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Total Place - services and support for older people: one year on
- Author:
- ARCHIBALD Andrew
- Journal article citation:
- Working with Older People, 15(3), 2011, pp.106-111.
- Publisher:
- Emerald
Bournemouth, Dorset and Poole were, in 2008, selected to participate in a pilot project called Total Place, the focus of which was to examine how services could be improved and provided at less cost by bringing together all public sector partners around specific themes for older people. This paper presents the progress to date of Dorset. Areas tackled included: locality working; connecting health and social care; workforce planning; person centred planning; reablement; housing; partnership for older people programme; and Dorset age partnership. The agenda of work provided in this paper provides a snap shot of the journey towards improving services in more efficient ways. The paper provides tips to follow for improving service provision for older people which include not cutting Ageing Well programmes, not having constant talks about dementia, and making sure providers do not reinvent the same solutions to care.
Treating older persons with severe mental illness in the community: impact of an interdisciplinary geriatric mental health team
- Author:
- CUMMINGS Sherry M.
- Journal article citation:
- Journal of Gerontological Social Work, 52(1), January 2009, pp.17-31.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study examines the treatment efficacy of a mental health geriatric interdisciplinary team in Tennessee, which includes social workers, a psychologist, a clinical nurse specialist, a psychiatrist, case managers and a programme manager, all with geriatric training. The sample consisted of 69 community dwelling clients aged 55 or older with severe mental health problems defined as schizophrenia, schizoaffective disorder, bipolar disorder or major recurrent depression. The majority had major recurrent depression. The results show a reduction in depressive symptoms and psychiatric hospital admissions, and an increase in life satisfaction, at six-month follow-up. No changes were found in health status or in medical hospital admissions.
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.
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)
Feasibility of integrating mental health screening and services into routine elder abuse practice to improve client outcomes
- Authors:
- SIREY Anne, et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 27(3), 2015, pp.254-269.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The goal of this pilot programme was to test the feasibility of mental health screening among elder abuse victims and of offering those victims a brief psychotherapy for depression and anxiety. Elder abuse victims who sought assistance from a large, urban elder abuse service were screened for depression and anxiety using standardized measures. Clients with clinically significant depression (PHQ-9) or anxiety (GAD-7) were randomised to receive one of three different interventions concurrent with abuse resolution services. Staff were able to screen 315 individuals, with 34% of clients scoring positive for depression or anxiety. Of those with mental health needs, only 15% refused all services. The mental health intervention (PROTECT) was successfully implemented in two different formats with collaboration between staff workers. These findings support both the need for mental health care among elder abuse victims and the feasibility of integrating mental health screening and treatment into routine elder abuse practice. (Edited publisher abstract)
Making the case for integrated, impartial information and advice about housing and care for older people
- Authors:
- ADAMS Sue, GREEN Gill
- Publisher:
- Foundations
- Publication year:
- 2015
- Pagination:
- 39
- Place of publication:
- London
This joint report sets out the case for the provision of integrated information and advice for older people which covers housing, care and finance. It looks at how this will enable local councils to meet their new duties under the Care Act; identifies current integrated information and advice provision; and demonstrates there wider cost benefits and their value to older people themselves. It also shows how these services meet specific NHS, Public Health and Social Care Outcomes Framework measures. Case studies are used throughout to illustrate the financial and social benefits of integrated provision and the added value that the voluntary sector can bring. The report has been jointly produced was Care and Repair England, EAC First Stop, Foundations, Independent Age and Age UK. It is of particular relevance to commissioners and providers of care, health or housing services. (Edited publisher abstract)
A framework for understanding outcomes of integrated care programs for the hospitalised elderly
- Authors:
- HARTGERINK Jacqueline M., et al
- Journal article citation:
- International Journal of Integrated Care, 13(4), 2013, Online only
- Publisher:
- International Foundation for Integrated Care
Integrated care is a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. This article provides a framework to identify the underlying mechanisms of integrated care delivery in order to increase understanding between the relation between structure and outcomes. The overall aim is to improve the quality of care delivery and eventually patient outcomes. First, the cognitive components of the framework are outlined. These components consist of mechanisms that alter the way of thinking by professionals delivering care to older patients. Next the behavioural components are explained, which consist of mechanisms that explain how professionals actively share and combine patient information from various sources. An example of an application of the evaluation model for an integrated care programme for hospitalised and vulnerable older people is then provided. The following aspects are discussed: organisational context; care delivery by interdisciplinary teams; team context; health service delivery; quality of life for elderly patients. Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. Effective integrated care programmes combine the interacting components of care delivery. These components affect professionals’ cognitions and behaviour, which in turn affect quality of care. Insight is gained into how these components alter the way care is delivered through mechanisms such as combining individual knowledge and actively seeking new information. (Edited publisher abstract)
Integrated care pilot in north-west London: a mixed methods evaluation
- Authors:
- CURRY Natasha, et al
- Journal article citation:
- International Journal of Integrated Care, 13(3), 2013, Online only
- Publisher:
- International Foundation for Integrated Care
This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study). The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes. The paper concludes that it is critical that National Health Service managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time. (Publisher abstract)
Singing from the same hymn sheet? commissioning of preventative services from the third sector
- Authors:
- MILLER Robin, et al
- Journal article citation:
- Journal of Integrated Care, 21(5), 2013, pp.288-299.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the delivery of preventative services for older people from third sector organisations (TSOs) and the extent to which current commissioning arrangements enables the aspirations of policy to be achieved. Design/methodology/approach: Semi-structured interviews with key-contacts within a sample of TSOs which had been identified by directors of Adult Social Services as delivering one of the top three preventative interventions in their local authority area. Findings: There was evidence of considerable trust between local authorities and TSOs and as a consequence TSOs were given autonomy to develop holistic and integrated models of delivery that supported rather than diverted the TSOs’ core missions. Both sectors found it difficult to set target outcomes and connected performance frameworks for preventative services. As a consequence a major element of the commissioning cycle is not being completed and TSOs cannot be confident that they are using their resources as effectively as possible. Research limitations/implications: This study was based in one English region, and would benefit from being extended to other English regions and home nations. Practical implications: Universities, policy makers, commissioners and the third sector need to work together to develop common outcome frameworks for preventative services and to gather consistent data sets that can be more easily synthesised to give a “realistic” understanding of the impact of different interventions and delivery models. Originality value: The paper contributes to the limited evidence bases of commissioning of TSOs and preventative services. (Publisher abstract)