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Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: a narrative review. Don’t we need a value-based approach?
- Authors:
- MARINO Marta, et al
- Journal article citation:
- International Journal of Care Coordination, 21(4), 2018, pp.120-129.
- Publisher:
- Sage
Introduction: The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centredness of care. The authors conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods: MEDLINE, Scopus and EBSCO were searched. They reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilisation outcomes, cost and cost-effectiveness). Results: Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilisation rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalised on a large scale. Discussion: The authors found out a favourable impact of integrated care models/methods on health outcomes, care utilisation and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. A value-based framework for the evaluation of these services is proposed. (Edited publisher abstract)
Home care for the elderly in Sweden, Germany and Italy: a case of multi‐level governance strategy‐making
- Authors:
- LONGO Francesco, NOTARNICOLA Elisabetta
- Journal article citation:
- Social Policy and Administration, 52(7), 2018, pp.1303-1316.
- Publisher:
- Wiley
Home care is a policy field characterized by strong interdependencies and multi‐level governance. In such a setting, decision‐ and strategy‐making is complex, with interrelated governance mechanisms between the private and public actors involved, and the risk of lack of a clear and sharp definition of public contents. In this article the authors are interested in understanding “if and how” multi‐level governance influences planning in home care and, more generally, social care fields. Through the analysis of home care services for the elderly in three prominent European countries, the article highlights critical dimensions that should be taken into consideration in such contexts: users' selection, services features, coordination and funding mechanisms, provision forms. These dimensions turn out to be representative of key processes of strategic development within multi‐level settings. (Edited publisher abstract)
Social care and social exclusion: a comparative study of older people's care in Europe
- Editors:
- BLACKMAN Tim, BRODHURST Sally, CONVERY Janet
- Publisher:
- Palgrave
- Publication year:
- 2001
- Pagination:
- 236p.,bibliog.
- Place of publication:
- Basingstoke
Explores the diversity of social care provision for older people in six European states. Discusses diversity in relation to general models of welfare and the relevance of social care provision to the emerging risk of social exclusion in Europe's ageing societies. Analyses the main features of care in each country, and significant differences and similarities between them, through case studies. Concludes by considering the utility of the concept of social exclusion in evaluating social care provision.
Social care in Europe
- Editors:
- MUNDAY Brian, ELY Peter
- Publisher:
- Prentice Hall
- Publication year:
- 1996
- Pagination:
- 247p.,bibliogs.
- Place of publication:
- London
Collection of articles looking at the contexts for, and the outcomes of, the diversity of social care provision by the member states of the European Union. The book first addresses how we define social care in Europe and looks at the differences between member states. Goes on to look in more detail at the context for social care provision and the constitutional framework provided by the European Union itself. Further chapters cover Europe's mixed economy of welfare and provide detailed analysis of the impact of social care provision on 3 key clients groups: children and families, disabled people and older people.
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.