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Developing a joint outcomes contracting model for integrated health and social care for older people
- Authors:
- BILLINGS Jenny, DAVIS Alison
- Journal article citation:
- Journal of Integrated Care, 24(5/6), 2016, pp.282-299.
- Publisher:
- Emerald
Purpose: Current debates surrounding the NHS contract in England are suggesting that it is in need of change to support an integrated health and social care transformation agenda that meets the needs of an ageing chronically ill population. The purpose of this paper is to describe a three-phase project in England that sought to develop and validate a whole systems contracting model for integrated health and social care focusing on older people with long-term conditions, and based on joint outcomes. Design/methodology/approach: A participative mixed-method approach for the development of the contracting model was used; this consisted of a literature review, a design phase drawing on consensus method through stakeholder discussions and an international validation phase. Findings: The final contracting model consists of four overarching and interrelated core elements: outcomes; partnership, collaboration and leadership; financial: incentives and risk; and legal criteria. Each core element has a series of more detailed contracting criteria, followed by further specifications attached to each criteria. Research limitations/implications: While the policy environment appears to be conducive to change and encourages the adoption of new ways of thinking, there are difficulties with the implementation of new innovative models that challenge the status quo, and this is discussed. Practical implications: The paper concludes with reflections on the way forward for local development and implementation. Originality/value: There is currently much discussion for the need to realign contracting for integrated care that has a better fit for the transformation agenda, but until now, there have been no attempts to develop a whole systems approach that focusses on joint outcomes. This research bridges the gap but recognizes the challenges to implementation. (Publisher abstract)
Late-life bereavement and complicated grief: a proposed comprehensive framework
- Authors:
- SHAH Shruti N., MEEKS Suzanne
- Journal article citation:
- Aging and Mental Health, 16(1-2), January 2012, pp.39-56.
- Publisher:
- Taylor and Francis
Following a bereavement, some older adults experience grief reactions that are considered to be difficult or complicated in terms of duration and emotional intensity. The recent proposal to include the construct of complicated grief (CG) as a diagnostic category for the upcoming Diagnostic and Statistical Manual of Mental Disorders-V has resulted in a proliferation of research on CG. The aim of this review is to critically examine the construct validity in light of a proposed conceptual framework that considers pre-loss conditions in the prediction of late-life grief outcomes, and to determine the degree to which research supports the inclusion of CG as a valid standardised diagnostic entity. The review critically examines current bereavement and grief models, exploring discriminant and convergent validity between CG and uncomplicated grief and other psychopathological constructs in terms of symptom intensity, symptom trajectories, bereavement outcomes, and treatment response. The findings show mixed support for differentiating CG from other outcomes of bereavement. They also emphasise the importance of considering pre-bereavement circumstances, such as pre-existing depression, in the conceptualisation of broader bereavement outcome. A comprehensive framework that emphasises pre-bereavement circumstances is proposed in order to better predict various grief trajectories and outcomes of late-life loss.
Proactive aging: a longitudinal study of stress, resources, agency, and well-being in late life
- Authors:
- KAHANA Eva, KELLEY-MOORE Jessica, KAHANA Boaz
- Journal article citation:
- Aging and Mental Health, 16(4), May 2012, pp.438-451.
- Publisher:
- Taylor and Francis
During late life, older adults are exposed to stressors of social losses and increasing frailty, which can threaten their quality of life (QOL). The Proactivity Model of Successful Aging proposes that older adults utilise personal and social resources in anticipation of, and in response to, age-related stressors. The aim of this study was to examine how internal and external resources contribute to the maintenance of QOL outcomes (psychological well-being and social activities) among older adults who experience normative stressors of aging. Data was obtained from the Florida Retirement Study, a panel study which focuses on late-life adaptation of retirement community-dwelling elderly persons. Five annual interviews were conducted with a sample of 561 participants. QOL outcomes were measured at the 5th year, and predictor variables were measured in the 4 prior annual waves. The findings showed that stressors negatively influenced QOL 4 years later. Internal and external resources led to better QOL 4 years later, both directly and indirectly through proactive adaptations of marshalling support and planning for the future. These findings lend support to the Proactivity Model of Successful Aging by documenting the value of proactive adaptations (such as exercise, planning ahead, and marshalling support) as proximate influences on QOL outcomes.
