%0 Journal Article
%@ 1929-0748
%I JMIR Publications
%V 8
%N 12
%P e15006
%T Development and Implementation of a Nurse-Led Model of Care Coordination to Provide Health-Sector Continuity of Care for People With Multimorbidity: Protocol for a Mixed Methods Study
%A Davis,Kate M
%A Eckert,Marion C
%A Shakib,Sepehr
%A Harmon,Joanne
%A Hutchinson,Amanda D
%A Sharplin,Greg
%A Caughey,Gillian E
%+ Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia, 61 08 8302 2129, kathryn.davis@mymail.unisa.edu.au
%K continuity of patient care
%K multimorbidity
%K nurse led
%K integrated health
%K transitional
%K chronic disease
%D 2019
%7 9.12.2019
%9 Protocol
%J JMIR Res Protoc
%G English
%X Background: Innovative strategies are required to reduce care fragmentation for people with multimorbidity. Coordinated models of health care delivery need to be adopted to deliver consumer-centered continuity of care. Nurse-led services have emerged over the past 20 years as evidence-based structured models of care delivery, providing a range of positive and coordinated health care outcomes. Although nurse-led services are effective in a range of clinical settings, strategies to improve continuity of care across the secondary and primary health care sectors for people with multimorbidity have not been examined. Objective: To implement a nurse-led model of care coordination from a multidisciplinary outpatient setting and provide continuity of care between the secondary and primary health care sectors for people with multimorbidity. Methods: This action research mixed methods study will have two phases. Phase 1 includes a systematic review, stakeholder forums, and validation workshop to collaboratively develop a model of care for a nurse-led care coordination service. Phase 2, through a series of iterative action research cycles, will implement a nurse-led model of care coordination in a multidisciplinary outpatient setting. Three to five iterative action research cycles will allow the model to be refined and further developed with multiple data collection points throughout. Results: Pilot implementation of the model of care coordination commenced in October 2018. Formal study recruitment commenced in May 2019 and the intervention and follow-up phases are ongoing. The results of the data analysis are expected to be available by March 2020. Conclusions: Nursing, clinician, and patient outcomes and experiences with the nurse-led model of care coordination will provide a template to improve continuity of care between the secondary and primary health care systems. The model template may provide a future pathway for implementation of nurse-led services both nationally and internationally. International Registered Report Identifier (IRRID): DERR1-10.2196/15006 
%M 31815675
%R 10.2196/15006
%U http://www.researchprotocols.org/2019/12/e15006/
%U https://doi.org/10.2196/15006
%U http://www.ncbi.nlm.nih.gov/pubmed/31815675