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Reinhoudt-den Boer L, Huijsman R, van Wijngaarden JDH. Identifying Differences in Frames of Reference That Are Hard to Reconcile During the Process of Normative Integration to Deliver Care for People with Multiple Problems: A Mixed-Method Delphi Study in the Netherlands. Int J Integr Care 2024; 24:2. [PMID: 38618043 PMCID: PMC11012147 DOI: 10.5334/ijic.7583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/07/2024] [Indexed: 04/16/2024] Open
Abstract
Background Integrated care is enhanced by integration on system, organizational, professional, and clinical levels including functional and normative integration. Many studies have been done on functional integration on these different levels, less studies focus on how normative integration takes place. In this study, we focus on the question: what differences in frames of refence must be addressed to establish consensus on appropriate care for People with Multiple Problems? Methods A mixed-method Delphi study was carried out in which professionals and managers regularly involved in care for people with multiple problems (PWMPs) worked towards consensus on appropriate care delivery through the assessment of 15 vignettes representing real trajectories of PWMPs. Results No consensus on appropriate care delivery was reached on any of the 15 vignettes. Five differences in perspective explained the dissensus: 1) an individual versus a systemic perspective on the client; 2) a focus on self-expressed needs of clients or professionally assessed (normative) needs; 3) client-directed or caregiver-directed care; 4) client as victim of circumstances or responsible for circumstances; 5) a focus on barriers or opportunities. Conclusions In general, panelists agreed that care for PWMPs should be integrated. However, the further integrated care was to be operationalized in practice the greater the dissensus between panelists emerged. To understand how these differences in perspectives may be overcome to provide care for PWMPs normative integration needs to be studied during actual processes of care delivery.
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Garattini L, Badinella Martini M. Modeling European health systems: a theoretical exercise. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1249-1252. [PMID: 37665522 DOI: 10.1007/s10198-023-01628-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
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Neill R, Zia N, Ashraf L, Khan Z, Pryor W, Bachani AM. Integration measurement and its applications in low- and middle-income country health systems: a scoping review. BMC Public Health 2023; 23:1876. [PMID: 37770887 PMCID: PMC10537146 DOI: 10.1186/s12889-023-16724-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Despite growing interest in and commitment to integration, or integrated care, the concept is ill-defined and the resulting evidence base fragmented, particularly in low- and middle-income countries (LMICs). Underlying this challenge is a lack of coherent approaches to measure the extent of integration and how this influences desired outcomes. The aim of this scoping review is to identify measurement approaches for integration in LMICs and map them for future use. METHODS Arksey and O'Malley's framework for scoping reviews was followed. We conducted a systematic search of peer-reviewed literature measuring integration in LMICs across three databases and screened identified papers by predetermined inclusion and exclusion criteria. A modified version of the Rainbow Model for Integrated Care guided charting and analysis of the data. RESULTS We included 99 studies. Studies were concentrated in the Africa region and most frequently focused on the integration of HIV care with other services. A range of definitions and methods were identified, with no single approach for the measurement of integration dominating the literature. Measurement of clinical integration was the most common, with indicators focused on measuring receipt of two or more services provided at a single point of time. Organizational and professional integration indicators were focused on inter- and intra-organizational communication, collaboration, coordination, and continuity of care, while functional integration measured common information systems or patient records. Gaps were identified in measuring systems and normative integration. Few tools were validated or publicly available for future use. CONCLUSION We identified a wide range of recent approaches used to measure integration in LMICs. Our findings underscore continued challenges with lack of conceptual cohesion and fragmentation which limits how integration is understood in practice.
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Affiliation(s)
- Rachel Neill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Nukhba Zia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Lamisa Ashraf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Zainab Khan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Wesley Pryor
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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Garattini L, Freemantle N, Nobili A, Mannucci PM. Conceptualizing a model for European health systems: the institutional framework. Intern Emerg Med 2023; 18:1213-1215. [PMID: 37014494 DOI: 10.1007/s11739-023-03261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - N Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - P M Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Moradzadeh M, Karamouzian M, Najafizadeh S, Yazdi-Feyzabadi V, Haghdoost AA. International Journal of Health Policy and Management (IJHPM): A Decade of Advancing Knowledge and Influencing Global Health Policy (2013-2023). Int J Health Policy Manag 2023; 12:8124. [PMID: 37579384 PMCID: PMC10425691 DOI: 10.34172/ijhpm.2023.8124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Mina Moradzadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Centre On Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV, Kerman University of Medical Sciences, Kerman, Iran
| | - Sahar Najafizadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Reinhoudt‐den Boer L, van Wijngaarden J, Huijsman R. How do clients with multiple problems and (in)formal caretakers coproduce integrated care and support? A longitudinal study on integrated care trajectories of clients with multiple problems. Health Expect 2022; 26:268-281. [PMID: 36523166 PMCID: PMC9854308 DOI: 10.1111/hex.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/07/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Integrated care can create several advantages, such as better quality of care and better outcomes. These advantages apply especially to clients with multiple problems (CWMPs) who have multiple, interconnected needs that span health and social issues and require different health care (e.g., mental health care or addiction care), social care (e.g., social benefits) and welfare services at the same time. Integrated care is most often studied as a phenomenon taking place at the system, organizational, professional and clinical levels. Therefore, in many studies, clients seem to be implicitly conceptualized as passive recipients of care. Less research has been conducted on how clients and (in)formal caretakers coproduce integrated care. METHODS We performed a longitudinal study to investigate how CWPMs and (in)formal caretakers coproduce integrated care. Data were collected among CWMPs and their (in)formal caretakers in Rotterdam, the Netherlands. CWMPs' care trajectories were followed for 1-1.5 years. CWMPs were interviewed three times at an interval of 6 months (T0, T1, T2). Informal caretakers were interviewed three times (T0, T1, T2), and formal caretakers of 16 clients were interviewed twice (T1, T2). Data in the municipal record systems about participating CWMPs were also included. RESULTS Our study shows that the CWMPs' multidimensional needs, which should function as the organizing principle of integrated care, are rarely completely assessed at the start (first 6 weeks) of CWMPs' care trajectories. Important drivers behind this shortcoming are the urgent problems CWMPs enter the support trajectory with, their lack of trust in 'the government' and the complexity of their situations. We subsequently found two distinct types of cases. The highest level of integrated care is achieved when formal caretakers initiate an iterative process in which the CWMP's multidimensional needs are constantly further mapped out and interventions are attuned to this new information. CONCLUSIONS Our study indicates that integrated care is the joint product of formal caretakers and CWMPs. Integrated care however does not come naturally when CWMPs are 'put at the center'. Professionals need to play a leading role in engaging CWMPs to coproduce integrated care. PATIENT CONTRIBUTION CWMPs and their (in)formal caretakers participated in this study via interviews and contributed with their experiences of the process.
