International Journal of Integrated Care, 16(4), 2016, Online only
Publisher:
International Foundation for IntegratedCare
Health economists are increasingly interested in integratedcare in order to support decision-makers to find cost-effective solutions able to tackle the threat that chronic diseases pose on population health and health and social care budgets. However, economic evaluation in integratedcare is still in its early years, facing several difficulties. The aim of this paper is to describe the unique...
(Publisher abstract)
Health economists are increasingly interested in integratedcare in order to support decision-makers to find cost-effective solutions able to tackle the threat that chronic diseases pose on population health and health and social care budgets. However, economic evaluation in integratedcare is still in its early years, facing several difficulties. The aim of this paper is to describe the unique nature of integratedcare as a topic for economic evaluation, explore the obstacles to perform economic evaluation, discuss methods and techniques that can be used to address them, and set the basis to develop a research agenda for health economics in integratedcare. The paper joins the voices that call health economists to pay more attention to integratedcare and argues that there should be no more time wasted for doing it.
(Publisher abstract)
International Journal of Integrated Care, 13(4), 2013, Online only
Publisher:
International Foundation for IntegratedCare
Integratedcare is a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integratedcare delivery. This article provides a framework to identify the underlying mechanisms of integratedcare delivery in order to increase understanding between the relation between structure and outcomes. The overall aim...
(Edited publisher abstract)
Integratedcare is a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integratedcare delivery. This article provides a framework to identify the underlying mechanisms of integratedcare delivery in order to increase understanding between the relation between structure and outcomes. The overall aim is to improve the quality of care delivery and eventually patient outcomes. First, the cognitive components of the framework are outlined. These components consist of mechanisms that alter the way of thinking by professionals delivering care to older patients. Next the behavioural components are explained, which consist of mechanisms that explain how professionals actively share and combine patient information from various sources. An example of an application of the evaluation model for an integratedcare programme for hospitalised and vulnerable older people is then provided. The following aspects are discussed: organisational context; care delivery by interdisciplinary teams; team context; health service delivery; quality of life for elderly patients. Interprofessional collaboration among professionals is considered to be critical in integratedcare delivery due to many interdependent work requirements. Effective integratedcare programmes combine the interacting components of care delivery. These components affect professionals’ cognitions and behaviour, which in turn affect quality of care. Insight is gained into how these components alter the way care is delivered through mechanisms such as combining individual knowledge and actively seeking new information.
(Edited publisher abstract)
International Journal of Integrated Care, 14(3), 2014, Online only
Publisher:
International Foundation for IntegratedCare
Introduction: Notwithstanding care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of integratedcare lacks specificity and clarity. This article presents a literature review to identify mechanisms for achieving integratedcare objectives.
Theory and methods: Existing models often present a large variety...
(Publisher abstract)
Introduction: Notwithstanding care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of integratedcare lacks specificity and clarity. This article presents a literature review to identify mechanisms for achieving integratedcare objectives.
Theory and methods: Existing models often present a large variety of dimensions, archetypes and categories of integration without specifying them. Models and programmes describing integratedcare for chronic diseases were reviewed. Data were extracted related to objectives and clusters of mechanisms of integration.
Results: Thirty-four studies presented four objectives: functional, organisational, professional and service integration. The authors categorised approaches and interventions to achieve these objectives by strategy and clusters of ‘mechanisms of integration’: degree, patient centredness and normative aspects.
Conclusions and discussion: The clarification of mechanisms to achieve objectives of integratedcare as presented may be used as starting point for the development and refinement of integratedcare programmes, including methodological grounding of their evaluation. Given that most studies reviewed lack both empirical data and descriptions of the methods used, future research needs to close these gaps. Validation of the findings by a large panel of experts is suggested as recommendation to work towards a grounded framework.
(Publisher abstract)
Subject terms:
models, integrated services, health care, organisational structure, multidisciplinary services, person-centred care;
International Journal of Integrated Care, 13(3), 2013, Online only
Publisher:
International Foundation for IntegratedCare
This paper provides the results of a year-long evaluation of a large-scale integratedcare pilot in north-west London. The pilot aimed to integratecare across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. The evaluation team...
(Publisher abstract)
This paper provides the results of a year-long evaluation of a large-scale integratedcare pilot in north-west London. The pilot aimed to integratecare across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study). The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes. The paper concludes that it is critical that National Health Service managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time.
