Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study
Background. Gaps in coordination and transitions of care for liver cirrhosis contribute to high rates of hospital readmissions and inadequate quality of care. Understanding the differences in the mental models held by specialty and primary care physicians may help to identify the root causes of prob...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2021/5582297 |
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| _version_ | 1832549825035370496 |
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| author | Tanya Barber Lynn Toon Puneeta Tandon Lee A. Green |
| author_facet | Tanya Barber Lynn Toon Puneeta Tandon Lee A. Green |
| author_sort | Tanya Barber |
| collection | DOAJ |
| description | Background. Gaps in coordination and transitions of care for liver cirrhosis contribute to high rates of hospital readmissions and inadequate quality of care. Understanding the differences in the mental models held by specialty and primary care physicians may help to identify the root causes of problems in the coordination of cirrhosis care. Aim. To compare and identify differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions. Methods. Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling to select family physicians (n = 8), specialists (n = 9), and cirrhosis-dedicated nurse practitioners (n = 2) across Alberta. Results. Family physicians do not maintain rich mental models of cirrhosis care. They see cirrhosis patients relatively infrequently, rebuilding their mental models when required (knowledge on demand). They have reactive and patient-need-focused, rather than proactive and system-of-care, mental models. Specialists’ mental models are rich but vary widely between patient-centered and task-centered and in the degree to which they incorporate responsibility for addressing system gaps. Nurse practitioners hold patient-centered mental models like specialists but take responsibility for addressing gaps in the system. Conclusions. Improving the coordination of cirrhosis care will require infrastructure to design care pathways and work processes that will support family physicians’ knowledge-on-demand needs, facilitate primary care-specialist relationships, and deliberately work toward building a shared mental model of responsibilities for addressing medical care and social determinants of health. |
| format | Article |
| id | doaj-art-d57db140da8d4b42b2d4effafffc5bd5 |
| institution | Kabale University |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-d57db140da8d4b42b2d4effafffc5bd52025-02-03T06:08:33ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972021-01-01202110.1155/2021/55822975582297Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis StudyTanya Barber0Lynn Toon1Puneeta Tandon2Lee A. Green3Department of Family Medicine, University of Alberta, T6G 2T4, Edmonton, AB, CanadaAccelerating Change Transformations Team, Alberta Medical Association, T5N 3Y8, Edmonton, AB, CanadaDivision of Gastroenterology (Liver Unit), Zeidler Ledcor Centre, T6G 2X8, Edmonton, AB, CanadaDepartment of Family Medicine, University of Alberta, T6G 2T4, Edmonton, AB, CanadaBackground. Gaps in coordination and transitions of care for liver cirrhosis contribute to high rates of hospital readmissions and inadequate quality of care. Understanding the differences in the mental models held by specialty and primary care physicians may help to identify the root causes of problems in the coordination of cirrhosis care. Aim. To compare and identify differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions. Methods. Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling to select family physicians (n = 8), specialists (n = 9), and cirrhosis-dedicated nurse practitioners (n = 2) across Alberta. Results. Family physicians do not maintain rich mental models of cirrhosis care. They see cirrhosis patients relatively infrequently, rebuilding their mental models when required (knowledge on demand). They have reactive and patient-need-focused, rather than proactive and system-of-care, mental models. Specialists’ mental models are rich but vary widely between patient-centered and task-centered and in the degree to which they incorporate responsibility for addressing system gaps. Nurse practitioners hold patient-centered mental models like specialists but take responsibility for addressing gaps in the system. Conclusions. Improving the coordination of cirrhosis care will require infrastructure to design care pathways and work processes that will support family physicians’ knowledge-on-demand needs, facilitate primary care-specialist relationships, and deliberately work toward building a shared mental model of responsibilities for addressing medical care and social determinants of health.http://dx.doi.org/10.1155/2021/5582297 |
| spellingShingle | Tanya Barber Lynn Toon Puneeta Tandon Lee A. Green Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study Canadian Journal of Gastroenterology and Hepatology |
| title | Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study |
| title_full | Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study |
| title_fullStr | Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study |
| title_full_unstemmed | Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study |
| title_short | Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study |
| title_sort | eliciting and understanding primary care and specialist mental models of cirrhosis care a cognitive task analysis study |
| url | http://dx.doi.org/10.1155/2021/5582297 |
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