A funding settlement that works for people, not services
- Authors:
- STONE Emma, WOOD Claudia
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2010
- Pagination:
- 9p., bibliog.
- Place of publication:
- York
This paper was written in advance of the Comprehensive Spending Review in October 2010 and the coalition Government's new vision for social care, expected in early November. It is hoped that together these will form the foundations of a permanent settlement for how we all will contribute towards our care in later life and the system that delivers it. The paper considers the question regarding whether the proposed funding settlement and statute will be aligned with each other, and, critically, with a vision for social care that is designed around people’s lives, rather than around services. It argues that only a funding system acceptable in principle and in practice to those who contribute to it will survive over time. It considers four key principles for a future funding settlement, arguing that it should be: fair; transparent; sustainable; and capable of supporting self-defined outcomes. The importance of an outcome-based funding system, which is compatible with how people live their lives, and what they want and value from life, is discussed. The paper considers what a settlement enshrining these principles would look like. It concludes by examining the challenges of an outcome-based model.
Assessing the impact of integrated delivery systems: practical advice from three experiments conducted in Quebec
- Authors:
- BRAVO Gina, et al
- Journal article citation:
- Journal of Integrated Care, 16(4), August 2008, pp.9-18.
- Publisher:
- Emerald
Interest has grown in integrated care models as means of responding better to the needs of frail older adults. In order to provide appropriate input for health policy reforms, the effects of integrated care must be assessed with sound methodologies. Based on three experiments conducted in the province of Quebec, Canada, this article provides practical advice on key issues involved in evaluating integrated care models. The article discusses the complexity inherent in assessing an integrated delivery system (IDS); summarises the features of a framework proposed by the UK Medical Research Council to measure its effects; sets out three questions considered determinant in selecting the study design; and deals with the other elements in and evaluation protocol.
Ways of integrating care that better coordinate services may benefit patients
- Author:
- NATIONAL INSTITUTE FOR HEALTH RESEARCH. Dissemination Centre
- Publisher:
- National Institute for Health Research
- Publication year:
- 2018
- Place of publication:
- London
New integrated care models can increase patient satisfaction, perceived quality of care and improve access to services. It is less clear whether there may be effects on hospital admissions, appointments or healthcare costs. This NIHR Signal focuses on an NIHR-funded review which looked at the international literature to understand how new integrated care models may affect patients, providers and systems. It included a qualitative review of attitudes, barriers and enablers of integration. Nearly half of the 267 studies came from the UK. Most investigated integrated care pathways, often as part of a multicomponent intervention including multidisciplinary teams and some form of case management. Most studies focused on older people. The review finds some positives in relation to improved patient satisfaction and perceived quality of care, but overall highlights the complexity of implementing and assessing new models of care. NIHR Signals highlight examples of important research and explain why the study was needed, what the study found and the implications of the findings. They include commentary from experts, researchers and those working in practice. (Edited publisher abstract)
Improving care for older people with long-term conditions and social care needs in Salford: the CLASSIC mixed-methods study, including RCT
- Authors:
- BOWER Peter, et al
- Journal article citation:
- Health and Social Care Delivery Research, 6(31), 2018, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
Background: The Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness. Objectives: To explore the process of implementation of the SICP and the impact on patient outcomes and costs. Design: Qualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies. Setting: Salford in the north-west of England. Participants: Older people aged ≥ 65 years, carers, and health and social care professionals. Interventions: A large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’). Main outcome measures: Patient self-management, care experience and quality of life, and health-care utilisation and costs. Data sources: Professional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation. Results: The SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776). Limitations: The Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were < 40%. Conclusions: The SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes. Future work: Further research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use. (Edited publisher abstract)