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Affiliation(s)
- Lieke Reinhoudt‐den Boer
- Department of Health Services Management & OrganisationErasmus School of Health Policy and ManagementRotterdamThe Netherlands
| | - Jeroen van Wijngaarden
- Department of Health Services Management & OrganisationErasmus School of Health Policy and ManagementRotterdamThe Netherlands
| | - Robbert Huijsman
- Department of Health Services Management & OrganisationErasmus School of Health Policy and ManagementRotterdamThe Netherlands
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Agerholm J, Teni FS, Sundbye J, Rolfson O, Burström K. Patient-reported outcomes among patients undergoing total hip replacement in an integrated care system and in a standard care system in Region Stockholm, Sweden. BMC Health Serv Res 2022; 22:1414. [PMID: 36434638 PMCID: PMC9694819 DOI: 10.1186/s12913-022-08722-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Coordination, cooperation and efficient use of resources is vital for the health- and social care sector if it is to meet the needs of an aging population. Integrated care is a patient-centred approach to provision of care aiming to improve quality of care and overcome fragmented care through co-productive partnerships and may positively affect quality of care and health outcomes, especially among those in need of highly coordinated care services. AIM To compare patient-reported outcomes (PROs) among patients undergoing total hip replacement (THR) in the integrated care system in Norrtälje Municipality and in the standard care system in other municipalities in Region Stockholm, Sweden. METHODS Swedish Hip Arthroplasty Register PRO data during 2008-2015 were compared 1 year after THR among patients (≥50 years) in integrated care (n = 407) and standard care (n = 3501) systems using linear (EQ VAS score), logistic (EQ-5D-3L dimensions) and negative binomial (hip pain VAS score) regressions. Analyses were adjusted for the preoperative factors age, sex, BMI, ASA class and type of incision. RESULTS 1-year postoperatively, patients in the integrated care system did not report their health significantly different from patients receiving standard care. Exceptions: Female patients in integrated care reported less problems with self-care (OR:0.52; 0.29-0.96) and patients above 70 years reported more problems with mobility (OR: 1.37; 1.01-1.87). CONCLUSION No significant differences were found between the two care systems for postoperative PROs. A longer follow-up time and analyses by socioeconomic groups would be valuable.
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Affiliation(s)
- J. Agerholm
- grid.4714.60000 0004 1937 0626Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18A, SE – 171 77 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - F. S. Teni
- grid.4714.60000 0004 1937 0626Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - J. Sundbye
- grid.4714.60000 0004 1937 0626Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - O. Rolfson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg University, Gothenburg, Sweden ,grid.512495.eSwedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - K. Burström
- grid.4714.60000 0004 1937 0626Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Garattini L, Badinella Martini M, Nobili A. Integrated care in Western Europe: a wise solution for the future? Expert Rev Pharmacoecon Outcomes Res 2022; 22:717-721. [PMID: 35196951 DOI: 10.1080/14737167.2022.2046465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION IC is a term commonly adopted across the world underpinning a positive attitude against fragmentation of healthcare service provision. While the principles supporting IC are simple, their implementation is more controversial. AREAS COVERED The growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by aging multi-morbid patients. A comprehensive definition of IC should now include the coordination of health and social services useful to deliver continuous care across organizational boundaries. The recent debate on IC is largely influenced by the mismatch between the increasing burden of health and social needs for chronic conditions from the demand side, and the design of health-care systems still focused on acute care from the supply side. EXPERT OPINION The major reasons of persisting IC weakness in European countries stem from arguable choices of health policy taken in the recent past. The political creed in 'market competition' is probably the most emblematic. All initiatives encouraging health-care providers to compete with each other are likely to discourage IC. Since most European GPs are still self-employed professionals working in their own cabinets, the anachronistic professional status of GPs is another historically rooted reason of IC weakness.
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Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
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Garattini L, Badinella Martini M, Nobili A. Integrated Care in Europe: Time to Get it Together? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:145-147. [PMID: 34458969 DOI: 10.1007/s40258-021-00680-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
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Malisauskaite G, Jones K, Allan S, Roland D, Birks Y, Baxter K, Gridley K. How local partnerships to improve urgent and emergency care have impacted delayed transfers of care from hospitals in England: an analysis based on a synthetic control estimation method. BMJ Open 2022; 12:e054568. [PMID: 35131830 PMCID: PMC8823209 DOI: 10.1136/bmjopen-2021-054568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Patients should be discharged from hospital when they are medically fit. However, discharges are often delayed for non-medical reasons including access to social care. One aim of local health and social care partnerships to improve urgent and emergency care in England (known as urgent and emergency care (UEC) vanguards) was to improve integration of health and social care, which could lead to fewer delays. Consequently, we aimed to assess the impact of UEC vanguards on delayed discharges from hospital (delayed transfers of care (DTOC)) in England. DESIGN Using a synthetic control estimation method 29 local authorities (LAs) that were UEC vanguards partners were averaged into a single 'treated' unit and compared with a unit created using data from LAs that were not UEC vanguards partners to estimate the impact of UEC vanguards on DTOC. Sensitivity analysis included fixed effects panel regressions and various placebo tests. SETTING 150 LAs in England (excluding city of London and Isles of Scilly); 29 LAs were partners in UEC vanguards between August 2015 and March 2018. PRIMARY OUTCOME MEASURE Quarterly data on days of DTOC at LA level for the period 2010-2017. RESULTS Synthetic control estimation showed a large difference in DTOC days between UEC vanguards partner LAs compared with those that were not, with on average 23.7% lower DTOC per quarter (491 DTOC days per quarter). Fixed effect panel regressions found DTOC rates lower by 43.1% (99% CI 13.8% to 72.4%) in UEC partner LAs after the start of the vanguards programme. We found no indication of UEC partner LAs having lower DTOC rates prior to initiation of vanguards. CONCLUSIONS The evidence indicates a sizeable statistically significant impact of UEC vanguards on DTOC; however, more research is required to explain the underlying reasons for this relationship.
