1,894 results
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2. Evolution of the health record in the basque country. From the paper to an intelligent-integrated eHR.
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Mitxelena, Asier, Zubeltzu, Beñat, Alberdi, Ander, Aguirre, Eñaut, Goicoecha, Xabier, Vaquero, Marta, Berroeta, Ander, Fuertes, Ana, Elola, Maitane, Errasti, Uxue, and Perez, Naiara
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MEDICAL records , *MANAGEMENT of electronic health records , *ELECTRONIC health records , *NURSING home patients , *HEALTH information services , *MEDICAL care - Abstract
Introduction: After the era of paper health record, in 2002 standard questionnaires for chronic patients were collected and registered by a hospital nurse. Since then, our electronic health record has been evolving. Nowadays the same electronic health record (eHR) is shared by the whole public health system that attends 2 million people, nursing homes included. The next step forward comes with the creation of standard questionnaires within an "Integral Program Manager", this meaning that relevant information of the patient will be registered and analyzed giving identical recommendations in any setting (primary care, specialist or hospital) in a given clinical change. This will lead to "message reconciliation" in the system avoiding contradictions and helping educate and empower the patients for self-control. The creation of the personal health record and the new technologies (smartphones) will enable patients to fill the questionnaires by themselves. Description of practice change implemented: Change of paper based fragmented health record to an electronic and integrative one. Aim: Same electronic health record, questionnaires and recommendations in different settings Target population: All patients, but specially: - Pluripathological patients - Home-dependent patients - Nursing home residents - End of life patients Timeline: *Until 1996: health record on paper. *1996-2000: some reports are digitalized and the copy is carried by the patient. *2000-2009: basic electronic health record, different for primary care *Since 2002: assessment questionnaires for heart failure and COPD by phone by a case management nurse *2009-2012: health care based on an electronic health record, but different for hospital and primary care. Beginning of a electronic prescription tool (same for all) *Since 2012: creation of personal health records for patients *2012-2018: integrative electronic health record accessible for all healthcare workers, old paper reports are digitalized, warnings (allergies e.g.), same prescription tool ("Presbide"). *Since 2018: beginning of electronic application forms including those for pluripathological patients. Beginning of the "Integral Program Manager" to suggest recommendations according to clinical changes registered in the application forms. Highlights: -Creation of the electronic health record. -Computer integration: only one electronic health record -Healthcare integration: same questionnaires for all pluripathological patients (generic and specific disease related application forms). Information collected in any setting (call center, primary care physician or hospital) and creation of recommendations accordingly (by the "Integral Program Manager") leading to remote treatment adjustment, face-to-face assessment in primary care or direct hospital admission. Sustainability: The unification of theelectronic health record reduces maintenance costs and those related to the lack of coordination. Transferability: Transferable for all health services with compatible information systems. Conclusions: Integrative electronic health record and healthcare process with the same questionnaires and recommendations are desirable for a coordinated health care, especially for multipathological patients. Discussion: The new technologies should allow patients to choose the easiest way to fill in control questionnaires by themselves. Lessons learned: This process is not easy because apart from the technical difficulties requires important habit changes, but is the only way to achieve our goals. [ABSTRACT FROM AUTHOR]
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- 2019
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3. Nationwide implementation of the electronic sick leave certificates in Poland: quality improvement initiative towards value-based primary care resulting in rapid implementation in integrated care.
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Szafraniec-Buryło, Sylwia, Gluchowski, Piotr, Bukato, Grzegorz, Prusaczyk, Artur, and Żuk, Paweł
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SICK leave ,PRIMARY care ,ELECTRONIC paper ,APPLICATION software ,PAPER arts - Abstract
Introduction: Electronic sick leave certificates, called e-ZLA, were being implemented nationwide in Poland from 1 January 1 2016 until 30 November 30 2018. During the time of implementation doctors in Poland could issue sick leave certificates alternatively in electronic or in the paper form. Since 1 December 2018 sick leave certificates are to be issued in the whole Poland electronically only. Practice change: Paper form certificates in Medical and Diagnostic Centre (CMD) - an integrated care organization located in Siedlce (Poland) used to be prepared with the help of the registration or nurse staff. The average work time consumed for that process was calculated in CMD for 13 minutes per one paper form certificate. CMD is serving approximately 85000 patients and issues about 1500 sick leaves certificates every month. Therefore, CMD made an effort of rapid implementation of electronic sick leave certificates issuing. Aim and theory of change: The vendor of computer application for managing of health care related processes introduced in February 2018 in CMD's client application a new functionality of issuing electronic sick leave certificates. The personnel of CMD was trained adequately. Timeline: The first e-ZLA in the CMD was issued on 20February 2018. After short period of time when the correctness of sickleaves certificates issued via client application was being verified, the change was implemented in the whole organization. Highlights: The concept of having an e-certificate uploaded and stored within the system was highly appreciated by CMD staff. The average time of e-ZLA issuing and its online transmission is 2-3 min compared to 13 min for managing paper-form sick leave certificates. Between 20 February 2018 and 30 November 2018, CMD doctors used to issue about 1200 e-ZLAs monthly. The necessity of writing multiple sick leave certificates for patients having more than one employer was also eliminated. This system allows also for review the history of e-ZLAs received by the patient and thus prevent potential abuses. Conclusions: As a result of e-ZLA introduction, the registration staff and nurses were relieved from paper work related to issuing paper-form certificates and additional administrative tasks related to providing copies of sick leave certificates to health insurer branches. Decrease of paper work burden resulted in saving of time which could be sacrificed for patients. Enabling the release of electronic sick leave certificates was an important milestone on the way to better integrated care. [ABSTRACT FROM AUTHOR]
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- 2019
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4. Components and Outcomes in Under- and Postgraduate Medical Education to Prepare for the Delivery of Integrated Care for the Elderly: A Scoping Review.
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VAN WIJNGAARDEN, M. T.(MARIËLLE), VAN ASSELT, D. Z. B. (DIENEKE), GROL, S. M.(SIETSKE), SCHERPBIER-DE HAAN, N. D.(NYNKE), and FLUIT, C. R. M. G.(LIA)
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ONLINE information services ,PSYCHOLOGY information storage & retrieval systems ,MEDICAL information storage & retrieval systems ,INTERDISCIPLINARY research ,SYSTEMATIC reviews ,RESEARCH methodology ,UNDERGRADUATES ,TREATMENT effectiveness ,CONCEPTUAL structures ,RESEARCH funding ,INTEGRATED health care delivery ,LITERATURE reviews ,THEMATIC analysis ,MEDLINE ,INTERDISCIPLINARY education ,CONTENT analysis ,MEDICAL education ,ERIC (Information retrieval system) - Abstract
Introduction: The ageing society requires physicians who can deliver integrated care, but it is unclear how they should be prepared for doing so. This scoping review aims to create an overview of educational programmes that prepare (future) physicians to deliver integrated care while addressing components and outcomes of the interventions. Method: We included papers from five databases that contained: (1) integrated care (2) education programme (3) medical students (4) elderly, or synonyms. We divided the WHO definition of integrated care into ten components for the concept of ‘integrated care’. Data were collected with a charting template, and template analysis was used to formulate themes. Results: We found 17 educational programmes in different learning settings. All programmes addressed several components of the WHO definition. The programmes primarily focused on care for individual patients (micro-level), and the outcomes suggested that experiencing the complexity of care is key. Conclusion: This review revealed the limited evidence on educational programmes about integrated care for the elderly. Our findings suggest that educational programmes on integrated care should not be limited to the micro-level, and that students should obtain adaptive expertise by experiencing complexity. Future research should contain an explicit description and definition of integrated care. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Integrated Health and Social Care in the United States: A Decade of Policy Progress
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Rushina Cholera, Sahil Sandhu, Anu Sharma, and Janet Prvu Bettger
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Economic growth ,Medicine (General) ,Health (social science) ,Sociology and Political Science ,business.industry ,Policy Paper ,Medicaid ,Health Policy ,health care reform ,Social Welfare ,Population health ,Integrated care ,integrated care ,health policy ,social determinants of health ,R5-920 ,Health care ,Business ,Health care reform ,Social determinants of health ,Health policy - Abstract
Introduction Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. Policy practice This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. Discussion and conclusion National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors.
