International Journal of Integrated Care, 22(1), 2022, p.11. Online only
Publisher:
International Foundation for IntegratedCare
Introduction: Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integratedcare and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management...
(Edited publisher abstract)
Introduction: Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integratedcare and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integratedcare, and healthcare services use. Methods: A mixed methods multiple embedded case study design was conducted, with six CMP implemented in six hospitals of a region of Quebec (Canada). Results: Within-case analysis describes the structural, environmental, organizational, practitioner, patient, and innovation level characteristics of each CMP and their services integration outcomes based on patient experience, self-management and healthcare services use. Cross-case analysis suggests that the skills, leadership and experience of the case manager, providers’ access to the individualized services plan, consideration of the needs of the patient and family members, their participation in decision-making, and the self-management approach, impact integratedcare and healthcare services use. Conclusion and discussion: This study underscores the necessity of an experienced, knowledgeable and well-trained case manager with interpersonal skills to optimize CMP implementation such that patients are more proactive in their care and their outcomes improve.
(Edited publisher abstract)
Subject terms:
case management, integratedcare, policy implementation, health care, complex needs, case studies;
International Journal of Integrated Care, 22(1), 2022, p.5. Online only
Publisher:
International Foundation for IntegratedCare
In the development process of integratedcare many impeding factors occur. Our premise is, that many of these barriers are related to the differences in values or perspectives. This article aims to clarify what an important challenge is for the further development of integratedcare and for integratedcare research. Professionals and managers in integratedcare need to cope with and embrace...
(Edited publisher abstract)
In the development process of integratedcare many impeding factors occur. Our premise is, that many of these barriers are related to the differences in values or perspectives. This article aims to clarify what an important challenge is for the further development of integratedcare and for integratedcare research. Professionals and managers in integratedcare need to cope with and embrace uncertainty. However, that requires collective reflexivity. Collective reflexivity is a means to investigate the values of the partners interacting to co-create integratedcare and to remove the roadblocks on the way.
(Edited publisher abstract)
Subject terms:
policy implementation, integratedcare, values, quality assurance, service development, integrated services;
International Journal of Integrated Care, 21(4), 2021, p.22. Online only
Publisher:
International Foundation for IntegratedCare
Introduction: The prevalence of people with complex chronic conditions is increasing. This population’s high social and health needs require person-centred integrated approaches to care. Methods: To collect data about experiences with the health system and identify priorities for care, this study conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity...
(Edited publisher abstract)
Introduction: The prevalence of people with complex chronic conditions is increasing. This population’s high social and health needs require person-centred integrated approaches to care. Methods: To collect data about experiences with the health system and identify priorities for care, this study conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity and advanced conditions, caregivers, and representatives of patients’ associations. To design the programme, this study combined this information with evidence-based recommendations from local healthcare and social care professionals. Results: Patients’ and caregivers’ main priorities were to ensure (a) comprehension of information provided by healthcare professionals; (b) coordination between patients, caregivers, and professionals; (c) access to social services; (d) support to caregivers in managing situations; (e) perceived support throughout the healthcare process; (f) home care, when available; and (d) a patient-centred approach. These dimensions were included in 37 of 63 clinical actions of the programme to cover the whole care trajectory: identifying high needs, defining, and providing care plans, managing crises, and providing transitional care and end-of-life care. Conclusion: the researchers developed an evidence-based integratedcare programme tailored to high-need patients combining input from patients, caregivers, and healthcare and social care professionals.
(Edited publisher abstract)
Subject terms:
person-centred care, integratedcare, case studies, complex needs, long term conditions, older people, user views, carer views;
International Journal of Integrated Care, 21(S2), 2021, p.14. Online only
Publisher:
International Foundation for IntegratedCare
...funding needs to increase, rationing to be reformed, sectors to be integrated (the managed care approach), and an analytical information base to be developed if supervision of new technological approaches is to improve. The period of system transitions in CEE countries entailed significant changes in their health systems, including health care financing. Discussion: Large deficits in the public
(Edited publisher abstract)
Introduction: Health and social care systems in Central and Eastern European (CEE) countries have undergone significant changes and are currently dealing with serious problems of system disintegration, coordination and a lack of control over the market environment. Description: The increased health needs related to the ageing society and epidemiological patterns in these countries also require funding needs to increase, rationing to be reformed, sectors to be integrated (the managed care approach), and an analytical information base to be developed if supervision of new technological approaches is to improve. The period of system transitions in CEE countries entailed significant changes in their health systems, including health care financing. Discussion: Large deficits in the public financing of health systems were just one of the challenges arising from the economic downturn of the 1990s, which was coupled with inflation, increasing unemployment, low salaries, a large informal sector and tax evasion in a number of CEE countries. During the communist period, there was universal access to a wide range of health services, proving it difficult to retain this coverage. As a result, many states sought to ration publicly funded health services – for example, through patient cost-sharing or decreasing the scope of basic benefits. Yet, not all of these reform plans were implemented, and in fact, some were rolled back or not implemented at all due to a lack of social or political consensus. Conclusion: CEE health systems had come to practice implicit rationing in the form of under-the-table payments from patients, quasi-formal payments to providers to compensate for lack of funding, and long waiting lists forcing patients to the private sector. All these difficulties pose a challenge to the implementation of integratedcare.
