex conditions, and implementing tailored early discharge and hospital-at-home programs as top priorities. However, while these priorities suggest areas of high stakeholder interest, further research is required to prove the effectiveness and cost-effectiveness of some of these models (Putrik et al., 2021).