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- 2022
6. Link Workers in Social Prescribing for Young People Work: A Case Study From Sheffield Futures.
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FARINA, ISABEL, BERTOTTI, MARCELLO, MASELLA, CRISTINA, and SANGIORGI, DANIELA
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RISK assessment ,POLICY sciences ,OCCUPATIONAL roles ,MENTAL health ,PRIMARY health care ,INTERVIEWING ,DESCRIPTIVE statistics ,ATTITUDES of medical personnel ,RESEARCH methodology ,COMMUNITY health workers ,PUBLIC welfare ,CASE studies ,MEDICAL needs assessment ,PSYCHOSOCIAL factors ,SOCIAL participation ,WELL-being - Abstract
Introduction: Social Prescribing has an established recognition regarding the benefits provided to the health-related social needs of adults, but little is known about how the intervention addresses young people's needs. There is optimism regarding the central role of two core mechanisms that allows social prescribing to be effective, such as the empathetic role of Link Workers and the connection with community resources. This paper aims to describe the role played by Link Workers working a Social Prescribing intervention targeting young people. Description: This paper adopts a case study methodology to describe the role of Link Workers addressing young people's needs and implementing Social Prescribing scheme in Sheffield (UK). Data were collected through semi-structured interviews with four of the seven link workers of one organisation based in Sheffield. Data were analysed through an inductive approach for emerging themes. Discussion: We provided a description of the profiles and background of Link Workers and described the three models of referral pathways into the intervention. The paper also shows how Link Workers identify young people's needs and how they connect with the community. Conclusion: Based on the insights and the internationally accepted definition of Social Prescribing, we provide a visual representation of the Social Prescribing model and discuss challenges. The paper highlights lessons learned and future directions regarding the role of Link Workers from the case study. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec
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Paul Wankah, Maxime Guillette, Yves Couturier, and Louise Belzile
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Government ,Medicine (General) ,Health (social science) ,Sociology and Political Science ,Healthcare policies ,Policy Paper ,Health Policy ,media_common.quotation_subject ,Change management ,Context (language use) ,Social Welfare ,bureaucracy ,Public administration ,healthcare reforms ,Modernization theory ,Integrated care ,Appropriation ,R5-920 ,Political science ,Bureaucracy ,implementation ,media_common ,integrated care - Abstract
Introduction: Demographic and epidemiological transitions of industralized countries mean health systems have to integrate health and social services to respond to the changing needs of their populations. Efforts to integrate care involve important policy and structural changes. This paper examines whether integration efforts are lost in translation during the bureaucratic appropriation of models, or, in an allegorical way, do they reveal genes of bureaucracy? Description: Since the 1960s, the health system of Quebec has undergone four major structural and progressively integrative transformations, characterized as – modernization, shock of reality, explicit integration, and centralization phases. Discussion: Although integration efforts progressively transformed Quebec’s health and social services system, embedded bureaucracies impeded the realisation of these projects. Notably, inadequate change management strategies and lack of integrated funding models hindered integration efforts. Furthermore, there was variability in government prioritisation and support of different aspects of the model by making some components happen, helping others happen and letting others happen. Conclusion: Drawing insights from bureaucratic obstacles to integration efforts may improve implementation strategies. This paper highlights important policy and administrative challenges that have to be taken into consideration in improving the implementation of integrated care initiatives in a real-life context.
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- 2021
8. How is Integration Defined and Measured, and what Factors Drive Success in Brazil? An Integrative Review.
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NEIVA, ELAINE R., ABBAD, GARDENIA, GANDOLFO CONCEIÇÃO, MARIA INÊS, MOURA PINHO, DIANA LÚCIA, and XYRICHIS, ANDREAS
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ONLINE information services ,SYSTEMATIC reviews ,RESEARCH funding ,INTEGRATED health care delivery ,MEDLINE ,SUCCESS - Abstract
Introduction: Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success. Methods: This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation. Results: 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society. Conclusion: Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts. [ABSTRACT FROM AUTHOR]
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- 2023
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9. Critical Success Factors for Intersectoral Collaboration: Homelessness and COVID-19 – Case Studies and Learnings from an Australian City.
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Macfarlane, Stephanie, Haigh, Fiona, Woodland, Lisa, Goodger, Brendan, Larkin, Matthew, Miller, Erin, Parcsi, Lisa, Read, Phillip, and Wood, Lisa
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SOCIAL service associations ,WORLD Wide Web ,INTERPROFESSIONAL relations ,QUALITATIVE research ,DESCRIPTIVE statistics ,THEMATIC analysis ,ADULT education workshops ,TRUST ,HEALTH facilities ,HOMELESSNESS ,MEDICAL needs assessment ,CASE studies ,COMPARATIVE studies ,COVID-19 pandemic - Abstract
Introduction: The COVID-19 pandemic disproportionally impacted people experiencing homelessness, including people sleeping rough, people in temporary accommodation and those living in boarding houses. This paper reports on intersectoral responses across six health and social care agencies in Inner Sydney, New South Wales, Australia. Prior to the pandemic the six agencies had established an Intersectoral Homelessness Health Strategy (IHHS), in recognition of the need for intersectoral collaboration to address the complex health needs of people experiencing homelessness. Description: The governance structure of the IHHS provided a platform for several innovative intersectoral responses to the pandemic. A realist informed framework was used to select, describe, and analyse case studies of intersectoral collaboration. Discussion: The resultant six critical success factors (trust, shared ways of working, agile collaboration, communication mechanisms, authorising environment, and sustained momentum), align with the existing literature that explores effective intersectoral collaboration in complex health or social care settings. This paper goes further by describing intersectoral collaboration 'in action', setting a strong foundation for future collaborative initiatives. Conclusion: While there is no single right approach to undertaking intersectoral collaboration, which is highly context specific, the six critical success factors identified could be applied to other health issues where dynamic collaboration and integration of healthcare is needed. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces
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Shannon Berg, Nelly D. Oelke, Alexandra Lukey, Mylaine Breton, Stephanie Montesanti, Paul Wankah, Lee A. Green, Sara Mallinson, Caille Pritchard, Catherine Donnelly, Sharon Johnston, Isabelle Gaboury, Simone Parniak, and Karin Maiwald
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Medicine (General) ,Health (social science) ,Knowledge management ,Sociology and Political Science ,business.industry ,Policy Paper ,Health Policy ,Primary health care ,Integration ,Policy analysis ,Primary care ,Team-based care ,Financial management ,Integrated health services ,Health services ,R5-920 ,Interprofessional teams ,Primary healthcare ,Information system ,System integration ,Performance measurement ,business ,Pace - Abstract
Introduction: Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care. In Canada, there has been variation in both the timing/pace of adoption and approach to interprofessional PHC (IPHC) policy. Provinces are at different stages in the development, implementation, and evaluation of team-based PHC models. This paper describes how different policies, contexts, and innovations across four Canadian provinces (British Columbia, Alberta, Ontario, Quebec) facilitate or limit integrated health services through IPHC teams. Methods: Systematic searches identified 100 policy documents across the four provinces. Analysis was informed by Walt and Gilson’s Policy Triangle (2008) and Suter et al.’s (2009) health system integration principles. Provincial policy case studies were constructed and used to complete a cross-case comparison. Results: Each province implemented variations of an IPHC based model. Five key components were found that influenced IPHC and integrated health services: patient-centred care; team structures; information systems; financial management; and performance measurement. Conclusion: Heterogeneity of the implementation of PHC teams across Canadian provinces provides an opportunity to learn and improve interprofessional care and integrated health services across jurisdictions.
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- 2021
11. Exploring the evidence base for the benefits of generalism to patients, professionals, and the health system in modern healthcare.