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Affiliation(s)
| | - Karen Jones
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Stephen Allan
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Daniel Roland
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Kate Baxter
- Social Policy Research Unit, University of York, York, UK
| | - Kate Gridley
- Social Policy Research Unit, University of York, York, UK
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Feryn N, De Corte J, Roose R. Interprofessional primary care practice including social workers: exploring the experiences of patients in vulnerable situations. J Interprof Care 2022; 36:793-800. [PMID: 35050834 DOI: 10.1080/13561820.2021.2015302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The link between social inequality and health has been widely recognized, as there are systematic differences in health between people from lower and higher social classes. Furthermore, the complexity and multidimensionality of health and social problems has resulted in primary health care services that are increasingly integrating the approach of interprofessional collaboration between medical professionals and social workers. Despite this current focus, there is a lack of empirical insights into patients' experience of the quality of care resulting from these collaborations. This paper aims to contribute to knowledge by adopting a research approach that captures the narratives of patients in vulnerable situations from a primary care center by conducting semi-structured interviews. Through content analysis, data was analyzed according to five themes: (1) availability, (2) accessibility, (3) affordability, (4) comprehensibility, and (5) usefulness. The results suggest a positive role for interprofessional collaboration between medical professionals and social workers within a primary health care setting. This includes the opportunity for giving greater attention to social rights and collaboration within the local community.
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Affiliation(s)
- Nele Feryn
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
| | - Joris De Corte
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
| | - Rudi Roose
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
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Schlünsen ADM, Christiansen DH, Fredberg U, Vedsted P. Effectiveness of a 24-hour access outpatient clinic for patients with chronic conditions in hospital outpatient follow-up: a registry-based controlled cohort study of healthcare utilisation and mortality. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2020-000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo evaluate the effectiveness of a 24-hour telephone access outpatient clinic (24-hour access clinic) in terms of healthcare utilisation and mortality in patients with five chronic conditions (chronic obstructive pulmonary disease, atrial fibrillation/flutter, congestive heart failure, inflammatory bowel disease and chronic liver disease).Methods and analysisThis was a registry-based controlled cohort study. The 24-hour access clinic was established at Silkeborg Regional Hospital in Central Denmark Region. The five other regional hospitals served as comparison hospitals. The 24-hour access clinic allowed patients with five chronic conditions with ongoing hospital outpatient follow-up to call the hospital outpatient clinic in case of an exacerbation. Outcomes were use of hospital admissions, length of stay (LOS), outpatient visits, contacts to general practice and all-cause mortality during 18 months of follow-up.ResultsThe study included 992 the 24-hour access patients and 3878 usual care patients. For the five conditions combined, the 24 hours access patients had fewer all-cause admissions (incidence rate ratio (IRR) 0.81, 95% Cl 0.71 to 0.92), general practice out-of-hours contacts (IRR 0.81, 95% C 0.71 to .92) and shorter LOS (IRR 0.71, 95% CI 0.57 to 0.88). The rate of all-cause outpatient visits tended to be higher (IRR 1.07, 95% CI 0.99 to 1.15). General practice daytime contacts were similar between the groups, and there was no significant difference in mortality.ConclusionsThe results suggest that a 24-hour telephone access clinic may lead to enhanced integration of care measured as unplanned acute care substituted with planned outpatient care.
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Garattini L, Badinella Martini M, Mannucci PM. Integrated care: easy in theory, harder in practice? Intern Emerg Med 2022; 17:3-6. [PMID: 34491514 DOI: 10.1007/s11739-021-02830-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
Integrated care (IC) is a term now commonly adopted across the world, which implies a positive attitude towards addressing fragmentation of service provision inside health systems. While the principles of IC are simple, their implementation is more controversial. The ever growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by ageing multi-morbid patients. An exhaustive definition of IC should now enclose the coordination of health and social services useful to deliver seamless care across organizational boundaries. The current debate on IC is largely fueled by the modern mismatch between the growing burden of health needs for chronic conditions from the demand side and the design of health systems still largely centered on acute care from the supply side. The major reasons of persisting IC weakness in Western European nations stem from arguable choices of health policy taken in a quite recent past. The political creed in 'market competition' is likely to be the most emblematic. All initiatives encouraging healthcare providers to compete with each other are likely to discourage IC. Another historically rooted reason of IC weakness is the occupational status of European general practitioners (GPs). While single large-scale organizations have become a pressing priority for a modern primary care, most GPs are still selfemployed professionals working in their own cabinets. It is time to reconsider the anachronistic status of GPs so as to enhance IC in the future.
