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Care and service trajectories for people with intellectual disabilities: defining its course and quality determinants from the client's perspective
- Author:
- BARELDS Anna
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 6(3), September 2009, pp.163-172.
- Publisher:
- Wiley
Care and service trajectories are identifiable routes through service systems that consist of all steps that people with intellectual disabilities (ID) and their families have to take to realize the care and services they need. Trajectories are especially prominent during the transitions from children's services to adult services. Within a service system in Noord-Brabant (in the Netherlands), the authors examined the course of such trajectories and their main bottlenecks and sought to identify their quality determinants. The first research question was addressed by an exercise in document analysis and the holding of semistructured interviews with key informants within the healthcare sector specialized for serving people with ID. A second research question was addressed by means of a literature review on integrated care. The authors observe that trajectories generally follow a "model route" consisting of five phases but may vary according to age category, degree of disability, and life domain. With respect to "bottlenecks," the authors noted that a lack of suitable supply and long waiting lists are good examples. They found that the literature on integrated care revealed that continuity, accessibility, availability, and flexibility of care and services, together with the seamlessness of transitions, are all important quality determinants for people with ID when judging their service trajectories. Bottlenecks and quality determinants of trajectories are strongly interrelated. The authors concluded that the literature and the key informants agree as to which factors are most important in realizing high-quality trajectories for individual clients. They recommend asking which criteria people with ID and their families value most when judging the quality of trajectories.
Implementing the Forward View: supporting providers to deliver
- Author:
- NHS IMPROVEMENT
- Publisher:
- NHS Improvement
- Publication year:
- 2016
- Pagination:
- 35
This document is part of a series of roadmaps that draw on messages from the NHS Planning Guidance and set out the key priorities for specific audiences that are responsible for delivering high quality health and care this year and beyond. The document outlines the challenges and changes ahead; describes a coherent set of activities for NHS providers in the coming years; shows how providers across the country are beginning to deliver these; and outlines the support providers can expect from NHS Improvement. (Edited publisher abstract)
How different quality paradigms undermine a shared value base for integrated care: the need for collective reflexivity
- Authors:
- VAN KEMENADE Everard, et al
- Journal article citation:
- International Journal of Integrated Care, 22(1), 2022, p.5. Online only
- Publisher:
- International Foundation for Integrated Care
In the development process of integrated care 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 integrated care and for integrated care research. Professionals and managers in integrated care 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 integrated care and to remove the roadblocks on the way. (Edited publisher abstract)
Methodological quality of economic evaluations in integrated care: evidence from a systematic review
- Journal article citation:
- International Journal of Integrated Care, 19(3), 2019, Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: The aim of this review is to systematically assess the methodological quality of economic evaluations in integrated care and to identify challenges with conducting such studies. Theory and methods: Searches of grey-literature and scientific papers were performed, from January 2000 to December 2018. A checklist was developed to assess the quality of economic evaluations. Authors’ statements of challenges encountered during their evaluations were qualitatively coded. Results: Forty-four articles were eligible for inclusion. The review found that study design, measurement of cost and outcomes, statistical analysis and presentation of data were the areas with most quality variation. Authors identified challenges mostly related to time horizon of the evaluation, inadequate or lack of comparator group, contamination bias, and a post-hoc evaluation culture. Discussion: Our review found significant differences in quality, with some studies showing poor methodological rigor; challenging conclusions on the cost-effectiveness of integrated care. Conclusion: It is essential for evaluators to use best-practice standards when planning and conducting economic evaluations, in order to build a reliable evidence base for decision-making in integrated care. (Edited publisher abstract)
Creating integrated care: evaluation and management of local care in Sweden
- Author:
- AHGREN Bengt
- Journal article citation:
- Journal of Integrated Care, 15(6), December 2007, pp.14-21.
- Publisher:
- Emerald
This article presents two case studies of different approaches of how integration performance can be evaluated, and the practical implications when creating integrated care. It is based on the state of integration in Local Care and similar arrangements for integrated care in Sweden. Local Care is an upgraded family- and community- orientated primary care system, supported by adaptable hospital services. The article concludes that it seems impossible to create a comprehensive evaluation model which fully takes into account the multi-dimensional context of integrated health and social care. For more extensive evaluations, a quality chain matrix, including co-operating acts by different providers, has proven to be useful.