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Smith, Sophie
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INTERDISCIPLINARY research ,EVALUATION of human services programs ,EVIDENCE-based medicine ,CONFERENCES & conventions ,INTERDISCIPLINARY education - Abstract
Introduction: There are many challenges we must adapt to in healthcare - health inequalities, environmental concern, ageing populations and multimorbidity to name a few. The English health system has responded by restructuring into Integrated Care Systems1. These are collaborative, place-based partnerships tackling health inequalities and improving care coordination. Additional skills are likely needed for professionals to thrive in and potentiate the promise of ICSs for patients. One key component identified in the Future Doctor Report2, was cultivating generalism. This led to the inception of the Enhance programme for generalism3 - a developing multiprofessional educational offer in England. Aim and Method: Any change is best supported by academically rigorous evidence. Some published evidence was anticipated, as the generalism concept has existed for centuries and some professionals practice in this way today. Three literature searches were commissioned from the Health Education England library service around the evidence for generalism. This presentation will focus on "what are the benefits of generalism to patients, the healthcare system and healthcare professionals". A second search was performed by a HEE fellow. All included papers were critically analysed. Results: 32 papers were identified by the library service. No further papers were included from the second search due to their age (approx. 30 years). All were written in English, 19 from the UK and 13 from across Europe, Asia and Africa, published between 2017-2020. Papers were methodologically diverse, predominantly qualitative, reviews, opinion pieces or project evaluations. Common themes included doctor preparedness, CPD and skills learning. Two papers each, respectively, explored professional and patient satisfaction. A subset of 8 papers felt to be of most relevance to the question were then analysed. Article types were similar to the above, originating from the UK, Thailand or Norway. Four common themes were identified: QI; CPD; preparedness and professional satisfaction. Only one examined patient satisfaction. Interestingly, this paper's findings aligned closely with the principles and aims of the Enhance programme and ICSs - person-centred, well-coordinated care, understanding realworld causes of ill health4. Conclusion: Although there are some proponent opinion pieces and indirect evidence, no papers have been identified that examine this question directly. There is a distinct lack of robust academic exploration of the actual (as opposed to posited potential) benefits to patients, professionals other than doctors and system-wide impacts from generalism. Implications: This work highlights several new and exciting areas for future research - likely to be interdisciplinary. How best to research applying a generalist approach for its benefits to stakeholders in terms of the Institute of Medicine's 6 domains of quality may be a future key question to consider. [ABSTRACT FROM AUTHOR]
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- 2022
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12. Integrated Care’s New Protagonist: The Expanding Role of Digital Health
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Carolyn Steele Gray
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system transformation ,Window of opportunity ,Medicine (General) ,Health (social science) ,Sociology and Political Science ,business.industry ,Health Policy ,Perspective (graphical) ,digital health ,Public relations ,Digital health ,implementation ,integrated care ,Health equity ,Market fragmentation ,Integrated care ,R5-920 ,Perspective Paper ,Normative ,business ,Set (psychology) - Abstract
Digital health technologies hold significant promise to advance both functional and normative health and social care integration. The COVID-19 pandemic has created a window of opportunity to rapidly advance the adoption of digital solutions which can improve activities that support integration at clinical, professional, organizational and system levels. Global examples demonstrate how the pandemic has also created opportunities to use technology to address core values of integrated care like person-centredness and coordination. However, rapid and reactive changes could lead to increased fragmentation and exacerbate health inequity. This perspective paper outlines some of the opportunities and threats to advancing integrated care presented by the rapid adoption of digital health tools, suggesting we maintain a long view to ensure the stage we set today will mean greater integration tomorrow.
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- 2021
13. Integrated People-Centred Care in Canada – Policies, Standards, and Implementation Tools to Improve Outcomes
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Patricia Sullivan-Taylor, Esther Suter, Samantha Laxton, Nelly D. Oelke, and Emma Park
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Health (social science) ,Sociology and Political Science ,Policy Paper ,health systems integration ,Health Policy ,standards ,co-design ,integrated care ,people-centred ,policy - Abstract
Introduction: Despite the national and international policy commitment to implement integrated health systems, there is an absence of national standards that support evidence-based design, implementation, and monitoring for improvement. Health Standards Organization (HSO)’s CAN/HSO 76000:2021 – Integrated People-Centred Health Systems (IPCHS) National Standard of Canada (NSC) has been developed to help close this gap. This manuscript outlines the policy context and the process taken to develop the IPCHS standard. Description: The IPCHS standard is built around 10 design principles with detailed, action-oriented criteria and guidance for policy makers and health system partners. The IPCHS standard was co-designed with a technical committee that included balanced representation of policy makers, health system decision-makers, Indigenous leaders, providers, patients, caregivers, and academics. Additional feedback was received from a diverse audience during two public review periods and targeted consultation via interviews. This qualitative feedback, combined with the evidence reviews completed by the technical committee, informed the final content of the IPCHS standard. Discussion: The IPCHS standard was developed through a co-design process and complements existing frameworks by providing 66 detailed, action-oriented criteria, with specific guidance. The co-design process and consultations resulted in increased awareness and capacity among policy makers and health system partners. Supplementary tools are also in development to facilitate implementation and monitoring of progress and outcomes. This manuscript was developed in collaboration with technical committee members and HSO staff who led the targeted consultation and adoption of the IPCHS standard in six integrated care networks. Conclusion: Implementing integration strategies requires that we create and sustain a culture of continuous improvement and learning. Key lessons from the development process focused on the importance of co-design, embedding people-centred practices throughout the standard, formal yet iterative methodology inclusive of broad consultation, clear accountability for both policy makers and system partners, tools that support action and can be adapted to local context and level of integrated system maturity.
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- 2022
14. Conducting a Cost-Benefit Analysis of Transitional Care Programmes: The Key Challenges and Recommendations
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Ke Xin Eh, Ian Yi Han Ang, Milawaty Nurjono, and Sue-Anne Ee Shiow Toh
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Health (social science) ,Process management ,Sociology and Political Science ,Process (engineering) ,Total cost ,03 medical and health sciences ,0302 clinical medicine ,Perspective Paper ,Health care ,Transitional care ,030212 general & internal medicine ,integrated care ,lcsh:R5-920 ,Cost–benefit analysis ,transitional care ,business.industry ,cost-benefit analysis ,030503 health policy & services ,Health Policy ,post-discharge care ,mortality ,Integrated care ,Key (cryptography) ,Resource allocation ,health expenditures ,lcsh:Medicine (General) ,0305 other medical science ,business - Abstract
Transitional care encompasses a range of services designed to promote care integration as patients transfer between different locations or different levels of care. Transitional care programmes have been proven to produce positive outcomes in reducing hospital readmissions and improving patients’ health outcomes. However, little is known about the benefits of the programmes on healthcare cost and the published results have been inconsistent. With increasing healthcare expenditures and limited public healthcare resources, cost-benefit analyses become paramount in informing healthcare resource allocation decisions. This perspective paper describes the approaches used in estimating the total costs of a bundle of transitional care services from an academic medical centre, identifies the key methodological challenges encountered in the process of cost-benefit analysis, and recommends potential solutions to tackle these challenges. By providing a comprehensive perspective on the methodological challenges, this paper encourages program evaluators to take these possible challenges into consideration for future cost-benefit analyses.
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- 2020
15. Evaluation of the Impact and Implementation of Social Prescribing in Primary Healthcare Units in Lisbon: A Mixed-Methods Study Protocol
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Sónia Dias, Louíse Viecili Hoffmeister, Andreia Coelho, Cristiano Emanuel Marta Figueiredo, Mariana Nunes, Ana Gama, Mariana Filipa Fraga Oliveira, Pedro Aguiar, and Paula Massano
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Medicine (General) ,medicine.medical_specialty ,Health (social science) ,Sociology and Political Science ,Referral ,health promotion ,social prescribing ,Psychological intervention ,03 medical and health sciences ,R5-920 ,0302 clinical medicine ,Quality of life (healthcare) ,complex interventions ,Nursing ,medicine ,030212 general & internal medicine ,Social determinants of health ,Methodology Paper ,integrated care ,study protocol ,public health ,030503 health policy & services ,Health Policy ,Public health ,Focus group ,Integrated care ,Health promotion ,Public Health ,0305 other medical science ,Psychology - Abstract
Background: Social Prescribing (SP) is an intervention to link users of the primary healthcare services to non-clinical organizations based on the community to tackle social determinants of health. Despite the potential benefits of SP, the effectiveness of this complex intervention remains uncertain. This paper presents the study protocol of the evaluation of the first SP project in Portugal. Methods: A mixed-methods study will be conducted to evaluate the SP project. For the quantitative component, a longitudinal, prospective study with a pre-post design will be performed. Data on patients referred to SP will be collected in four different points in time throughout the intervention, using questionnaires on patients’ health status and sociodemographic characteristics, and scales on patients’ well-being, quality of life and activation. The secondary data will be collected using patients’ medical records and SP’s forms about the referral and social responses elaborated within the intervention. Semi-structured interviews with patients and focus groups with stakeholders will be conducted to assess experiences of participation and improvement suggestions on SP. Conclusion: Comprehensive and complementary evidence will provide insights and learning for the implementation of future SP interventions. This can contribute to inform policy and practice, and to increase investment in social prescribing interventions.