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Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
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Ramos A, Fonseca C, Pinho L, Lopes M, Oliveira H, Henriques A. Functional Profile of Older Adults Hospitalized in Convalescence Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study. J Pers Med 2021; 11:jpm11121350. [PMID: 34945822 PMCID: PMC8704872 DOI: 10.3390/jpm11121350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: To evaluate the evolution of the functional profile of older adults admitted to a health unit in Portugal; to relate the functional profile of these individuals with age, sex, education level and emotional state; and to evaluate the probability of the degree of dependence as a function of age and sex. Methods: longitudinal, retrospective study with a sample of 59,013 older adults admitted to convalescence units of the National Network of Integrated Continuous Care of Portugal. Results: In the first 75 days of hospitalization, activities of daily living, mobility and cognitive state improved, but there was a decline after 75 days of hospitalization. The ability to perform instrumental activities of daily living improved in the first 15 days of hospitalization, stabilized until 45 days and then began to worsen. Women had a higher probability of having a severe/complete dependence three years earlier than men (88 years to 91 years). A higher education level and stable emotional state were protective factors against functional decline. Conclusions: The functional profile of older adults improved during the length of stay recommended for hospitalization in convalescence units (30 days). It is critical for health systems to adopt strategies to prevent declines in the emotional state of frail individuals.
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Affiliation(s)
- Ana Ramos
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal; (A.R.); (A.H.)
| | - César Fonseca
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
| | - Lara Pinho
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
- Correspondence:
| | - Manuel Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
| | | | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal; (A.R.); (A.H.)
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
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Liapi F, Chater A, Randhawa G, Pappas Y. Factors that facilitate or hinder whole system integrated care for obesity and mental health: a scoping review protocol. BMJ Open 2021; 11:e050527. [PMID: 34376452 PMCID: PMC8356181 DOI: 10.1136/bmjopen-2021-050527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Integrated care aims to improve population health. Obesity and mental health are major health issues worldwide. The complexity of the multifactorial drivers of these public health problems has led to the adoption of a whole system approach. This review aims to highlight factors that influence the planning, implementation and evaluation of whole system integrated care for these conditions. METHODS AND ANALYSIS Using the framework of Arksey and O' Malley, we will perform a comprehensive search in the following databases: MEDLINE, CINAHL, PsychINFO, PubMed, British Nursing Database, Web of Science, Health Systems Evidence, Cochrane Library and University of York Centre for Reviews and Dissemination. Further hand-search of reference lists and the grey literature will be conducted. The search will be restricted to articles published from 2000 to 2020. The review is expected to be completed by August 2021. Full texts of the potential studies will be screened for the inclusion criteria. Quality of studies will be appraised. Narrative synthesis will be completed using data extracted from the included studies. ETHICS AND DISSEMINATION A favourable ethics opinion for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC937). This review expects to identify information relating to factors that facilitate or hinder whole system integrated care for obesity and mental health. The finding from this review will be widely disseminated to stakeholders to inform implementation of whole system integrated care initiatives.
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Affiliation(s)
- Fani Liapi
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Angel Chater
- Department of Sport Science and Physical, University of Bedfordshire, Luton, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Impact of Integrated Care on the Rate of Hospitalization for Ambulatory Care Sensitive Conditions among Older Adults in Stockholm County: An Interrupted Time Series Analysis. Int J Integr Care 2021; 21:22. [PMID: 34163311 PMCID: PMC8195125 DOI: 10.5334/ijic.5505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Reducing avoidable hospital admissions is often viewed as a possible positive consequence of introducing integrated care (IC). The aim of this study was to investigate the impact of implementing IC in Norrtälje on the rate of admissions for ambulatory care sensitive conditions (ACSC). Method: Using interrupted time series analyses we investigated the effect of implementing IC in Norrtälje municipality in the northern part of Stockholm county, Sweden. The time period included 48 time points, from year 2000 to year 2011 with measurements before and after introducing IC in Norrtälje in 2006. In order to control for other extraneous events that could affect the outcome measure, but not related to the introduction of IC, we included a control population from Stockholm municipality. Results: After introducing IC in Norrtälje the rate of admissions for ACSC decreased. This decrease was greater in Norrtälje than in the matched control population, however the difference between the two areas was not statistically significant (p = 0.08). Conclusion: Introducing IC in Norrtälje may have had positive impact on admissions for ACSC for older people living in Norrtälje; however, the interpretation of the impact of IC on admissions for ACSC is complicated by intervening policy changes in health and social care during the study period.
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Yip O, Huber E, Stenz S, Zullig LL, Zeller A, De Geest SM, Deschodt M. A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project. Int J Integr Care 2021; 21:9. [PMID: 33976598 PMCID: PMC8064293 DOI: 10.5334/ijic.5607] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/03/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integrated care for frail older adults is successful in practice. In this study, we aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integrated care model in newly created information and advice centers for older adults in Canton Basel-Landschaft, Switzerland. METHODS We conducted a contextual analysis to determine factors which may influence the integrated care model and implementation strategies needed. A logic model depicting the overall program theory, including inputs, core components, outputs and outcomes, was designed using a deductive approach, and included stakeholders' feedback and preliminary implementation strategies. RESULTS Contextual factors were identified (e.g., lack of integrated care regulations, existing community services, and a care pathway needed). Core components of the care model include screening, referral, assessment, care plan creation and coordination, and follow-up. Outcomes included person-centred coordinated care experiences, hospitalization rate and symptom burden, among others. Implementation strategies (e.g., nurse training and co-developing educational materials) were proposed to facilitate care model adoption. CONCLUSION Contextual understanding and a clear logic model should enhance the potential for successful implementation of the integrated care model.