(Publisher abstract)
Subject terms:
health care, evaluation, diabetes, older people, integrated services, change management, outcomes, interprofessional relations, social care, mental health care;
TUMMERS Johanneke F.M.M., SCHRIJVERS Augustinus J.P., VISSER-MEILY Anne J.M.
Journal article citation:
International Journal of Integrated Care, 12(4), 2012, Online only
Publisher:
International Foundation for IntegratedCare
Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of all integratedcare arrangements for stroke patients compared to usual care...
(Edited publisher abstract)
Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of all integratedcare arrangements for stroke patients compared to usual care. Integratedcare was defined as a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and standardize the outcome-orientated care. A systematic literature review of cost analyses and economic evaluations was performed. The databases of MEDLINE and EMBASE were searched in parallel for relevant English articles published up to July 2011.Study characteristics, study quality and results were summarized. Fifteen studies met the inclusion criteria; six on early-supported discharge services, four on home-based rehabilitation, two on stroke units and three on stroke services. The follow-up per patient was generally short; 1 year or less. The comparators and the scope of included costs varied between studies. Six out of six studies provided evidence that the costs of early-supported discharge are less than for conventional care, at similar health outcomes. Home-based rehabilitation is unlikely to lead to cost-savings, but achieves better health outcomes. Care in stroke units is more expensive than conventional care, but leads to improved health outcomes. The cost-effectiveness studies on integrated stroke services suggest that they can reduce costs. For future research we recommend to focus on the moderate and severely affected patients, include stroke severity as variable, adopt a societal costing perspective and include long-term costs and effects.
(Edited publisher abstract)
International Journal of Integrated Care, 12(1), 2012, Online only
Publisher:
International Foundation for IntegratedCare
This perspectives paper reflects upon the authors experience in researching long-term care, the rationale for creating integrated long-term care systems, and discusses some innovations. As a researcher and consultant he has coordinated local pilots and European research projects to improve long-term care for older people by better integrating health and social care systems. One of his main...
This perspectives paper reflects upon the authors experience in researching long-term care, the rationale for creating integrated long-term care systems, and discusses some innovations. As a researcher and consultant he has coordinated local pilots and European research projects to improve long-term care for older people by better integrating health and social care systems. One of his main conclusions is the need to treat long-term care as a system in its own right. It is suggested that long-term care systems require a discernable identity; specific policies, structures, processes and pathways; and the leadership and resources that can underpin expectations, drive performance for better outcomes for those living with (and working for those with) long-term care needs. The author notes that progress in developing LTC systems can be identified in all European countries. Integratedcare solutions at the interface of health and social care, and between formal and informal care, have appeared. He notes that these have been achieved partly by means of (slow) political reforms, partly as a response to market-oriented governance, and in many cases through pioneering community and civil society initiatives. The paper concludes that it will depend on such initiatives, and their ability to convince both citizens and policy-makers, as to whether new societal approaches to long-term care are created that meet the demands of ageing societies.
Subject terms:
informal care, integrated services, long term care, older people, social care provision, health care, government policy;
International Journal of Integrated Care, 9(3), 2009, Online only
Publisher:
International Foundation for IntegratedCare
Integratedcare in an inter-organisational cooperative setting of in-home elderly care is studied. It aims to how home care workers coordinate their daily work, identify coordination issues in situ and discuss possible actions for supporting seamless and integrated elderly care at home. The empirical findings are drawn from an ethnographic workplace study of the cooperation and coordination...
Integratedcare in an inter-organisational cooperative setting of in-home elderly care is studied. It aims to how home care workers coordinate their daily work, identify coordination issues in situ and discuss possible actions for supporting seamless and integrated elderly care at home. The empirical findings are drawn from an ethnographic workplace study of the cooperation and coordination taking place between home care workers in a Swedish county. Data were collected through observational studies, interviews and group discussions. The paper identifies a need to support two core issues. Firstly, it must be made clear how the care interventions that are currently defined as ‘self-treatment’ by the home health care should be divided. Secondly, the distributed and asynchronous coordination between all care workers involved, regardless of organisational belonging must be better supported. Integratedcare needs to be developed between organisations as well as within each organisation. As a matter of fact, integratedcare needs to be built up beyond organisational boundaries. Organisational boundaries affect the planning of the division of care interventions, but not the coordination during the home care process. During the home care process, the main challenge is the coordination difficulties that arise from the fact that workers are distributed in time and/or space, regardless of organisational belonging. A core subject for future practice and research is to develop IT tools that reach beyond formal organisational boundaries and processes while remaining adaptable in view of future structure changes.