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- 2021
16. How Different Quality Paradigms Undermine a Shared Value Base for Integrated Care: The Need for Collective Reflexivity
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Everard van Kemenade, Marlou de Kuiper, Marjolijn Booij, and Mirella Minkman
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collective reflexivity ,Medicine (General) ,Health (social science) ,R5-920 ,Sociology and Political Science ,quality paradigms ,Perspective Paper ,Health Policy ,complexity ,integrated care ,Organisational development, quality management - Abstract
In the development process of integrated care many impeding factors occur. Our premise is, that many of these barriers are related to the differences in values or perspectives. This article aims to clarify what an important challenge is for the further development of integrated care and for integrated care research. Professionals and managers in integrated care need to cope with and embrace uncertainty. However, that requires collective reflexivity. Collective reflexivity is a means to investigate the values of the partners interacting to co-create integrated care and to remove the roadblocks on the way.
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- 2022
17. Co-Design for People-Centred Care Digital Solutions: A Literature Review.
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SANZ, M. FERRI, ACHA, B. VALLINA, and GARCÍA, M. FERRANDO
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HYPERTEXT literature ,LITERATURE reviews ,MEDICAL care - Abstract
Introduction: The implementation of people-centred care requires strategies that respond to local conditions and contexts, with the participation of local stakeholders in collaborative approaches such as co-design. Within this framework, the authors performed a literature review to identify the most implemented practices in health and social care services for co-designing digital solutions. Methods: The literature review was conducted following five steps: (i) Definition of the Keywords and their relations; (ii) Definition of the selection criteria; (iii) Search in PubMed; (iv) Selection of papers; and (v) Analysis of the selected papers. Results: 20 papers addressed to co-design health digital solutions with stakeholders were analysed in terms of the activities implemented and participants involved. Discussion: Previous studies using co-design methods for the deployment of health digital solutions employed a wide range of activities, most of them combining activities and/or mixed target groups. Conclusion: Co-design is the key to deliver people-centred care as it allows to involve stakeholders in the development of health digital solutions. Implementing one or more of the co-design methods identified in this literature review should be considered to better address the needs and specific projects and target groups. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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18. Integrated Care in Aotearoa New Zealand 2008–2020
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Lesley Middleton, Jacqueline Cumming, Tim Tenbensel, and Pushkar Raj Silwal
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Medicine (General) ,Health (social science) ,Equity (economics) ,Sociology and Political Science ,Policy Paper ,Health Policy ,Chronic care management ,Public administration ,Aotearoa ,Indigenous ,Integrated care ,primary health care ,equity ,R5-920 ,Incentive ,Sovereignty ,Political science ,National Policy ,integrated care ,New Zealand ,Health Services Research ,new zealand - Abstract
Introduction: Ten years ago, progress towards integrated care in Aotearoa New Zealand was characterised as slow. Since then, there has been a patchwork of practices occurring under the broad umbrella of integrated care. These include: collective planning approaches (i.e., alliancing), agreed pathways of care, chronic care management initiatives, shared patient information systems, co-located centres and indigenous models of holistic care (e.g., Whānau Ora). Description: Although integrated care is often mentioned in national policy documents, implementation has been left to regional and local decision making, and very few initiatives have spread beyond their initial locations. Discussion: System incentives that preserve organisational “sovereignty” and path-dependent funding have slowed progress towards more integrated care in some areas. There is some evidence about specific initiatives and their impact, but it is difficult to discern significant trends and commonalities around the country. Conclusion: In the last ten years, the broad range of initiatives designed to achieve integrated care has absorbed regional and local attention and produced some evidence of progress, but the national picture of change is mixed.
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- 2021
19. Non-Pharmacological Integrated Interventions for Adults Targeting Type 2 Diabetes and Mental Health Comorbidity: A Mixed- Methods Systematic Review.
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TUUDAH, ELIZABETH, FOYE, UNA, DONETTO, SARA, and SIMPSON, ALAN
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TYPE 2 diabetes ,MEDICAL personnel ,ADULTS ,MENTAL health ,EARLY death - Abstract
Objective: Adults living with Type 2 diabetes (T2D) and severe mental illness (SMI) disproportionally experience premature mortality and health inequality. Despite this, there is a limited evidence-base and evaluation of non-pharmacological integrated interventions that may contribute to improved patient experience and outcomes. To improve our understanding of how to optimise integrated care for this group, this review evaluates the effectiveness, acceptability, and feasibility of non-pharmacological integrated interventions for adults with SMI and T2D. Methods: Studies from nine electronic databases were searched. Of the 6750 papers retrieved, seven papers (five quantitative and two qualitative) met the inclusion/exclusion criteria. A convergent integrated approach was used to narratively synthesise data into four main themes: effectiveness, acceptability, feasibility, integrated care. Results: There is moderate evidence to suggest non-pharmacological integrated interventions may be effective in improving some diabetes-related and psychosocial outcomes. Person-centred integrated interventions that are delivered collaboratively by trained facilitators who exemplify principles of integrated care may be effective in reducing the health-treatment gap. Conclusions: Recommendations from this review can provide guidance to healthcare professionals, commissioners, and researchers to inform improvements to nonpharmacological integrated interventions that are evidence-based, theoretically driven, and informed by patient and healthcare professionals' experiences of care. [ABSTRACT FROM AUTHOR]
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- 2022
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20. Reimagining Day Rehabilitation For Frailty and Neurodegenerative Conditions through the integrated Rehabilitation and EnAblement Program (iREAP).
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Maiden, Genevieve, Kingsford, Annabel, Wang, Audrey P., Tran-Nam, Anh R., and Nelson, Julia
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HOLISTIC medicine ,SELF-evaluation ,SELF-management (Psychology) ,DATA analysis ,T-test (Statistics) ,RESEARCH funding ,FRAIL elderly ,SCIENTIFIC observation ,QUESTIONNAIRES ,NEURODEGENERATION ,TREATMENT effectiveness ,DESCRIPTIVE statistics ,GERIATRIC rehabilitation ,QUALITY of life ,STATISTICS ,MEDICAL care for older people ,NEEDS assessment ,COMPARATIVE studies ,DATA analysis software ,INTEGRATED health care delivery ,PHYSICAL activity ,HEALTH care teams ,ACCIDENTAL falls ,NONPARAMETRIC statistics ,OLD age - Abstract
Background: integrated Rehabilitation and EnAblement Program (iREAP) is an innovative redesign of the traditional day rehabilitation model, providing an anticipatory, early assessment and intervention program that manages care of community-dwelling older people with complex needs. It coordinates access to disciplines across medical, allied health and nursing, with a self-management focus, partnering with primary health in an integrated approach. Objective: This observational study reviews the effectiveness of iREAP on frailty, patient activation, quality of life and physical outcome measures on older people at risk of, or experiencing falls and frailty, or with neurodegenerative conditions, including Parkinson's Disease. Methods: 99 participants completed the eight-week multidisciplinary program. Patient outcome measures included Rockwood Clinical Frailty Scale, quality of life measures, Patient Activation Measure, Timed Up and Go, 6 Minute Walk Test and Berg Balance Scale. Results: On completion of iREAP, participants displayed improvements in their Rockwood Clinical Frailty Scores (mildly frail to vulnerable), 'patient activation' (55.08 to 60.61), quality of life (Parkinson's Disease Questionnaire-39, 49.93 to 47.16; WHO Quality of Life – Bref physical domain, 21 to 22.7) and physical measures including balance (44 to 49/56 Berg Balance scale) and mobility (294 m to 336 m, 6-minute walk test). Falls were not reduced at twelve months post-program (3.40 to 2.01). Conclusion: iREAP is an interdisciplinary, early assessment and intervention program with the potential to reverse frailty and improve quality of life for complex older patients. This paper offers a platform for future research, given the paucity of evidence reviewing the efficacy of integrated anticipatory models of care in older adults with complex needs. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Effectiveness of Integrated Care for Diabetes Mellitus Type 2, Cardiovascular and Chronic Respiratory Diseases: A Systematic Review and Meta-Analysis.
- Author
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Valentijn, Pim P., Tymchenko, Liza, Gruisen, Wiro, Bruls, Bem, Abdalla Pereira, Fernando, and Arends, Rosa Y.
