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Using patient reported outcomes measures to promote integrated care
- Authors:
- RIKKERT Marcel G.M. Olde, et al
- Journal article citation:
- International Journal of Integrated Care, 18(2), 2018, p.8. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Patient reported outcome measures (PROMs) have been introduced as standardised outcomes, but have not been implemented widely for disease targeted pathways of care, nor for geriatric patients who prefer functional performance and quality of life. Discussion: innovative multipurpose implementation of PROMs as evidenced by two best practices of PROMs application in geriatric and physiotherapy practice is described. The study shows that PROMs can show meaningful outcomes in older subjects’ patient journeys, which can at the same time serve individuals and groups of both patients and professionals. Key lesson: PROMs can deliver generic outcomes relevant for older patients, may improve patient-physician relationship, quality of care and prediction of future outcomes in geriatric care, if they are valid, reliable and responsive, but still short and simple. A precondition to make the hard tip from research to practice is that PROMs are carefully positioned in the clinical encounters and in electronic health records. (Edited publisher abstract)
Lessons learned from the CQC’s Local Systems Reviews Support Programme
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2018
Short report highlighting insights and recommendations from SCIE's work supporting local areas following Care Quality Commission local system reviews. The reviews aimed to understand how services are working together to meet the needs of people who move between health and care services, with a focus on people aged over 65. The recommendations highlight the need for any area developing plans to tackle the interface between health and care to: engage all local partners in planning; clarify governance arrangements to ensure ownership and delivery of action plans are clear; align plans with existing programmes; balance short-term fixes with longer-term improvements; and consider the use of external facilitators to challenge and support planning. The insights will be useful for leaders responsible for developing integrated working within health and wellbeing boards, local authorities and clinical commissioning groups. (Edited publisher abstract)
What works in delivering effective enhanced primary care support in care homes?
- Author:
- CORDIS BRIGHT
- Publisher:
- Cordis Bright
- Publication year:
- 2018
- Pagination:
- 12
- Place of publication:
- London
Based on a review of the evidence, this briefing outlines the key elements to effective practice in delivering enhanced primary care and support in care homes to improve the quality of life and healthcare for residents. The briefing identifies some of the reasons for implementing enhanced primary care in care homes and the potential to improve outcomes. These include improved resident and care quality outcomes; beneficial impact on secondary care and community services; improved integration and partnership working; and cost benefits. It also outlines key supportive features and the barriers and limitations to delivering enhanced primary care in care homes. Three short case studies highlight three different models: a nurse-led model, a GP-led model, and a multi-disciplinary team model. (Edited publisher abstract)
An integrated care programme in London: qualitative evaluation
- Authors:
- ROUND Thomas, et al
- Journal article citation:
- Journal of Integrated Care, 26(4), 2018, pp.296-308.
- Publisher:
- Emerald
Purpose: A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment. Design/methodology/approach: Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes. Findings: The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of “successes”, “challenges” and “lessons learnt”. Research limitations/implications: Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit. Practical implications: Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation. Originality/value: Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation. (Edited publisher abstract)
Housing and ageing: linking strategy to future delivery for Scotland, Wales and England 2030
- Author:
- UNIVERSITY OF STIRLING
- Publisher:
- University of Stirling
- Publication year:
- 2018
- Pagination:
- 23
- Place of publication:
- London
This report looks at the role that housing should play in supporting older people to age in place. It draws on insights gathered through a series of events with over 200 people, including practitioners, older adults and policy makers from areas of Scotland, England and Wales. Participants also took part in a strategic exercise to explore the potential long-term impacts of different policies, help examine the issues and decide what action should be taken. The key finding from the project was the importance of enabling people to ‘age in the right place’ and the central role of housing in the provision of services to support older people. Additional recommendations include: the creation of a Commissioner for Ageing in England and Scotland to ensure cross-national working across the United Kingdom; investment in early intervention and prevention within the home and community; meaningful co-production and consultation with older people; accessible information and advice for older people living in urban and rural communities; and building new suitable housing, such as intergenerational and lifetime homes that are adaptable, flexible, inclusive and affordable. (Edited publisher abstract)
Care coordination in adult social care: exploring service characteristics within the non-statutory sector in England
- Authors:
- SUTCLIFFE Caroline, et al
- Journal article citation:
- Journal of Social Work, 18(5), 2018, pp.501-524.