(Edited publisher abstract)
Subject terms:
integratedcare, policy implementation, health care, social care;
International Journal of Integrated Care, 21(S2), 2021, p.5. Online only
Publisher:
International Foundation for IntegratedCare
Introduction: For more than a decade the English NHS has pursued integratedcare through three national pilot programmes. The independent evaluators of these programmes here identify several common themes that inform the development of integratedcare. Description: The three pilot programmes shared the aim of better coordination between hospital and community-based health services and between...
(Edited publisher abstract)
Introduction: For more than a decade the English NHS has pursued integratedcare through three national pilot programmes. The independent evaluators of these programmes here identify several common themes that inform the development of integratedcare. Description: The three pilot programmes shared the aim of better coordination between hospital and community-based health services and between health and social care. Each programme recruited local pilot sites that designed specific interventions to support inter-professional and inter-organisational collaboration. The pilots were highly heterogenous and results varied both within and between the three programmes. While staff were generally positive about their achievements, pilots had mixed success especially in reducing unplanned hospital admissions. Common facilitators to achieving pilots’ objectives included effective senior leadership and shared values, simple interventions and additional funding. Barriers included short timescales, poor professional engagement, information and data sharing problems, and conflicts with changing national policy. Discussion: There was little stable or shared understanding of what ‘integratedcare’ meant resulting in different practices and priorities. An increasing focus on reducing unplanned hospital use among national sponsors created a mismatch in expectations between local and national actors. Conclusion: Pilots in all three national programmes made some headway against their objectives but were limited in their impact on unplanned hospital admissions.
(Edited publisher abstract)
International Journal of Integrated Care, 21(3), 2021, p.14. Online only
Publisher:
International Foundation for IntegratedCare
Introduction: Networks constitute a promising strategy for interorganisational collaboration, but may fail due to network tensions. By investigating the activities and internal dynamics of a voluntary meso-level network operating in the intersection of health and social care, this study aims to enhance the understanding of the relationship between pragmatism and sustainability and the role...
(Edited publisher abstract)
Introduction: Networks constitute a promising strategy for interorganisational collaboration, but may fail due to network tensions. By investigating the activities and internal dynamics of a voluntary meso-level network operating in the intersection of health and social care, this study aims to enhance the understanding of the relationship between pragmatism and sustainability and the role network governance plays in this respect. Methods: In this descriptive case study, 2–3 researchers observed 3 three-hour long network meetings during the course of a year, and four complementary interviews were performed. Data were analysed based on the literature on network functioning and effectiveness. Results: Pragmatism (a focus on ‘getting things done’) was more emphasised than sustainability although the network meetings also contained elements of relationship- and trust-building. The network leadership (a Network Administrative Organisation, NAO) created structure and concretized the participants’ ideas while remaining flexible and perceptive, and also carried out tasks which would otherwise not have been performed. Discussion: The emphasis on pragmatism did not seem to influence sustainability negatively which has been pointed out as a potential risk in previous literature. Rather, the focus on pragmatism reinforced sustainability in a way that is similar to what has been described in prior research as a “trust-building loop” and discussed further in terms of a “perception of progress” mechanism. However, it was unclear what future the voluntary network would have without the NAO. Conclusion: Network governance is instrumental to success, and should be carefully considered when initiating interorganisational network initiatives for integratedcare.
(Edited publisher abstract)
Subject terms:
case studies, integratedcare, older people, interagency cooperation, collaboration, joint working, leadership, governance, adult social care, health care;
International Journal of Integrated Care, 21(3), 2021, Online only
Publisher:
International Foundation for IntegratedCare
Introduction: Three peak organisations in Queensland, Australia partnered with consumers and other health and social sector partners to co-design and pilot the first known integrated, health navigation model to improve outcomes for children and young people in care in Australia. Description: An Organisational Learning theoretical lens has been used to present a narrative case study of findings...
(Edited publisher abstract)
Introduction: Three peak organisations in Queensland, Australia partnered with consumers and other health and social sector partners to co-design and pilot the first known integrated, health navigation model to improve outcomes for children and young people in care in Australia. Description: An Organisational Learning theoretical lens has been used to present a narrative case study of findings structured as key learnings from the Navigate Your Health pilot to inform quality improvement, scalability and program sustainability. A developmental evaluation was completed whereby semi-structured interviews, focus groups, surveys, chart reviews, database excerpts and economic modelling was completed alongside project documentation analyses to create an evaluation framework. Discussion: Findings highlighted the agency partners’ drive to foster a more integrated and person-centred approach to care. The pilot’s aim of improving health outcomes for a vulnerable population were achieved through a co-designed process which provided additional insights regarding partnerships, improvement, scalability and sustainability. Conclusion: Inter-agency responses to system fragmentation provide significant organisational learning opportunities. System integration is achievable through strengthened partnerships that can be sustained beyond a pilot phase to improve health outcomes for vulnerable/priority populations.