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MORTALITY prevention ,CARDIOVASCULAR disease treatment ,TREATMENT of respiratory diseases ,CARDIOVASCULAR disease related mortality ,CHRONIC disease treatment ,RESEARCH funding ,CARDIOVASCULAR diseases ,SELF-management (Psychology) ,MENTAL health ,MAJOR adverse cardiovascular events ,TREATMENT effectiveness ,META-analysis ,FUNCTIONAL status ,CAUSES of death ,DESCRIPTIVE statistics ,SYSTEMATIC reviews ,MEDLINE ,TYPE 2 diabetes ,CONCEPTUAL structures ,QUALITY of life ,BLOOD pressure ,ONLINE information services ,CONFIDENCE intervals ,DATA analysis software ,INTEGRATED health care delivery ,DISEASE complications - Abstract
Introduction: In this paper, we use the Rainbow Model of Integrated Care (RMIC) framework to evaluate the effectiveness of integrated care in terms of enhancing the outcomes of chronic conditions such as diabetes mellitus type 2 (DMT2), cardiovascular diseases (CVD), chronic respiratory diseases (CRD), or their combinations. Methods: The data extracted from randomized controlled trials (RCT) of integrated care interventions for DMT2, CVD, and CRD (follow-up ≥ 3 months) in 11 databases were analysed using random-effects meta-analysis. Results: A total of 54 eligible studies covering 12,976 participants, with a mean follow-up of 54 weeks, were included. In moderate-quality evidence, integrated care interventions reduced mortality for CVD, adverse events for CVD and DMT2, and improved quality of life for CVD and DMT2, physical and mental functioning, self-management, and blood pressure control. Conclusion: Integrated care can reduce all-cause mortality, adverse events, and improve quality of life, physical and mental functioning, self-management and blood pressure control in chronic disease patients. However, available evidence for some outcomes (e.g., all-cause hospital admissions) remains uncertain. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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22. Scaling-Out Digitally Enabled Integrated Care in Europe Through Good Practices Transfer: The JADECARE Study.
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Fullaondo, Ane, Hamu, Yhasmine, Txarramendieta, Jon, and de Manuel, Esteban
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DIGITAL technology ,DIFFUSION of innovations ,LONG-term health care ,HEALTH policy ,CONCEPTUAL structures ,INDIVIDUALIZED medicine ,HEALTH promotion ,INTEGRATED health care delivery ,MEDICAL practice ,MEDICAL care costs - Abstract
Introduction: The absence of a coordinated approach to health and social care compromises the ability of health systems to provide universal, equitable, high-quality, and financially sustainable care. Transferring evidence-based practices focused on digitally-enabled integrated care to new contexts can overcome this challenge if implementation is satisfactory. This paper presents the scaling-out methodology that JADECARE has designed to spread effective innovative practices across Europe. Methodology: The scaling-out methodology pretends to guide the Next Adopters in the transfer and adoption of practices, whereas increasing their implementation capacity and providing an evaluation framework to assess impact and success. Discussion: JADECARE scaling-out effort is based on guiding principles found in the literature such as the balance between fidelity to the original practice and the degree of adaptation required to fit the new context, the need for capacity building in implementation to bridge the gap between research and routine practice and the focus on explaining why, for whom and in what circumstances an intervention works. Conclusion: The JADECARE scaling-out methodology is theory-driven and pragmatic and aims to facilitate the transfer of complex interventions across different contexts. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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23. Integrated Care in Switzerland: Strengths and Weaknesses of a Federal System
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Peter Berchtold, Séverine Schusselé Filliettaz, Ursula Koch, and Isabelle Peytremann-Bridevaux
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switzerland ,Medicine (General) ,Health (social science) ,Sociology and Political Science ,healthcare systems ,health policies ,Policy Paper ,Health Policy ,media_common.quotation_subject ,integrated delivery systems ,political systems ,Public administration ,Democracy ,MeSH ,Switzerland ,Integrated care ,R5-920 ,mesh ,Health insurance ,Life expectancy ,Federalism ,Business ,Strengths and weaknesses ,Healthcare system ,media_common - Abstract
Introduction: Switzerland’s fragmented healthcare system mirrors its federal structure and mix of cultures and languages. Although the Swiss have a higher life expectancy than most of their neighbours, their healthcare system faces similar challenges that call for more integrated care (IC). Aim/Method: This article aims to provide insight into the specificities of and latest developments in Switzerland’s healthcare system and how they may have influenced the development and implementation of IC there. Description/Discussion: The number of local IC initiatives has been growing steadily for 20 years. With a certain lag, various policies supporting IC have been established. Among them, a recent democratic debate on the federal mandatory health insurance law could either induce a radical move towards centralised support for IC or continue to support scattered local IC initiatives. Conclusion: In the future, Switzerland’s healthcare system will probably navigate between local IC initiatives and centralised, federal support for IC initiatives. This will be the reflection of a very Swiss way forward in a world without clear evidence on whether centralised or decentralised initiatives are more successful at developing IC.
- Published
- 2021
24. Integrated Health and Social Care in England: Ten Years On
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Jon Glasby, Robin Miller, and Helen Dickinson
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leadership ,Medicine (General) ,Economic growth ,Health (social science) ,Sociology and Political Science ,Inequality ,Policy Paper ,Health Policy ,media_common.quotation_subject ,Investment (macroeconomics) ,partnership working ,Integrated care ,Competition (economics) ,R5-920 ,Work (electrical) ,General partnership ,Political science ,Workforce ,Social care ,england ,England ,policy ,integrated care ,media_common - Abstract
Introduction: As part of major policy reforms begun in 2010, England introduced a wave of initiatives to encourage more integrated care between health and social care. These built on previous attempts which sought to achieve similar objectives through a focus on better partnership working. This article provides an overview and critical commentary on integrated care policy in England from 2010–2020 based on reviews by regulators, parliamentary committees and the national audit office. Overview of Policy: Integrated care became a priority through the work of the Future Forum, a group of leading stakeholders established due to concerns about greater competition in public health care. This led to a public statement of shared commitment to integrated care by national health and social care bodies. Early mechanisms included a pooled fund to achieve nationally set objectives, the creation of local authority led partnership boards, and high profile innovation programmes. Later in the 2010’s, new health led partnerships became more dominant vehicles to achieve integrated care at regional level. Impact of Policy: Despite progress within a few local areas, and reduction in delayed discharges from hospital the overall picture from national reviews was that expected improvements were not achieved. Emergency admissions to hospital continued to grow, patients within primary care reported being less involved in their care, and health inequalities worsened. The initial response to COVID-19 was health-centric contributing to outbreaks in care homes and inadequate supplies of protective personal equipment. The ability of leaders to look beyond their organisations’ interests was reported as vital for local progress. National government performance frameworks discouraged system based working and chronic underfunding of social care led to major capacity and workforce challenges. Conclusion: The experience of England suggests that greatest progress is made when integrated care focusses on tangible issues and when there is a clear understanding of how success will be measured. Even with considerable investment and intent progress should be expected to be slow and difficult. Layering of numerous policy initiatives provides confusion and can distract from the important work of relationship building. And ultimately, integrated care cannot by itself address major inadequacies in the underlying resources and structural inequalities.
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- 2021
25. Integrated care: meaning, logic, applications, and implications - a discussion paper.
- Published
- 2002
26. Service Delivery Reforms for Asian Ageing Societies: A Cross-Country Study Between Japan, South Korea, China, Thailand, Indonesia, and the Philippines
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Emiko Tateishi, Wahyu Sulistya Affarah, Kenzo Takahashi, Paul Michael R. Hernandez, Shinichiro Noda, Hamsu Kadriyan, Kimiko Inaoka, Jun Kobayashi, He Chen, Nam Eun Woo, and Kyoko Sudo
- Subjects
Economic growth ,Medicine (General) ,Health (social science) ,Sociology and Political Science ,Service delivery framework ,Policy Paper ,service delivery reforms ,media_common.quotation_subject ,Public Health, Health policy ,03 medical and health sciences ,0302 clinical medicine ,R5-920 ,Political science ,Health care ,030212 general & internal medicine ,China ,media_common ,integrated care ,healthcare service delivery ,ageing societies ,Service system ,Cross country ,business.industry ,030503 health policy & services ,Health Policy ,Investment (macroeconomics) ,Integrated care ,0305 other medical science ,business ,Welfare - Abstract
Introduction: Japan’s health policies to address the most advanced-aged society have been the target of focus in Asia, but no studies have investigated this issue using tools for cross-country comparisons. Theory and methods: A cross-country study design was used to compare healthcare reform policies with a framework in Japan, Korea, Thailand, China, Indonesia, and the Philippines. Data were collected via document reviews and key informant interviews. Results: Three distinctions were identified. First, all countries except for the Philippines have policy decisions regarding reforms for the existing service delivery systems for healthcare, long-term care and welfare. Second, the most extensive service delivery reform is currently being implemented in Japan, whose system is shifting to primary health care. Third, the direction of the transformation of service delivery system is different between Thailand and China despite a similar level of ageing society. China has made progress on facility-based care integration between health and social care, whereas Thailand is focusing on home-based care. Conclusions and discussion: Doctor and hospital-based healthcare delivery system requires more drastic reform for an aged society. This fact implies that strengthening primary health care is not only useful for current health issues but also an investment for the aged society near future in low- and middle-income countries.