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Affiliation(s)
- Olivia Yip
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
| | - Evelyn Huber
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
- Institute of Nursing, School of Health Professions, ZHAW Zurich University of Applied Sciences, CH
| | - Samuel Stenz
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
| | - Leah L. Zullig
- Department of Population Health Sciences, Duke University Medical Center, USA
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Switzerland
| | - Sabina M. De Geest
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Mieke Deschodt
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Belgium
- Healthcare and Ethics, Faculty of Medicine and Life Sciences, UHasselt, Belgium
| | - the INSPIRE consortium
- Matthias Briel, Matthias Schwenkglenks, Franziska Zúñiga, Penelope Vounatsou, Carlos Quinto, Eva Blozik, Flaka Siqeca, Maria José Mendieta Jara
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Wilson P, Billings J, MacInnes J, Mikelyte R, Welch E, Checkland K. Investigating the nature and quality of locally commissioned evaluations of the NHS Vanguard programme: an evidence synthesis. Health Res Policy Syst 2021; 19:63. [PMID: 33845858 PMCID: PMC8042862 DOI: 10.1186/s12961-021-00711-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 03/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND With innovation in service delivery increasingly viewed as crucial to the long-term sustainability of health systems, NHS England launched an ambitious new model of care (Vanguard) programme in 2015. Supported by a £350 million transformation fund, 50 Vanguard sites were to act as pilots for innovation in service delivery, to move quickly to change the way that services were delivered, breaking down barriers between sectors and improving the coordination and delivery of care. METHODS As part of a national evaluation of the Vanguard programme, we conducted an evidence synthesis to assess the nature and quality of locally commissioned evaluations. With access to a secure, online hub used by the Vanguard and other integrated care initiatives, two researchers retrieved any documents from a locally commissioned evaluation for inclusion. All identified documents were downloaded and logged, and details of the evaluators, questions, methodological approaches and limitations in design and/or reporting were extracted. As included evaluations varied in nature and type, a narrative synthesis was undertaken. RESULTS We identified a total of 115 separate reports relating to the locally commissioned evaluations. Five prominent issues relating to evaluation conduct were identified across included reports: use of logic models, number and type of evaluation questions posed, data sharing and information governance, methodological challenges and evaluation reporting in general. A combination of resource, data and time constraints means that evaluations often attempted to but did not fully address the wide range of questions posed by individual Vanguards. CONCLUSIONS Significant investment was made in independent local evaluations of the Vanguard programme by NHS England. This synthesis represents the only comprehensive attempt to capture methodological learning and may serve as a key resource for researchers and policy-makers seeking to understand investigating large-scale system change, both within the NHS and internationally. PROSPERO (Registration number: CRD42017069282).
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Affiliation(s)
- Paul Wilson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Jenny Billings
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Julie MacInnes
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Rasa Mikelyte
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Elizabeth Welch
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Kath Checkland
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Schlünsen ADM, Christiansen DH, Fredberg U, Vedsted P. Patient characteristics and healthcare utilisation among Danish patients with chronic conditions: a nationwide cohort study in general practice and hospitals. BMC Health Serv Res 2020; 20:976. [PMID: 33106173 PMCID: PMC7586660 DOI: 10.1186/s12913-020-05820-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background The complexity of caring for patients with chronic conditions necessitates new models of integrated care to accommodate an increasing demand. To inform the development of integrated care models, it is essential to map patients’ use of healthcare resources. In this nationwide registry-based cohort study, we describe and compare patient characteristics and healthcare utilisation between Danish patients with chronic conditions in general practice follow-up and in hospital outpatient follow-up. Methods On 1 January 2016, we identified 250,402 patients registered in 2006–2015 with a hospital diagnosis of atrial fibrillation/flutter, congestive heart failure, chronic liver disease, inflammatory bowel disease or chronic obstructive pulmonary disease. By linkage to national social and health registries, patient characteristics and 12-month healthcare utilisation were extracted. Incidence rates of health care utilisation were compared between patients with chronic conditions in general practice follow-up and patients in hospital outpatient follow-up using negative binomial regression. Results Across all five conditions, the largest proportions of patients were in general practice follow-up (range = 59–87%). Patients in hospital outpatient follow-up had higher rates of exacerbation-related admissions (adjusted incidence rate ratio (IRR) range = 1.3 to 2.8) and total length of stay (IRR range = 1.2 to 2.2). For these five conditions, all-cause admissions and lengths of stay, general practice daytime and out-of-hours contacts, and municipal home nursing contacts were similar between follow-up groups or higher among patients in general practice follow-up. The exception was patients with chronic obstructive pulmonary disease, where patients in hospital outpatient follow-up had higher utilisation of healthcare resources. Conclusions Patients in general practice follow-up accounted for the largest proportion of total healthcare utilisation, but patients in hospital outpatient follow-up were characterised by high exacerbation rates. Enhanced integration of chronic care may be of most benefit if patients in general practice follow-up are targeted, but it is also likely to have an impact on exacerbation rates among patients in hospital outpatient follow-up.
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Affiliation(s)
- Anders Damgaard Møller Schlünsen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Department of Clinical Medicine, Silkeborg Regional Hospital, Aarhus University, Silkeborg, Denmark.
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark.,Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Department of Clinical Medicine, Silkeborg Regional Hospital, Aarhus University, Silkeborg, Denmark
| | - Peter Vedsted
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Department of Clinical Medicine, Silkeborg Regional Hospital, Aarhus University, Silkeborg, Denmark.,Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Clark M, Jolley D, Benbow SM, Greaves N, Greaves I. Exploring the scope for Normalisation Process Theory to help evaluate and understand the processes involved when scaling up integrated models of care: a case study of the scaling up of the Gnosall memory service. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-11-2018-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT).Design/methodology/approachThe article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project.FindingsNPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future.Research limitations/implicationsThe research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies.Practical implicationsNPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up.Social implicationsNPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up.Originality/valueThis paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models.
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Morciano M, Checkland K, Billings J, Coleman A, Stokes J, Tallack C, Sutton M. New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis. Health Policy 2020; 124:826-833. [PMID: 32595094 PMCID: PMC7386936 DOI: 10.1016/j.healthpol.2020.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/30/2022]
Abstract
Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Models' programme. The programme, running from 2015 to 2018, was one of the largest pilots in English history, covering around 9 % of the population. It was largely intended to design prototypes aimed at reducing hospital utilisation by moving specialist care out of hospital into the community and by fostering coordination of health, care and rehabilitation services for (i) the whole population ('population-based sites'), or (ii) care home residents ('care home sites'). We evaluate and compare the efficacy of the population-based and care home site integrated care models in reducing hospital utilisation. We use area-level monthly counts of emergency admissions and bed-days obtained from administrative data using a quasi-experimental difference-in-differences design. We found that Vanguard sites had higher hospital utilisation than non-participants in the pre-intervention period. In the post-intervention period, there is clear evidence of a substantial increase in emergency admissions among non-Vanguard sites. The Vanguard integrated care programme slowed the rise in emergency admissions, especially in care home sites and in the third and final year. There was no significant reduction in bed-days. In conclusion, integrated care policies should not be relied upon to make large reductions in hospital activity in the short-run, especially for population-based models.
