“What is a Model?” workshop

Work Package 1 held an extremely productive workshop in Amsterdam on the 15th December, 2015 to discuss the question “What is a Model?”.

A crucial concept in the MOCHA project is to establish the different meanings of a ‘model’ of health care for children and young people. There are a number of interpretations in the literature and in common usage to this term. The members of work package 1 met for a very productive workshop to discuss ‘what is a model’ in terms of the the MOCHA project, and with specific reference to children. The meeting was held at the Amsterdam Medical Centre in the Netherlands, and hosted by Dr Dionne Kringos, an internationally renowned expert on models of primary health care. The meeting, and the MOCHA project benefited greatly from Dr Kringos’s input and experience.

Presentations were made by several members of WP1, discussing the approaches to the concept of a model of health care, and the different perspectives upon the models that are required by the different research questions.

Overview of work on models

Mitch Blair and Denise Alexander discussed how we can conceptualise the MOCHA project and our focus in terms of “What is a Model”. A health system is one part of many determinants of health. In MOCHA we define a child in terms of the UN Rights of a Child definition – a person aged below 18 years. At present, we are taking the Starfield definition of primary care, and basing our structure of a health system on Dionne Kringos’s system of Structure / Process / Outcome, but our discussions and debates need to refine this in the course of the project.

The concept of a child, and how a child centric view is essential

Dr Kinga Zdunek gave a presentation explaining how a child is intimately connected with context (family, culture, religion, values, beliefs, history), content (services at national, regional or local level) and process / structure (patient pathways, local or individual care, regional or secondary care, national or tertiary care) of a system – and is the main actor in the system. A child is not one single entity, but is different at different ages – and also in relation to the agents that represent a child (parent, teacher, doctor etc.).

The view from school health

Prof. Menno Reijneveld on behalf of Danielle Jansen discussed the definition of the model of school health system, and system for adolescent health care, which may well be outside the more generic models of health care – overlapping or extending beyond their parameters.

The view from Complex Care

Dr Miriam O’Shea explained the issues arising from models of complex care, and the coordination with the essential role of primary care in allowing children with complex conditions to live outside of hospital, with primary care support. There is great importance on effective communication and data exchange between parents / primary care / secondary care.

Economics Requirements – workforce

Filipa Ferreira on behalf of Graham Cookson looked at the cost of delivering these models in the EU, and the impact of the different systems economically. Concerns in this work package are definitions, secondary care and its role and data availability.

Data and Activity Measurement Aspects

Prof Simon de Lusignan gave a presentation on how we propose to look at metadata – the way we hold information and links to how it should be classified – and how this contributes to the functioning of models of health care.

Rewards, Penalties and Perverse Effects

Prof Mitch Blair, on behalf of Dr Helen Wells described the effects of rewards, penalties etc. on a health care model. A useful way is to describe them as ‘levers’. Dr Wells is looking at motivation – what motivates a patient to contact a health service / what motivates a health service to contact patients etc. in a health care model. She is conducting literature review on this, then looking at it with a ‘child’ lens.

What will the literature review contribute

Dr Barbara Corso and Dr Nadia Minicuci are undertaking a systematic literature review and meta-analysis. Defining specific topics, and looking at clinical effectiveness of healthcare intervention – need to find a quantitative measure for this.

MOCHA Model – what should it look like?

Prof Paul Kocken and Prof Mitch Blair described what WP9 are expecting to find from the project, and how it is important to be clear on the definitions and aims from the beginning.

These presentations formed the basis for an extremely rich discussion, and a further workshop was organised for Spring 2016 to create a MOCHA model, and how to describe the different types of models of health care for children in Europe, using the results of the discussions in Amsterdam.