- Published
- 2021
27. Health Innovation Manchester as AHSS -- the Test of a Hypothesis.
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RIGBY, JOHN, CHUKWUKELU, GODWIN, PINEDA MENDOZA, JOSE, and YEOW, JILLIAN
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MEDICAL care ,INTEGRATIVE medicine ,SOCIAL innovation ,MEDICAL innovations - Abstract
The ambitious and wide-ranging paper on Academic Health Science Systems ['AHSS'] [1] proposed a new model for health innovation and stimulated considerable interest. The paper made three main assumptions about AHSS: i) university-based centres should play linchpin roles in health and social care innovation; ii) medical innovation cannot be achieved without links to industry; iii) innovation occurs at the scientific end of a discovery-care continuum. But the paper had a pregnant coda for the NHS, and GM devolution in particular: the authors explicitly linked their view of the need for the integration of university-based research and health care delivery to population level approaches, suggesting that vertically integrated AHSSs should ultimately transform into integrated care organisations. When Manchester's experiment in the devolution of health and social care as a place-based approach to health and social care began in 2015, Health Innovation Manchester was created as an AHSS to support innovation in the Partnership. Five years after the start of devolution, this short paper, which is based on a longer study of Health Innovation Manchester's development [2], provides an overdue reflection on the proposition advanced just over a decade ago [1]. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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28. Integrating Community Care for the Prevention and Treatment of Diabetes.
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Fuse, Katsuya, Kamimura, Norihito, Iguchi, Seitaro, Kato, Kiminori, and Takahashi, Hideaki E.
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DIAGNOSIS of diabetes ,TREATMENT of diabetes ,DIABETES prevention ,COMMUNITY health services ,PATIENT education ,COMMUNITY support ,CURRICULUM ,GLYCOSYLATED hemoglobin ,INTERPROFESSIONAL relations ,GLYCEMIC control ,DIABETIC nephropathies ,MEDICAL students ,ORGANIZATIONAL change ,SOCIAL support ,HEALTH promotion ,MEDICAL screening ,INTEGRATED health care delivery ,DIABETES ,PATIENT participation ,MEDICAL ethics - Abstract
Introduction: This paper describes 'Project 8', a campaign that aims to reduce glycated haemoglobin (HbA1c) to 8% or more among patients with diabetes mellitus, utilising healthcare professionals and local community residents and focusing on education and support. The study is based in Uonuma—a small rural city in Japan with a declining population and an increased number of older people. Description: 'Project 8' began in Uonuma's Koide Hospital in 2008. The Uonuma School for Community Health and Social Care was established in 2011 with the cooperation of a clinic's general practitioner. Medical students, trainees, doctors, and health care professionals have been holding 'open schools' (daytime lectures) and 'night schools' (evening lectures) to educate the community residents about various health issues. Through repeated lectures, the residents have been made aware of lifestyle-related diseases, including diabetes, and the meaning of 'Project 8'. Discussion: Over the last decade, the hospital's campaign has expanded within the community, showing a statistically significant reduction of diabetic patients with HbA1c ≥ 8%, which successfully deferred the start of dialysis for many of them. Conclusion: Well-integrated community care requires interprofessional education, collaborative practice, and the participation of community residents in health education. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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29. Communities of Care Approach: Developing a Place-based Model of Care and Building Partnerships in the Communities in Central Singapore.
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CHEN, Wei TING, LIM, Sing YONG, How, Shermaine, TAN, Woan SHIN, and Leong, Ian Yi Onn
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ELDER care ,COMMUNITY health services ,HEALTH services accessibility ,INTERPROFESSIONAL relations ,HUMAN services programs ,OCCUPATIONAL roles ,DISEASE management ,DECISION making ,CHRONIC diseases ,WORKFLOW ,MATHEMATICAL models ,THEORY ,TERMINAL care ,MEDICAL needs assessment ,NEEDS assessment ,INTEGRATED health care delivery ,MANAGEMENT - Abstract
The population in Singapore is ageing, adding pressure to community care as the health and social needs of its residents increase. This has accelerated the pace at which Regional Health Systems adopt and deliver its population health strategies from early prevention, chronic disease management, crisis care to end-of-life care. To this end, the Central Health Integrated Care Network (ICN) began its journey to develop Communities of Care (CoCs) with other health and social care partners to meet the needs of residents in the Central Zone of Singapore. This paper describes the processes and steps taken by Central Health ICN to build partnerships with other agencies and organisations to build place-based models of care in the local neighbourhoods. The faciliating factors and the barriers faced in the implementation of CoCs were described to allow sharing of such learnings on large scale change. Strategies in overcoming some of the challenges were also presented to demonstrate the iterative processes required in building integrated place-based models of care to meet the needs of the residents in different communities. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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30. Towards Integrated Care for the Elderly: Exploring the Acceptability of Telemonitoring for Hypertension and Type 2 Diabetes Management.
- Author
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Mihevc, Matic, Lukančič, Majda Mori, Črt, Zavrnik, Potočnik, Tina Virtič, Šter, Marija Petek, Klemenc-Ketiš, Zalika, and Susič, Antonija Poplas
- Subjects
HEALTH self-care ,RESEARCH funding ,MEDICAL technology ,HYPERTENSION ,INTERVIEWING ,PRIMARY health care ,PSYCHOLOGICAL adaptation ,TELEMEDICINE ,TYPE 2 diabetes ,RESEARCH methodology ,CONCEPTUAL structures ,AMBULATORY blood pressure monitoring ,PATIENT monitoring ,HEALTH education ,HEALTH promotion ,INTEGRATED health care delivery ,PATIENTS' attitudes ,MEDICAL care costs ,OLD age - Abstract
Introduction: Telemonitoring has been proposed as an effective method to support integrated care for older people with hypertension and type 2 diabetes. This paper examines acceptability of telemontioring, its role in supporting integrated care, and identifies scale-up barriers. Methods: A concurrent triangulation mixed-methods study, including in-depth interviews (n = 29) and quantitative acceptability tool (n = 55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Interviews were analysed using template content analysis (TCA). Results: TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Discussion: Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. However, there were barriers that may limit its further scale-up. Conclusion: For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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31. Clinicians' Experiences and Perspectives about a New Lung Cancer Referral Pathway in a Regional Health Service.
