Elements and Performance Indicators of Integrated Healthcare Programmes on Chronic Diseases in Six Countries in the Asia-Pacific Region: A Scoping Review

Health Care Models for Persons with Multiple Chronic Conditions from Populations that Experience Health Disparities: A Scoping Review

Almost half of U.S. adults have multiple chronic conditions (MCC), and the prevalence of MCC has significantly increased for racial and/or ethnic minority groups, especially among those aged 45-64 years. Yet, little is known about evidence-based health care models for managing MCC in these populations. The overall objective of this scoping review was to identify the breadth of literature testing health care delivery models or components of models to improve the management of MCC for populations that experience health disparities. The databases of CINAHL Plus, Embase, PubMed, and Scopus were searched for original articles from 2016 to 2023. Included studies had to assess a health care delivery model, intervention, approach, or strategy for improving the management of two or more chronic conditions among U.S. adults. Using Covidence, each record was independently assessed by two reviewers and relevant data about the study, health care model, population studied, and outcomes were extracted. Out of 9583 initially screened records, 17 met the inclusion criteria, of which 5 (29%) were randomized controlled trials. Most (82%) studies focused on the management of psychiatric and physical chronic conditions. The most cited care model was the Patient-Centered Medical Home (41%). Most studies (82%) were conducted within clinical settings: primary care (n = 9), specialty care (n = 4), and behavioral health (n = 2). All studies documented positive improvements in patient outcomes, including fourteen (82%) studies that measured outcomes related to service utilization and eleven (65%) studies that measured clinical outcomes. Four studies (24%) measured cost-related outcomes. While the Chronic Care Model was developed almost 30 years ago, the applicable evidence for MCC is sparse for populations experiencing health disparities. There is an opportunity for research to develop, adapt, integrate, and implement evidence-based health care models for MCC to improve clinically significant health outcomes that align with the patient goal needs.

Availability and stability of palliative care for family members of terminally ill patients in an integrated model of health and social care

BACKGROUND

Palliative care and the integration of health and social care have gradually become the key direction of development to address the aging of the population and the growing burden of multimorbidity at the end of life in the elderly.

AIMS

To explore the benefits/effectiveness of the availability and stability of palliative care for family members of terminally ill patients in an integrated institution for health and social care.

METHODS

This prospective observational study was conducted at an integrated institution for health and social care. 230 patients with terminal illness who received palliative care and their family members were included. Questionnaires and scales were administered to the family members of patients during the palliative care process, including quality-of-life (SF-8), family burden (FBSD, CBI), anxiety (HAMA), and distress (DT). We used paired t-tests and correlation analyses to analyze the data pertaining to our research questions.

RESULTS

In the integrated institution for health and social care, palliative care can effectively improve quality of life, reduce the family's burden and relieve psychological impact for family members of terminally ill patients. Palliative care was an independent influencing factor on the quality of life, family burden, and psychosocial status. Independently of patient-related and family-related factors, the results are stable and widely applicable.

CONCLUSION

The findings underline the availability and stability of palliative care and the popularization of an integrated service model of health and social care for elder adults.

Implementing an Integrated Generalist-Led Inpatient Care Model: Results of a Mixed-Method Evaluation

Introduction

Healthcare integration has become prevalent as health systems manage a growing population of older adults with multi-morbid conditions. The integrated general hospital (IGH) is the latest example of how services can be remodelled to achieve greater care integration.

Methods

We conducted a mixed-method evaluation to identify factors impacting the implementation and effectiveness of the IGH model. Data were collected through in-depth interviews (n = 15) and focus group discussions (n = 8 groups) with hospital staff, and a staff survey (n = 226).

Results

Staff perceived improvements in clinical practice and better clinical outcomes for patients. The care model empowered nursing and allied health staff through a more collegial team structure. However, staff reported an unequal workload distribution; a third reported burnout; and some observed inconsistencies between leaders' aspirations for IGH and what was happening on the ground. For IGH to sustain, staff's education on the IGH model needs to be improved. Further examination of work processes is recommended to boost staff morale and prevent burnout.

Conclusion

Overall, IGH provided better integrated, team-based care. The model challenged traditional team structures and empowered staff to expand their roles and responsibilities. Policymakers could consider the IGH model a successful approach for integrating services across the care continuum.

Integrated Care for Multimorbidity Population in Asian Countries: A Scoping Review

Background

The complex needs of patients with multiple chronic diseases call for integrated care (IC). This scoping review examines several published Asian IC programmes and their relevant components and elements in managing multimorbidity patients.

Method

A scoping review was conducted by searching electronic databases encompassing Medline, Embase, Scopus, and Web of Science. Three key concepts - 1) integrated care, 2) multimorbidity, and 3) Asian countries - were used to define searching strategies. Studies were included if an IC programme in Asia for multimorbidity was described or evaluated. Data extraction for IC components and elements was carried out by adopting the SELFIE framework.

Results

This review yielded 1,112 articles, of which 156 remained after the title and abstract screening and 27 studies after the full-text screening - with 23 IC programmes identified from seven Asian countries. The top 5 mentioned IC components were service delivery (n = 23), workforce (n = 23), leadership and governance (n = 23), monitoring (n = 15), and environment (n = 14); whist financing (n = 9) was least mentioned. Compared to EU/US countries, technology and medical products (Asia: 40%, EU/US: 43%-100%) and multidisciplinary teams (Asia: 26%, EU/US: 50%-81%) were reported less in Asia. Most programmes involved more micro-level elements that coordinate services at the individual level (n = 20) than meso- and macro-level elements, and programmes generally incorporated horizontal and vertical integration (n = 14).

Conclusion

In the IC programmes for patients with multimorbidity in Asia, service delivery, leadership, and workforce were most frequently mentioned, while the financing component was least mentioned. There appears to be considerable scope for development.

Highlights

First scoping review to synthesise the key components and elements of integrated care programmes for multimorbidity in Asia.All programmes emphasized 'distinctive service delivery', 'leadership', and 'workforce' components.'Financing' component was least mentioned in identified integrated care programmes.

Integrated Healthcare and the Dilemma of Public Health Emergencies

Traditional healthcare services have demonstrated structural shortcomings in the delivery of patient care and enforced numerous elements of integration in the delivery of healthcare services. Integrated healthcare aims at providing all healthcare that makes humans healthy. However, with mainly chronically ill people and seniors, typically suffering from numerous comorbidities and diseases, being recruited for care, there is a need for a change in the healthcare service structure beyond direct-patient care to be compatible in peacetime and during public health emergencies. This article’s objective is to discuss the opportunities and obstacles for increasing the effectiveness of healthcare through improved integration. A rapid evidence review approach was used by performing a systematic followed by a non-systematic literature review and content analysis. The results confirmed that integrated healthcare systems play an increasingly important role in healthcare system reforms undertaken in European Union countries. The essence of these changes is the transition from the episodic treatment of acute diseases to the provision of coordinated medical services, focused on chronic cases, prevention, and ensuring patient continuity. However, integrated healthcare, at a level not yet fully defined, will be necessary if we are to both define and attain the integrated practice of both global health and global public health emergencies. This paper attains the necessary global challenges to integrate healthcare effectively at every level of society. There is a need for more knowledge to effectively develop, support, and disseminate initiatives related to coordinated healthcare in the individual healthcare systems.