- Publisher:
- Sage
Summary: As a result of national policy in respect of social care of adults in England, the non-statutory sector is increasingly more evident in the provision of care services previously undertaken by local government, including the delivery of care coordination for older people. However, little is currently known about the scope, content, or quality of services providing care coordination within this sector. This article reports the findings from a postal survey undertaken in January 2014 of non-statutory organisations in England providing care coordination services and investigates variations in their key attributes. Organisations providing care coordination services were identified using various strategies to create a database of services. Questionnaires encompassing several areas of enquiry were mailed to managers of care coordination services identified from the database. Findings: There was similarity in the operation of the care coordination services sampled. Many were small-scale services, contract-funded, and providing short-term support. Volunteer staff were a feature of most services. All services worked to written protocols and standards and almost all levied no charge. Many shared information with healthcare or local authority staff with user consent. Service user satisfaction was measured and used for service improvement. Application: This is one of the first studies undertaken in England to investigate the provision of care coordination by the non-statutory sector and to identify patterns of variation in key service attributes. Implications for commissioners, service providers, workforce, and social workers are further discussed. The findings provide baseline data against which future developments can be measured. (Edited publisher abstract)
Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis
- Authors:
- BLOM J.W., et al
- Journal article citation:
- Age and Ageing, 47(5), 2018, pp.705-714.
- Publisher:
- Oxford University Press
Purpose: To support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: Individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: Primary care sector. Interventions: Combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main: Outcome activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: Quality of life (visual analogue scale 0–10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: Intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: Included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was −0.01 (95% confidence interval −0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: Compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective. (Publisher abstract)
Biomedical nemesis? Critical deliberations with regard to health and social care integration for social work with older people
- Author:
- CAREY Malcolm
- Journal article citation:
- International Social Work, 61(5), 2018, pp.651-664.
- Publisher:
- Sage
This article questions ongoing moves towards integration into health care for social work with older people in the United Kingdom. While potentially constructing clearer pathways to support, integration risks reducing welfare provisions for a traditional low priority user group, while further extending the principles of privatisation. Integration models also understate the ideological impact of biomedical perspectives within health and social care domains, conflate roles and undermine the potential positive role of ‘holistic’ multi-agency care. Constructive social work for older people is likely to further dilute within aggressive integrated models of welfare, which will be detrimental for meeting many of the complex needs of ageing populations. (Publisher abstract)
Liverpool: local system review report
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2018
- Pagination:
- 49
- Place of publication:
- London
This report is one of 20 targeted reviews of local authority areas looking at how people move through the health and social care system, with a focus on how services work together. The reviews look at how hospitals, community health services, GP practices, care homes and homecare agencies work together to provide seamless care for older people living in a local area. The review found that there was a clear strategic direction for health and social care in Liverpool which was focused on the needs of people living in the city and described in the strategy ‘One Liverpool’. However, the review found the experiences of people using health and social care services varied. People were not always seen in the right place, at the right time by the right person; there were inconsistencies in commissioning and provision of services. Other findings were that local people were not actively enabled to participate in service planning and delivery and that people using services and their carers were not always supported to take control in making decisions about their care. Although a neighbourhood model had been developed to bring together primary, community, mental health and social care services, the model was not being implemented with a consistent approach, with GPs not always participating in multidisciplinary meetings. The report makes suggestions of areas for the local system to focus on to secure improvement including: organisational development work to strengthen relationships, improve communication and ensure there is a shared understanding among staff; improve information flows between services, including independent care providers, to facilitate safe and timely discharges from acute hospitals; and develop the personalisation agenda with more people supported to access personal budgets and direct payments. (Edited publisher abstract)
Sheffield: local system review report
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2018
- Pagination:
- 52
- Place of publication:
- London
This report is one of 20 targeted local reviews looking at how people move through the health and social care system, with a focus on how services work together for older people. Specifically, it looks at how the local system is functioning within and across three key areas: maintaining the wellbeing of a person in usual place of residence; crisis management; and step down, return to usual place of residence and/ or admission to a new place of residence. The review found there was a system-wide commitment to serving the people of Sheffield, but that system partners had not always worked effectively together. It found that although there had been improvements in information sharing and joint working, social care providers felt they were not meaningfully involved in market shaping or service development. It also found admission avoidance services were under developed and that there was a lack of integration of health and social care. Other findings included that people at risk of deterioration reported not being listened to and experiencing a crisis before they received the support they needed; and that people did not always experience safe discharges to their usual place of residence because of a lack of communication and coordination, adequate assessment and provision of services. The report suggests a number of areas for improvement. These include the need for system leaders to continue to engage with people who use services, families and carers and undertake a review of people’s experiences to target improvements; an evaluation of health and social care professionals’ skills in communication and interaction with people to establish where improvements are needed; and for health and social care to be equal partners in the system transformation programme. (Edited publisher abstract)