- Author
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Otty, Zulfiquer, Larkins, Sarah, Evans, Rebecca, Brown, Amy, and Sabesan, Sabe
- Subjects
QUALITATIVE research ,GENERAL practitioners ,INTERVIEWING ,WORK experience (Employment) ,PHYSICIANS' attitudes ,TERTIARY care ,PSYCHOLOGICAL adaptation ,THEMATIC analysis ,SOUND recordings ,LUNG tumors ,RURAL conditions ,RESEARCH methodology ,COMMUNICATION ,ONCOLOGISTS ,PSYCHOSOCIAL factors ,MEDICAL referrals - Abstract
Introduction: Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. Methods: This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Results: Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Discussion: Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Conclusion: Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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32. Use of patient involvement to improve/design healthcare strategies
- Author
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Estíbaliz Cristóbal Domínguez, Nerea Gutierrez Bartolomé, Inma Laburu Montalbán, Coro Ruiz Villagarcia, Idoia Beistegui Alejandre, Belen Jiménez Valero, and Jaione Sánchez Zugazua
- Subjects
patient involvement ,Medical education ,education.field_of_study ,Service (systems architecture) ,lcsh:R5-920 ,Health (social science) ,Sociology and Political Science ,business.industry ,Health Policy ,Population ,Stakeholder ,strategy improvement ,mirror-meeting ,Timeline ,strategy design ,patient group ,Focus group ,White paper ,Documentation ,Health care ,business ,education ,Psychology ,lcsh:Medicine (General) - Abstract
Introduction: change towards patients/citizens who have more information, are educated and active regarding their health process is an important part of the evolution that all health systems need to integrate in all aspects of their activities, management and design. In Europe, the White Paper reiterates the importance of participation in any individual or collective health process whether in local or regional contexts. In our country, the Basic Law on Patient Autonomy Regulation and Rights and Obligations Regarding Clinical information and Documentation recognizes the patients ‘capacity to choose and influence the organisations that represent them. The active participation of patients represents a new way of understanding therapeutic relationships, one that is respectful of patients‘ rights and potentially beneficial for the therapeutic process. The main objective of this project is to promote patient involvement in order to help improve/design healthcare strategies; to achieve this goal, we will be implementing a patient group dynamic that is currently used in the Dutch health system. Short description: this project comprises the setting up of patient focus groups (named “mirror meetings" in The Netherlands) where patients’ contacts with the health system will be discussed so health professionals can learn and improve from the experiences of these patients. This dynamic allows patients/citizens that have been in contact with health services/units/procedures… (COPD, surgical or Hospital at Homepatients…) to communicate their experiences, satisfaction, positive outcomes, to improve aspects… It´s a patient focus group attended also by professionals so they can learn from patients ‘ opinions. These steps will be followed throughout the process: first the topic of debate will be chosen. Later, patients who have been in contact with that area/service will be contacted and consent obtained if they wish to take part. The next step will be group formation and debate; information from these debates will be gathered by witnessing professionals in situ; this information will be double checked with the patients that took part. Finally, the organisation will aim to implement, whenever suitable, those suggestions that are considered viable. For evaluation purposes, the utility of these groups will be measured based on patient/professional satisfaction and implemented suggestions. Targeted population and stakeholders: citizens from whom we, as health professionals, can learn after listening to their experiences as patients. We believe that society as a whole will be our stakeholder since this is a topic that will hopefully improve health provision. Timeline: this is a project aimed to be started in October of 2018 and that will run through the first semester of 2019 Transferability: the strategies will first be tested on a couple of units/health centers and the aim is to reach the whole OSI or even the whole of the Basque Health Service- Osakidetza once the pilot study is finished and its usefulness is confirmed.
- Published
- 2019
33. Identifying Individuals for Integrated Multidisciplinary Care: Lessons from Finland.
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KOIVISTO, JUHA, TIIRINKI, HANNA, and LIUKKO, EEVA
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EVALUATION of medical care ,SOCIAL support ,HEALTH care teams ,INTERPROFESSIONAL relations ,INTEGRATED health care delivery ,SOCIAL case work - Abstract
Introduction: This paper analyses and discusses the models and tools in the Finnish health and social care system to identify the individuals who might benefit from integrated multidisciplinary care. Description: The analysis and discussion of the paper is based on a study which mapped and studied the models and tools in practice or under development for identification in the Finnish health and social care organizations. The study used electric survey and structured interviews as research methods. Discussion: There are several different established models of identification in Finland and the experiences of using them are mainly positive. However, only every third of health and social care organizations in Finland have defined a common model or tool. The identification practices and criteria vary by region, municipality and/or organization. The identification is in general unsystematic and insufficient in practice that may inhibit the individuals to access the integrated care they might benefit from. Conclusions: Models and tools are needed for founding and identifying individuals who are outside the service system, those whose client-ship has just begun, and those who already access services. The identification of individuals for integrated multidisciplinary care and the assimilation and understanding of different identification models and tools requires the development of basic and further competence in the different fields of health and social care. Multidisciplinary collaboration requires shared concepts and positive attitudes on the development of integrated professional environments, identification models and services. It is therefore also a question of shared working culture. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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34. Population Health Management Approach: Integration of Community-Based Pharmacists into Integrated Care Systems: Reflections from the U.S., Achievements in Scotland and Discussions in Germany
- Author
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Alpana Mair, Lauren F. Lyles, and Helmut Hildebrandt
- Subjects
Economic growth ,Health (social science) ,Sociology and Political Science ,Pharmacist ,Mindset ,Community Pharmacists ,Collaborative Practice Agreements ,Prescription for Excellence ,Population Health Management ,Gesundes Kinzigtal ,Polypharmacy Management ,Population health ,Pharmacy ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Perspective Paper ,Health care ,Per capita ,030212 general & internal medicine ,Social determinants of health ,0101 mathematics ,health care economics and organizations ,Polypharmacy ,lcsh:R5-920 ,business.industry ,Health Policy ,010102 general mathematics ,Integrated care ,Business ,lcsh:Medicine (General) - Abstract
The annual amount spent on healthcare per capita is higher and expected to grow in the U.S. compared to healthier level 4 countries (e.g., United Kingdom, Canada, Germany, Australia, Japan, Sweden, Netherlands), while health outcomes continue to be suboptimal [1, 2, 3]. Therefore, healthcare is slowly shifting from a fee-for-service to value-based care, which addresses social determinants of health, promotes outcome-based contracting and employs more Population Health Management (PHM) activities. The root cause for this shift has been the increase in patients’ out-of-pocket costs and the pervasiveness of poorer outcomes. PHM has been defined by many as a mindset and activities that support the Triple Aim Initiative (i.e., improving population health, experience of care, reducing costs) [4]. This article outlines the value of pharmacists on health outcomes in the U.S., Germany, and Scotland and innovative PHM approaches through pharmacist collaborative networks, polypharmacy management and pharmacists’ integration in care models [1, 5].
- Published
- 2020
35. What is Case Management? A Scoping and Mapping Review.
- Author
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Lukersmith, Sue, Millington, Michael, and Salvador-Carulla, Luis
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MEDICAL case management ,HEALTH policy ,HEALTH care industry ,SOCIAL services ,MEDICAL technology - Abstract
The description of case management in research and clinical practice is highly variable which impedes quality analysis, policy and planning. Case management makes a unique contribution towards the integration of health care, social services and other sector services and supports for people with complex health conditions. There are multiple components and variations of case management depending on the context and client population. This paper aims to scope and map case management in the literature to identify how case management is described in the literature for key complex health conditions (e.g., brain injury, diabetes, mental health, spinal cord injury). Following literature searches in multiple databases, grey literature and exclusion by health condition, community-based and adequate description, there were 661 potential papers for data extraction. Data from 79 papers (1988-2013) were analysed to the point of saturation (no new information) and mapped to the model, components and activities. The results included 22 definitions, five models, with 69 activities or tasks of case managers mapped to 17 key components (interventions). The results confirm the significant terminological variance in case management which produces role confusion, ambiguity and hinders comparability across different health conditions and contexts. There is an urgent need for an internationally agreed taxonomy for the coordination, navigation and management of care. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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36. Values and principles of person-centered integrated care: a systematic literature review (SIG meeting)
- Author
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Nick Zonneveld, Mirella Minkman, and Robin Miller
- Subjects
Medical education ,Health (social science) ,Sociology and Political Science ,Management science ,business.industry ,Health Policy ,Delphi method ,Context (language use) ,Grey literature ,Special Interest Group ,Integrated care ,values ,principles ,building blocks ,person-centered care ,integrated care ,Systematic review ,White paper ,Health care ,Psychology ,business - Abstract