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Affiliation(s)
- Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom.
| | - Katherine Checkland
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Jenny Billings
- Centre for Health Service Studies, University of Kent, Canterbury, CT2 7NF, United Kingdom
| | - Anna Coleman
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Charles Tallack
- Research and Economic Analysis for the Long Term (REAL) Centre, The Health Foundation, London, EC4Y 8AP, United Kingdom
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom
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Doheny M, Agerholm J, Orsini N, Schön P, Burström B. Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis. BMJ Open 2020; 10:e036182. [PMID: 32499268 PMCID: PMC7279653 DOI: 10.1136/bmjopen-2019-036182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits. DESIGN Interrupted time series analysis from 2000 to 2015. SETTING Stockholm County. PARTICIPANTS All inhabitants 65+ years in Stockholm County on 31 December of each study year. INTERVENTION IC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County. OUTCOME Rates of hospital-based ED visits. RESULTS IC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65-79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years. CONCLUSION The implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.
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Affiliation(s)
- Megan Doheny
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Nicola Orsini
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Karolinska, Stockholm, Sweden
| | - Bo Burström
- Global Public Health, Karolinska Institute, Stockholm, Sweden
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Hiltunen AM, Hörhammer I, Silander K, Kaikuluoma J, Linna M. Integrating health service delivery for geriatric patients after hospital admission-A register study on the outcomes and costs. Health Serv Manage Res 2019; 33:24-32. [PMID: 31771358 DOI: 10.1177/0951484819887668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After a care episode in a hospital, elderly patients often face delays in transitions to permanent residence. Poor care coordination burdens both the patients and the healthcare system. Whereas different models for coordinating geriatric patients’ care and discharge planning have been developed, evidence on their cost-effectiveness remains scant. In this study, we evaluated the associations of an integrated care model on health and social care costs and service utilization among geriatric patients admitted to a hospital in a Finnish city with c. 68,000 citizens. Elderly patient cohorts admitted before (N = 709) and after (N = 364) the implementation of the integrated care model were compared restrospectively. The new model consisted of changes in regional care criteria, discharge planning, coordination between inpatient facilities, and the daily work of nursing staff. Patients treated in the new model spent, on average, 7.4 days less in institutionalized care during one year, and the total annual cost of care decreased by 967€ per patient. A regionally coordinated care pathway from hospital admission to permanent residence may improve the cost-effectiveness of elderly care. Coordination and monitoring of outcomes at regional level is essential to avoid fragmentation of care and suboptimization among different care providers serving the elderly.
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Affiliation(s)
- Anna-Maria Hiltunen
- HEMA Institute, Department of Industrial Engineering and Management, Aalto University, Espoo, Finland.,Nordic Healthcare Group, Helsinki, Finland
| | - Iiris Hörhammer
- HEMA Institute, Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | | | - Jaakko Kaikuluoma
- HEMA Institute, Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Miika Linna
- HEMA Institute, Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
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Harlock J, Caiels J, Marczak J, Peters M, Fitzpatrick R, Wistow G, Forder J, Jones K. Challenges in integrating health and social care: the Better Care Fund in England. J Health Serv Res Policy 2019; 25:86-93. [DOI: 10.1177/1355819619869745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The Better Care Fund is the first and only national policy in England that has legally mandated the use of pooled budgets to support local health and social care systems to provide better integrated care. Methods We report qualitative findings from the first national multi-method evaluation of the Better Care Fund, focusing on its implementation, perceptions of progress and expected impacts among key stakeholders. Interviews were carried out with 40 staff responsible for Better Care Fund implementation in 16 local health and social care sites between 2017 and 2018. Results Study participants reported their experiences of implementation, and we present these in relation to three themes: organizational issues, relational issues and wider contextual issues. Participants stressed the practical and political challenges of managing pooled budgets and the complexity of working across geographical boundaries. In a context of unprecedented austerity, shared vision and strong leadership were even more vital to achieve collaborative outcomes. Conclusion Pooling budgets through the Better Care Fund can lever closer collaboration between sectors and services. Shared vision and leadership are essential to develop and foster this closer collaboration. Although some successes were reported, the study highlights that there are major cultural, operational and territorial barriers to overcome.
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Affiliation(s)
- Jenny Harlock
- Senior Research Fellow, Division of Health Sciences, Warwick Medical School, University of Warwick, UK
| | - James Caiels
- Research Fellow, Personal Social Services Research Unit, University of Kent, UK
| | - Joanna Marczak
- Researcher, Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | - Michele Peters
- Associate Professor, Nuffield Department of Population Health, University of Oxford, UK
| | - Raymond Fitzpatrick
- Professor of Public Health and Primary Care, Nuffield Department of Population Health, University of Oxford, UK
| | - Gerald Wistow
- Professorial Research Fellow, Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | - Karen Jones
- Professor of the Economics of Social Policy, School of Social Policy, Sociology and Social Research, University of Kent, UK
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Deb P, Murtaugh CM, Bowles KH, Mikkelsen ME, Khajavi HN, Moore S, Barrón Y, Feldman PH. Does Early Follow-Up Improve the Outcomes of Sepsis Survivors Discharged to Home Health Care? Med Care 2019; 57:633-640. [PMID: 31295191 DOI: 10.1097/mlr.0000000000001152] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission. OBJECTIVE We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early physician follow-up (an outpatient visit in the first posthospital week) reduce 30-day readmissions among Medicare sepsis survivors. DESIGN A pragmatic, comparative effectiveness analysis of Medicare data from 2013 to 2014 using nonlinear instrumental variable analysis. SUBJECTS Medicare beneficiaries in the 50 states and District of Columbia discharged alive after a sepsis hospitalization and received home health care. MEASURES The outcomes, protocol parameters, and control variables were from Medicare administrative and claim files and the home health Outcome and Assessment Information Set (OASIS). The primary outcome was 30-day all-cause hospital readmission. RESULTS Our sample consisted of 170,571 mostly non-Hispanic white (82.3%), female (57.5%), older adults (mean age, 76 y) with severe sepsis (86.9%) and a multitude of comorbid conditions and functional limitations. Among them, 44.7% received only the nursing protocol, 11.0% only the medical doctor protocol, 28.1% both protocols, and 16.2% neither. Although neither protocol by itself had a statistically significant effect on readmission, both together reduced the probability of 30-day all-cause readmission by 7 percentage points (P=0.006; 95% confidence interval=2, 12). CONCLUSIONS Our findings suggest that, together, early postdischarge care by home health and medical providers can reduce hospital readmissions for sepsis survivors.