Subject terms:
home care, home care assistants, home help, integrated services, interagency cooperation, intervention, older people, community health care;
International Journal of Integrated Care, 2(4), 2002, Online only
Publisher:
International Foundation for IntegratedCare
Integratedcare is a burgeoning field. As is often the case in new areas of inquiry and action, conceptual clarification is demanded. Without such attention, it would be difficult to advance theory and practice in this increasingly important professional arena. In the following discussion paper, the authors explore the intellectual territory of integratedcare, and underscore the need...
Integratedcare is a burgeoning field. As is often the case in new areas of inquiry and action, conceptual clarification is demanded. Without such attention, it would be difficult to advance theory and practice in this increasingly important professional arena. In the following discussion paper, the authors explore the intellectual territory of integratedcare, and underscore the need for a patient-centric imperative and meaning. They also examine the practical applications and implications arising from their views. The intention is to stimulate fruitful dialogue and debate about what ‘integratedcare’ could and should be.
Subject terms:
integrated services, joint working, long term conditions, organisational structure, patients, service users;
International Journal of Integrated Care, 1, 2000, Online only
Publisher:
International Foundation for IntegratedCare
Integratedcare for the frail elderly and other populations with complex, chronic, disabling conditions has taken centre stage among policymakers, planners and providers in the United States and other countries. There is a growing belief that integratedcare strategies offer the potential to improve service co-ordination, quality outcomes, and efficiency. This article examines so-called “fully...
Integratedcare for the frail elderly and other populations with complex, chronic, disabling conditions has taken centre stage among policymakers, planners and providers in the United States and other countries. There is a growing belief that integratedcare strategies offer the potential to improve service co-ordination, quality outcomes, and efficiency. This article examines so-called “fully integrated” models of care in detail, concentrating on two major, well-established American programs, the social health maintenance organisation and the program of all-inclusive care for the elderly. The article builds upon the work of Walter Leutz, to develop a framework by which these programs can be analysed. This analysis strongly suggests that fully integrated models of care, such as the social health maintenance organisation and program of all-inclusive care for the elderly, are not only feasible, but offer significant potential to improve the delivery of health and social care for frail elderly patients. In addition, the authors identify the factors that are the most critical to the success of fully integratedcare, and offer lessons for their development and implementation. Finally, issues are raised concerning the transferability of this complex model to other countries, as well as the vital importance of evidence-based evaluation research in furthering the evolution of integratedcare.
Subject terms:
integrated services, long term care, long term conditions, models, older people, social care provision, evaluation, health care;
International Journal of Integrated Care, 22(2), 2022, p.16. Online only
Publisher:
International Foundation for IntegratedCare
...was instrumental in establishing content, encouraging system integration, and creating conditions to support provincial implementation. While intended to improve and standardize patient care in Alberta, the methods used and lessons learned throughout the development of the Guideline are applicable internationally.
(Edited publisher abstract)
Introduction: Patients worldwide experience fragmented and uncoordinated care as they transition between primary and acute care. To improve system integration and outcomes for patients, in 2017/2018 Alberta Health Services (largest health services delivery organization in Canada) called for a coordinated approach to improve transitions in care (TiC). Healthcare leadership responded by initiating the development of a province-wide guideline outlining core components of effective transitions in care. This case study highlights the extensive design process used to develop this guideline, with a focus on the participatory design (PD) approach used throughout. Methods: An iterative, mixed methods PD approach was used to engage over 750 stakeholders through the following activities to establish Guideline content: i) learning collaborative; ii) design-team; iii) targeted online surveys; iv) primary care stakeholder consultation; v) modified Delphi panel; and vi) patient advisory committee. Results: The result was Alberta's first guideline for supporting patients through TiC: "Alberta's Home to Hospital to Home Transitions Guideline". Conclusion: The extensive design process used to create the Guideline was instrumental in establishing content, encouraging system integration, and creating conditions to support provincial implementation. While intended to improve and standardize patient care in Alberta, the methods used and lessons learned throughout the development of the Guideline are applicable internationally.
(Edited publisher abstract)
Subject terms:
service transitions, integratedcare, case studies, user participation, good practice;