(Edited publisher abstract)
Subject terms:
case studies, child protection, children, integratedcare, interagency cooperation, joint working, looked after children, outcomes;
International Journal of Integrated Care, 21(3), 2021, Online only
Publisher:
International Foundation for IntegratedCare
...perspective, the extent to which professionals assess, understand and are responsive to informal carers’ needs. Methods: The researchers interviewed (2016–2018) 47 informal carers of older people being served by 12 integratedcare initiatives across seven countries in Europe. The interviews were thematically coded inductively and analysed. Results: Informal carers reported that professionals treated them
(Edited publisher abstract)
Introduction: Informal carers are increasingly relied on for support by older people and the health and social care systems that serve them. It is therefore important that health and social care professionals are knowledgeable about and responsive to informal carers’ needs. This study explores informal carers’ own needs within the context of caregiving; and examines, from the informal carers’ perspective, the extent to which professionals assess, understand and are responsive to informal carers’ needs. Methods: The researchers interviewed (2016–2018) 47 informal carers of older people being served by 12 integratedcare initiatives across seven countries in Europe. The interviews were thematically coded inductively and analysed. Results: Informal carers reported that professionals treated them with respect and made efforts to assess and respond to their needs. However, even though professionals encouraged informal carers to look after themselves, informal carers’ needs (e.g., for respite, healthcare) were insufficiently addressed, and informal carers tended to prioritize older people’s needs over their own. Discussion and conclusion: Informal carers need better support in caring for their own health. Health professionals should have regular contact with informal carers and proactively engage them in ongoing needs assessment, setting action plans for addressing their needs, and identifying/accessing appropriate support services. This will be important if informal carers are to continue their caregiving role without adverse effects to themselves.
(Edited publisher abstract)
International Journal of Integrated Care, 21(2), 2021, p.23. Online only
Publisher:
International Foundation for IntegratedCare
Introduction: Disadvantaged families experience many barriers to accessing health and social care. The Healthy Homes and Neighbourhoods (HHAN) IntegratedCare Initiative was developed to address these barriers, and ensure families have their complex needs met and are kept safe and connected to society. Description: A spatial epidemiology approach was taken, as part of the HHAN feasibility phase...
(Edited publisher abstract)
Introduction: Disadvantaged families experience many barriers to accessing health and social care. The Healthy Homes and Neighbourhoods (HHAN) IntegratedCare Initiative was developed to address these barriers, and ensure families have their complex needs met and are kept safe and connected to society. Description: A spatial epidemiology approach was taken, as part of the HHAN feasibility phase, to identify the geographical distribution of the “most vulnerable” families in Sydney Local Health District (SLHD). A literature review was conducted to identify indicators of family stress and disadvantage, and cluster and hotspot analyses were undertaken. Hotspots of family stress and disadvantage were mapped for SLHD and used to identify areas for HHAN place-based delivery, and for collaborative co-design. Discussion: The HHAN initiative called for consideration of context and the undertaking of collaborative design with communities. The spatial analysis provided a more accurate picture of family stress and disadvantage than previously available and provided a tool that could be used during consultation and planning activities. Conclusion: When planning place-based integratedcare initiatives, spatial analysis of small geographic scales can allow identification of areas of concentrated or complex disadvantage that may be masked when analysis is performed on larger areas, allowing for targeted, place-based delivery of programs to those most in need.
(Edited publisher abstract)
International Journal of Integrated Care, 21(2), 2021, p.9. Online only
Publisher:
International Foundation for IntegratedCare
Introduction: Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integratedcare for frail older adults is successful in practice. In this study, we aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integratedcare model in newly created information and advice...
(Edited publisher abstract)
Introduction: Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integratedcare for frail older adults is successful in practice. In this study, we aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integratedcare model in newly created information and advice centers for older adults in Canton Basel-Landschaft, Switzerland. Methods: We conducted a contextual analysis to determine factors which may influence the integratedcare model and implementation strategies needed. A logic model depicting the overall program theory, including inputs, core components, outputs and outcomes, was designed using a deductive approach, and included stakeholders’ feedback and preliminary implementation strategies. Results: Contextual factors were identified (e.g., lack of integratedcare regulations, existing community services, and a care pathway needed). Core components of the care model include screening, referral, assessment, care plan creation and coordination, and follow-up. Outcomes included person-centred coordinated care experiences, hospitalization rate and symptom burden, among others. Implementation strategies (e.g., nurse training and co-developing educational materials) were proposed to facilitate care model adoption. Conclusion: Contextual understanding and a clear logic model should enhance the potential for successful implementation of the integratedcare model.
(Edited publisher abstract)
Subject terms:
integratedcare, older people, home care, models, care pathways;