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Affiliation(s)
- Partha Deb
- Hunter College, City University of New York (CUNY) and National Bureau of Economic Research (NBER)
| | - Christopher M Murtaugh
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY
| | - Kathryn H Bowles
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY
- University of Pennsylvania School of Nursing
| | - Mark E Mikkelsen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Hoda Nouri Khajavi
- Hunter College and the Graduate Center, City University of New York (CUNY), New York, NY
| | | | - Yolanda Barrón
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY
| | - Penny H Feldman
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY
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Hurt L, Langley K, North K, Southern A, Copeland L, Gillard J, Williams S. Understanding and improving the care pathway for children with autism. Int J Health Care Qual Assur 2019; 32:208-223. [PMID: 30859873 DOI: 10.1108/ijhcqa-08-2017-0153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to describe current care pathways for children with autism including enablers and barriers, as experienced by health professionals, education professionals and families in South Wales, UK. DESIGN/METHODOLOGY/APPROACH This study is based on a mixed-methods approach using focus group discussions, creative writing workshops and visualisation using rich pictures. FINDINGS The experiences of the care pathways differed significantly across the three groups. Health professionals described the most rigidly structured pathways, with clear entry points and outcomes. Education professionals and parents described more complex and confusing pathways, with parents assuming the responsibility of coordinating the health and education activity in a bid to link the two independent pathways. All three groups identified enablers, although these differed across the groups. The barriers were more consistent across the groups (e.g. poor communication, missing information, lack of transparency, limited post-diagnosis services and access to services based on diagnosis rather than need). PRACTICAL IMPLICATIONS This research could inform the design of new services which are premised on multi-agency and multi-disciplinary working to ensure children with Autism spectrum disorders (ASD) receive joined up services and support. ORIGINALITY/VALUE Although this study did not represent all professional groups or all experiences of autism, the authors examined three different perspectives of the ASD pathway. In addition, the authors triangulated high-level process maps with rich pictures and creative writing exercises, which allowed the authors to identify specific recommendations to improve integration and reduce duplication and gaps in provision.
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Affiliation(s)
- Lisa Hurt
- Division of Population Medicine, School of Medicine, Cardiff University , Cardiff, UK
| | - Kate Langley
- School of Psychology, Cardiff University , Cardiff, UK
| | - Kate North
- Department of Humanities, Cardiff Metropolitan University , Cardiff, UK
| | - Alex Southern
- Faculty of Education and Communities, University of Wales Trinity Saint David - Swansea Campus , Cardiff, UK
| | | | | | - Sharon Williams
- College of Human and Health Sciences, Swansea University , Swansea, UK
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Reno R, Beaujolais B, Davis TS. Facilitating mechanisms for integrating care to promote health equity across the life course: reflections from social work trainees. SOCIAL WORK IN HEALTH CARE 2019; 58:60-74. [PMID: 30332345 DOI: 10.1080/00981389.2018.1531105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/01/2018] [Accepted: 09/28/2018] [Indexed: 06/08/2023]
Abstract
Integrated care is a promising practice to promote health equity and improve population health across the life course, but the mechanisms needed to integrate services remain nebulous. This study aimed to identify the components required to achieve a fully integrated health care system as articulated by social work trainees. The authors conducted five focus groups (N = 20). Transcripts were analyzed using structural and pattern coding. Three primary themes emerged: Organizational Structure and Support, Personal and Interpersonal Dynamics, and Practitioner Knowledge. Results from this study can inform the process of integration and has implications for social work education.
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Affiliation(s)
- Rebecca Reno
- a School of Public Health , University of California , Berkeley , CA , USA
| | - Brieanne Beaujolais
- b College of Social Work , The Ohio State University , Columbus , Ohio , USA
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Khayatzadeh-Mahani A, Nolte E, Sutherland J, Forest PG. International experiments with different models of allocating funds to facilitate integrated care: a scoping review protocol. BMJ Open 2018; 8:e021374. [PMID: 30446571 PMCID: PMC6252706 DOI: 10.1136/bmjopen-2017-021374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/21/2018] [Accepted: 09/12/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Integrated care is viewed widely as a potential solution to some of the major challenges faced by health and social care systems, such as those posed by service duplication, fragmentation and poor care coordination, and associated impacts on the quality and cost of services. Fragmented models of allocating funds to and across sectors, programmes and providers are frequently cited as a major barrier to integration and countries have experimented with different models of allocating funds to enhance care coordination among service providers and to reduce ineffective care and avoid costly adverse events. This scoping review aims to assess published international experiences of different models of allocating funds to facilitate integration and the evidence on their impacts. METHODS AND ANALYSIS We will adopt a scoping review methodology due to the potentially vast and multidisciplinary nature of the literature on different models of allocating funds in health and social care systems, as well as the scarcity of existing knowledge syntheses. The framework developed by Arksey and O'Malley will be followed that entails six steps: (1) identifying the research question(s), (2) searching for relevant studies, (3) selecting studies, (4) charting the data, (5) collating, summarising and reporting the results and (6) and conducting consultation exercises. These steps will be conducted iteratively and reflexively, making adjustments and repetitions when appropriate to make sure the literature has been covered as comprehensively as possible. To ensure comprehensiveness of our literature review, we also search a wide range of sources. ETHICS AND DISSEMINATION An integrated knowledge translation strategy will be pursued by engaging our knowledge users through all stages of the review. We will organise two workshops or policy roundtables/policy dialogues in Alberta and British Columbia with participation of diverse knowledge users to discuss and interpret the findings of our review and to draw out policy opportunities and lessons that can be applied to the context of these two provinces.