Solving the puzzle: delivering on the promise of integration in health and care
- Author:
- PATEL Parth
- Publisher:
- Institute for Public Policy Research
- Publication year:
- 2021
- Pagination:
- 30
- Place of publication:
- London
This report presents a new integrated care index that is based on the government’s stated ambitions for integration. The index was developed by Carnall Farrar and IPPR to analyse outcomes associated with integrated care across ICSs in England. It gives a benchmark of where we are at the start of the reform journey. Based on data from 2019, the index finds that Integrated Care Systems have very different starting points - differences in population health and existing service integration means each Integrated Care System will have a unique set of health priorities. The report also presents a conceptual framework, based on over 30 interviews with local and national health and care leaders, that proposes a ‘culture of collaboration’ as the ultimate determinant of integration in the health system. The key themes in the framework are 1. Distributed leadership; 2. Local relationships and community health-building; 3. Devolved governance; and 4. Resource to integrate productively. The last section explores how the reforms can be held to account and other ways to enhance democratic accountability with citizens. (Edited publisher abstract)
What happens to quality in integrated homecare? A 15-year follow-up study
- Authors:
- PALJARVI Soili, et al
- Journal article citation:
- International Journal of Integrated Care, 11(2), 2011, Online only
- Publisher:
- International Foundation for Integrated Care
A case study of a joint homecare unit in Finland, created following the merger of home healthcare and home help services in 1994 - 1995, is used to explore the impact of structural integration on home care quality. The case study included a before–after comparison with baseline and four follow-up measurements during 1994–2009, using interviews with clients (n=66–84) and postal inquiries to relatives (n=73–78) and staff (n=68–136). Home care quality was analysed in three domains: sufficiency of care; responsiveness of care; and guiding, counselling and informing clients. Despite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up. According to the clients, it even slightly improved in some homecare areas. The results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level. The results suggest that structural integration had a positive impact on homecare quality. To provide firmer evidence, the authors call for additional research with a randomised comparison design. (Edited publisher abstract)
Indicators and measurement tools for health systems integration: a knowledge synthesis
- Authors:
- SUTER Esther, et al
- Journal article citation:
- International Journal of Integrated Care, 17(6), 2017, Online only
- Publisher:
- International Foundation for Integrated Care
Background: Despite far reaching support for integrated care, conceptualising and measuring integrated care remains challenging. This knowledge synthesis aimed to identify indicator domains and tools to measure progress towards integrated care. Methods: The authors used an established framework and a Delphi survey with integration experts to identify relevant measurement domains. For each domain, we searched and reviewed the literature for relevant tools. Findings: From 7,133 abstracts, 114 unique tools were retrieved. Many quality tools to measure care coordination, patient engagement and team effectiveness/performance were identified. In contrast, there were few tools in the domains of performance measurement and information systems, alignment of organisational goals and resource allocation. The search yielded 12 tools that measure overall integration or three or more indicator domains. Discussion: The findings highlight a continued gap in tools to measure foundational components that support integrated care. In the absence of such targeted tools, “overall integration” tools may be useful for a broad assessment of the overall state of a system. Conclusions: Continued progress towards integrated care depends on the ability to evaluate the success of strategies across different levels and context. This study has identified 114 tools that measure integrated care across 16 domains, supporting efforts towards a unified measurement framework. (Edited publisher abstract)
The state of health care and adult social care in England: 2013/14
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2014
- Pagination:
- 82
- Place of publication:
- Newcastle upon Tyne
The Care Quality Commission’s report on the quality of health care and social care across England in 2013 to 2014, focusing on on safety, leadership, effectiveness and caring. It draws on the findings from its tougher, people-centred and expert-led inspections of more than 40,000 care services. The report examines in detail the responsiveness of services within adult social care, hospitals, mental health care and community health services, and primary medical services and integrated care and outlines CQC’s role in reducing variation and encouraging improvement. It shows that there is a wide and unacceptable variation in the quality of health and adult social care and suggests that strong, effective leadership at all levels is vital to drive up quality and safety. (Edited publisher abstract)
Priorities for the next government
- Author:
- KING'S FUND
- Publisher:
- King's Fund
- Publication year:
- 2014
- Pagination:
- 12
- Place of publication:
- London
Sets out the key health and social care challenges and priorities for the next government. These include: meeting the financial needs, with a renewed drive to improve productivity, the establishment of a health and social care transformation fund and a new settlement for health and social care; transforming services for patients, through integrated care delivered at scale and pace, a new deal for general practice and political backing for service changes; improving the quality of care, by engendering a new culture of care, parity of esteem for mental health and a revolution in the care of older people; and a new approach to NHS reform, with a new political settlement to demarcate the role of politicians, a focus on reform from within and investment in the right kind of leadership. (Edited publisher abstract)