The Integrated Care Evaluation Framework ((ICE-F): a realistic evaluation of integrated health and social care services in Wales
- Authors:
- CARNES-CHICHLOWSKA Susan, BURHOLT Vanessa, REA David
- Publisher:
- Welsh Government Social Research
- Publication year:
- 2015
- Pagination:
- 81
- Place of publication:
- Cardiff
Building on the interim report from researchers at the Centre for Innovative Ageing, Swansea University, this report sets out the Integrated Care Evaluation Framework (ICE-F) developed to help service providers to design and undertake evaluations of integrated services. Specifically the ICE-F assesses the impact of delivering integrated care to older people with the aim of improving wellbeing and independence. The model provides guidance on core elements that need to be considered in the evaluation, namely cost efficiency, effectiveness and the personal benefit of independence and wellbeing. It describes the stages necessary, the data requirements and the tools providers can use to assess the outcomes of their services.The framework is structured in four stages: describing what the service hopes to achieve and how; making a decision about what is going to be used to know whether the service will achieve it overall aims; the construction of a template for service evaluation; and the health economic evaluation of cost effectiveness, followed by a cost benefit analysis on the social return of investment. The final section provides a refined theory of integrated care, explaining why and how some aspects of the different contexts, mechanisms and outcomes work together in Wales. A series of recommendations for the Welsh Government and providers of integrated health and social care are also provided. (Edited publisher abstract)
Community services' involvement in the discharge of older adults from hospital into the community
- Authors:
- GUERIN Michelle, GRIMMER Karen, KUMAR Saravana
- Journal article citation:
- International Journal of Integrated Care, 13(3), 2013, Online only
- Publisher:
- International Foundation for Integrated Care
Aims: The primary aim of this systematic review was to identify and critically appraise the relevant literature detailing methods of community services' involvement in the discharge of older adults across the hospital-community interface. A secondary aim was to identify the most effective methods of community service involvement in the discharge process of older adults. Methods: Twenty-nine databases were searched from 1980 to 2012 (inclusive) for relevant primary published research, of any study design, as well as relevant unpublished work (e.g. clinical guidelines) which investigated community services' involvement in the discharge of older individuals from hospital into the community. Data analysis and quality appraisal (using McMaster critical appraisal tools) were undertaken predominately by the lead author. Data was synthesised qualitatively. Results: Twelve papers were eligible for inclusion (five randomised controlled trials, four before and after studies and three controlled trials), involving a total of 8440 older adults (>65 years). These papers reported on a range of interventions. During data synthesis, descriptors were assigned to four emergent discharge methods: Virtual Interface Model, In-reach Interface Model, Out-reach Interface Model and Independent Interface Model. In each model, the findings were mixed in terms of health care and patient and carer outcomes. Conclusions: It is plausible that each model identified in this systematic review has a role to play in successfully discharging different cohorts of older adults from hospital. Further research is required to identify appropriate population groups for various discharge models and to select suitable outcome measures to determine the effectiveness of these models, considering all stakeholders' involved. (Edited publisher abstract)
Strategic commissioning of long term care for older people: can we get more for less?
- Author:
- LAING William
- Publisher:
- LaingBuisson
- Publication year:
- 2014
- Pagination:
- 29
- Place of publication:
- London
This discussion paper analyses the state of the UK market in care services for older people in order to identify market failures and achievements in the area of both commissioning and in supply. The paper briefly outlines the development of the market from 1975 to 2014 and lists the key features of the social care market for older people today. It then looks at the successes and failures of the market, and the mismatch between public sector commissioners’ need to contain costs and providers’ need to earn an adequate return in order to sustain existing services and develop the new ones. The final section lists the features an efficiently functioning social care market should have and puts forward a new care commissioning strategy as a solution to current market failures. The strategy is founded on outcomes-based, long term contracts headed by a new group of professionals working for Social Care Maintenance Organisations (SCMOs). The model covers the whole care pathway from advice and guidance, home care and residential care. The paper then sets out the reasons why this model might be expected to deliver efficiency savings. (Edited publisher abstract)