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Affiliation(s)
- Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ellen Nolte
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Jason Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
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24-hour access outpatient clinic for patients with exacerbation of chronic disease: a before-after cohort study of differences in acute healthcare utilisation. BMC Health Serv Res 2018; 18:663. [PMID: 30153833 PMCID: PMC6114062 DOI: 10.1186/s12913-018-3475-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Chronic diseases are becoming more common due to an increasing ageing population. Patients with chronic conditions managed in outpatient clinics account for a large share of healthcare costs. We developed a 24-h access outpatient clinic offering 24-h telephone support and triaged access to the hospital for patients with acute exacerbation of four selected chronic diseases. The aim of this study was to conduct a 1-year before-after study of the acute healthcare utilisation in patients offered the 24-h access outpatient clinic intervention. Methods The study was conducted as an observational register-based cohort study. Data from the patient administrative register and the Danish National Health Service Register were extracted 12 months before and 12 months after implementation of the 24-h access intervention. Patients with chronic obstructive pulmonary disease, chronic liver disease, inflammatory bowel disease and heart failure managed in hospital outpatient clinics were enrolled in the study. Differences in healthcare utilisation were analysed for all patients, including the subgroup of high-risk patients with at least one acute admission in the year before enrolment. Results Length-of-stay remained unchanged for all diagnostic groups, except for patients with heart failure in whom a statistically significant reduction was observed. Statistically significant reductions of length of stay and acute admissions were observed in all high-risk groups, except for patients with chronic liver disease. A statistically significant reduction in the number of contacts to out-of-hours primary care was seen in patients with chronic obstructive pulmonary disease, whereas the level remained unchanged in the other diagnostic groups. Similar patterns were also seen in high-risk patients. Conclusions The 24-h access outpatient clinic did not increase the use of acute healthcare services inpatients with chronic disease. Significant reductions in hospital utilisation were seen in high-risk patients. These preliminary results should be interpreted with caution due to the observational before-after design of the study.
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Bower P, Reeves D, Sutton M, Lovell K, Blakemore A, Hann M, Howells K, Meacock R, Munford L, Panagioti M, Parkinson B, Riste L, Sidaway M, Lau YS, Warwick-Giles L, Ainsworth J, Blakeman T, Boaden R, Buchan I, Campbell S, Coventry P, Reilly S, Sanders C, Skevington S, Waheed W, Checkland K. Improving care for older people with long-term conditions and social care needs in Salford: the CLASSIC mixed-methods study, including RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe 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.ObjectivesTo explore the process of implementation of the SICP and the impact on patient outcomes and costs.DesignQualitative 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.SettingSalford in the north-west of England.ParticipantsOlder people aged ≥ 65 years, carers, and health and social care professionals.InterventionsA large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’).Main outcome measuresPatient self-management, care experience and quality of life, and health-care utilisation and costs.Data sourcesProfessional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation.ResultsThe 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).LimitationsThe 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%.ConclusionsThe 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 workFurther 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.Trial registrationCurrent Controlled Trials ISRCTN12286422.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 31. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Bower
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - David Reeves
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Kelly Howells
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Luke Munford
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Beth Parkinson
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Lisa Riste
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | - Yiu-Shing Lau
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Lynsey Warwick-Giles
- Policy Research Unit in Commissioning and the Healthcare System, Centre for Primary Care, University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Ruth Boaden
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care for Greater Manchester, Alliance Business School Manchester, University of Manchester, Manchester, UK
| | - Iain Buchan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Stephen Campbell
- National Institute for Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | | | - Caroline Sanders
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Suzanne Skevington
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Waquas Waheed
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Katherine Checkland
- Policy Research Unit in Commissioning and the Healthcare System, Centre for Primary Care, University of Manchester, Manchester, UK
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Exworthy M, Powell M, Glasby J. The governance of integrated health and social care in England since 2010: great expectations not met once again? Health Policy 2017; 121:1124-1130. [PMID: 28811098 DOI: 10.1016/j.healthpol.2017.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
Integrating health and social care has long been a goal of policy-makers and practitioners. Yet, this aim has remained elusive, partly due to conflicting definitions and a weak evidence base. As part of a special edition exploring the use of the TAPIC (transparency, accountability, participation, integrity and capability) framework in different national contexts and inter-agency settings, this article examines the governance of integrated care in England since 2010, focusing on the extent to which thesefive governance attributes are applicable to integrated care in England. The plethora of English policy initiatives on integrated care (such as the 'Better Care Fund', personal health budgets, and 'Sustainability and Transformation Plans') mostly shows signs of continuity over time although the barriers to integrated care often persist. The article concludes that the contribution of integrated care to improved outcomes remains unclear and yet it remains a popular policy goal. Whilst some elements of the TAPIC framework fit less well than others to the case of integrated care, the case of integrated care can be better understood and explained through this lens.
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Affiliation(s)
- Mark Exworthy
- Health Policy and Management, School of Social Policy, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Martin Powell
- Health and Social Policy, School of Social Policy, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Jon Glasby
- Health and Social Care, School of Social Policy, University of Birmingham, Birmingham, B15 2TT, UK.
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