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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)
Integrating public and private home care services: the Kotitori model in Tampere, Finland
- Authors:
- LIINA-KAISA Tynkkynen, et al
- Journal article citation:
- Journal of Integrated Care, 20(5), 2012, pp.284-295.
- Publisher:
- Emerald
This case study introduces a novel home care service integrator model called “Kotitori”. In the model the City contracts with a private provider in order to meet the older customer needs in a personalised way. The model introduces a unique form of public-private partnership in Finland, and describes the basic elements of Kotitori, the development process of the model, and the model's distinctive features compared to more traditional ways of home care service delivery. The author suggests that the transferability potential of the Kotitori model is good both nationally and internationally. The model is potentially beneficial for countries with an interest in developing integrated care in general, as it reflects a form of accountable care organisation.
The effects of integrated home care and discharge practice on functional ability and health-related quality of life: a cluster-randomised trial among home care patients
- Authors:
- HAMMAR Teija, PERALA Marja-Leena, RISSANEN Pekka
- Journal article citation:
- International Journal of Integrated Care, 7(3), 2007, Online only
- Publisher:
- International Foundation for Integrated Care
The aim of this study was to evaluate the effects of integrated home care and discharge practice on the functional ability (FA) and health-related quality of life (HRQoL) of home care patients. A cluster randomised trial (CRT) with 22 Finnish municipalities as the units of randomisation. At baseline the sample included 669 patients aged 65 years or over. Data consisted of interviews (at discharge, and at 3-week and 6-month follow-up), medical records and care registers. The intervention was a generic prototype of care/case management-practice. The aim of the intervention was to standardize practices and make written agreements between hospitals and home care administrations, and also within home care and to name a care/case manager pair for each home care patient. The main outcomes were HRQoL and also Activities of Daily Living (ADL). All analyses were based on intention-to-treat. At baseline over half of the patient population perceived their FA and HRQoL as poor. At the 6-month follow-up there were no improvements in FA or in EQ-5D scores, and no differences between groups. In energy, sleep, and pain the NHP improved significantly in both groups at the 3-week and at 6-month follow-up with no differences between groups. In the 3-week follow-up, physical mobility was higher in the trial group. Although the effects of the new practice did not improve the patients' FA and HRQoL, except for physical mobility at the 3-week follow-up, the workers thought that the intervention worked in practice. The intervention standardised practices and helped to integrate services.
Common experiences of staff working in integrated health and social care organisations: a European perspective
- Author:
- COXON Kirsite
- Journal article citation:
- Journal of Integrated Care, 13(2), April 2005, pp.13-21.
- Publisher:
- Emerald
Presents a comparison of the views of staff working in 18 integrated care settings, undertaken as part of the PROCARE study of integrated health and social care. The data reveals commonalities across the nine European countries (Austria, France, Germany, Italy, Finland, UK, Denmark, Greece and the Netherlands). Increased job satisfaction was an advantage of integrated working, but respondents also reported difficulties in working with hospitals or medical professionals, and continued barriers to integrated working generally. Single standalone organisations such as home care teams reported the clearest benefits from integrated working, while cross-agency models continued to encounter significant barriers to health and social care integration.