Introduction: In recent years many knowledge about integrated health services has been developed. So far research has focused on operational themes and interventions on the one side, which help decision makers in practice. On the other hand, a number of studies about generic elements of person-centered and integrated care have been published, resulting in valuable conceptual models and frameworks [1-9]. A third area of research is how to measure integrated care. However, if we want to further develop the person-centered integrated approach to improve the quality of services for civilians, a better understanding of the essence of integrated care and it’s underlying values is necessary. Shared values and principles can help to concretely identify what integrated care really is about and what integrated care thinking stands for [10,11]. Therefore, IFIC and Vilans have initiated a Special Interest Group (SIG) on values and principles of integrated care. The aim of the SIG is to develop a valuable and workable set of values and principles for person-centered integrated care. Within this context, a systematic literature review on value and principles of person-centered integrated care is carried out as a starting point. We propose a session with two objectives: A SIG-meeting with exchange of experiences A presentation and discussion about the first deliverable: the systematic literature review Theory/Methods: A systematic literature review of scientific and grey literature was conducted. Two researchers independently screened the initial results by title and abstract. Differences in interpretation were resolved by consensus. Each full text paper was independently assessed by two researchers on the criteria for inclusion. In each included article, values and principles of person-centered integrated care were identified and coded independently by two researchers. The codes were discussed in the research team. 3) Preliminary results 732 records were identified through the systematic search. After removing duplicates 396 articles remained, of which 48 were assessed for eligibility after the screening of titles and abstracts. 23 articles (48%) contained values and principles of person-centered integrated care and were coded. Currently (Dec 2016) an expert panel, mostly members of IFIC and Vilans’ SIG on Values of Integrated Care, is reflecting on the search results. Additional articles suggested by experts, are being added to the database the coming months (before ICIC2017). The experts have a range of backgrounds, including health and social care, and practice and academia. Conclusion & Discussion: A large amount of literature about integrated care is available, but less about the underlying values and principles. Preliminary results show that in the selected articles values and principles are present, which partly support the set of Ferrer and Goodwin [12]. At this moment the international expert panel is reviewing the search results, more definite results can be discussed in spring nest year. Lessons learned: Only limited literature has a focus on this level of abstraction (values and principles). The perspective appears to be quite new which is interesting a SIG topic. Limitations: Because the limited amount of literature, available conceptual models were analysed to derive values and principles. The quality of this process asks for skilled researchers; to enhance quality, all articles were independently assessed by two researchers. Suggestions for future research: To further develop the set of values and principles, a multi-perspective Delphi Study will be carried out. Multiple (SIG) experts with different backgrounds (clients, caregivers, developers, researchers) will be involved. The results of the Delphi Study will also be shared in the SIG. References: 1- Boshuizen D, Engels J, Versleijen M, Vlek H, Rebel M, Driessen S. White paper: Hoe maak je een succes van persoonsgerichte zorg?Vilans: Utrecht. 2014. 2- Cash-Gibson L, Rosenmoller M. Project INTEGRATE - a common methodological approach to understand integrated health care in Europe. International Journal of Integrated Care. 2014;14(4). DOI: http://doi.org/10.5334/ijic.1980 3- Kodner D, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications a dis¬cussion paper. International Journal of Integrated care. 2002;E12:2. 4- McCormack B, McCance T. Person-centred Nursing: Theory and Practice. Oxford: Wiley Blackwell. 2002. 5- Minkman M. Developing integrated care. Towards a development model for integrated care. PhD report. Deventer: Kluwer, ISBN 9789013100266801300; 2012. 6- Schlette S, Frohlich A, Marti T. The Bellagio Model - Population-oriented Primary Care: A diagnostic grid to assess, improve and enhance primary care. Vortrag BMJ International Forum, Session B5. 2009;Berlin: 18.03.2009. 7- Valentijn P. Rainbow of Chaos. A study into the the¬ory and practice of integrated primary care. Phd report;2015. 8- Wagner E. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1(1):2-4. 9- World Health Organization. Innovative care for chronic conditions: building blocks for action: global report. Geneva: World Health Organization Library Cataloging-in-Publication Data; 2002. 10- Minkman M. Values and Principles of Integrated Care. International Journal of Integrated Care. 2016;16(1):2. DOI: http://doi.org/10.5334/ijic.2458 11- Goodwin N. Taking integrated care forward: the need for shared values. International Journal of Integrated Care. 2013;13(2). DOI: http://doi.org/10.5334/ijic.1180 12- Ferrer L, Goodwin N. What are the principles that underpin integrated care? International Journal of Integrated Care 2014; Oct–Dec; URN:NBN:NL:UI:10-1-114804. 13-World Health Organization. WHO global strategy on people-centred and integrated health services. Interim report. WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland; 2015.
- Published
- 2017
37. Inter-Disciplinary Work in the Context of Integrated Care – a Theoretical and Methodological Framework.
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LENNOX-CHHUGANI, NIAMH
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TEAMS in the workplace ,PROFESSIONS ,NEGOTIATION ,CONCEPTUAL structures ,HEALTH care teams ,INTERPROFESSIONAL relations ,PROFESSIONAL identity ,INTEGRATED health care delivery ,POWER (Social sciences) - Abstract
Inter-disciplinary team working is an essential mechanism for the delivery of integrated care. This paper summarises a narrative review of the research on the ‘work’ that teams do to develop inter-disciplinary practices, addressing the question ‘How do interdisciplinary teams ‘become’ in the context of models of integrated care?’. The narrative review identities a gap in our understanding of the active boundary work that different disciplines working together to deliver care integration engage in when creating new interdisciplinary knowledge, creating an inter-disciplinary team identity and negotiating new social and power relations. This gap is particularly significant in relation to the role played by patients and care-givers. This paper presents a way of examining inter-disciplinary working as a process of creating knowledge, identity and power relations both in terms of a theoretical lens, circuits of power, and a methodology, institutional ethnography. An explicit focus on understanding power relations within inclusive inter-disciplinary teams in care integration will contribute to our understanding of the gap between theory and implementation of care integration by focusing on the ‘work’ that teams do to create new knowledge. [ABSTRACT FROM AUTHOR]
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- 2023
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38. Aintree University Hospital NHS Foundation Trust rolls out new electronic medical records system to improve the quality of patient care.
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Pearson, Mike
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ELECTRONIC health records ,MEDICAL quality control - Abstract
Summary of speech: o In the context of the Government's QIPP agenda and Jeremy Hunt's challenge to the NHS to be paperless by 2018, scanning paper medical records has gained in popularity as Trusts seek to solve seemingly mutually exclusive challenges - remove a unsustainable paper process, improve the quality of patient care, enhance operational productivity while reducing cost. 엯 A variety of approaches have been taken to try to achieve this: 엯 Some Trusts have invested heavily creating in-house scanning bureaus; 엯 Others have digitised the whole record but paid little attention to navigation so clinicians are faced with hundreds of pages of notes in an unwieldy PDF. 엯 With 86,000 emergency admissions every year, 330,000 outpatient visits and 77,000 inpatient day cases - some 4,200 paper files moved daily - Aintree University Hospital couldn't 100% guarantee availability with clinicians complaining that finding information took too long. 엯 To address this, the Trust has implemented an electronic medical records system to provide clinicians instant access to patient information, guarantee notes availability, improve efficiency, and reduce the costs, risks and space associated with paper handling and storage. 엯 The EDMS solution cost £1.5 million, with the Trust realising annual savings of £1 million. o Professor Mike Pearson, consultant physician and the clinical lead on the project, will talk about the project - its goals, the solution deployed, what has been achieved, and how the project was successfully managed so that others - both clinicians and operational staff - can benefit from Aintree's experience. 엯 Ultimately it is not the actual software or the underlying technologies which have ensured success, but the careful application of them along with an understanding of the accompanying organisational and medical processes. This mandates a partnership between the suppliers and the Trust as all have to deliver which has been the case on this project. 엯 Outlined below is comprehensive detail which it is hoped the King's Fund will find useful as it selects speakers for the International Digital Health and Care Congress 2014 [Innovations in technology category]. Project goals: 엯 Aintree University Hospital recognised that it needed to implement a solution which offered two key things: 1. Addressed the issue of legacy patient records and all the problems associated with a paper management and delivery process; 2. Provided a platform for the future which had clinical support. 엯 All project goals have all been met which are summarised as follows: o Save money; 엯 Provide fast access to health records; 엯 Improve patient care through 100% records availability; 엯 Improve clinical effectiveness and safety; 엯 Provide multiple user access; 엯 Offer 24/7 multi-site access - even from home 엯 Be simple, dependable and secure to use; 엯 Have the support of clinicians; 엯 Be built on standards-based best-of-breed technology; 엯 Provide intelligent document searching; 엯 Provide future expandability; Solution 엯 Aintree University Hospital has stopped using paper health records in clinical practice. It has installed CCube Solutions' electronic document management software (EDMS) and custom portal to provide clinicians a digital version. Outsourced scanning services have been provided by Capita Total Document Solutions powered by Kodak production scanners and Capture Pro imaging software. 엯 To ensure system acceptance by around 3,000 health professionals who use it every day, the following was carried out: 엯 A clinical team was involved in helping define the functionality of the software which CCube Solutions has incorporated into the user interface design work. 엯 Workshops were also set up so that staff could engage with a prototype system and provide feedback to the project managers. Groundbreaking IT 1. 1st NHS Trust to successfully use forms recognition technology including OCR to automate the process of recognising pre-printed forms - which make up 95% of the paper file - when digitising records. This ensures contents are correctly indexed even if forms are incorrectly filed in the physical records. This is in contrast to other Trusts where staff manually go through the paper files prior to scanning to check and order contents. Forms recognition technology allows the system to automatically "find" forms in the scanned patient record rather than clinicians having to "search" for them. 2. 1st NHS Trust to successfully work with a third party using a scan-on-demand approach to outsource the huge task of scanning its records library. Capita Total Document Solutions (TDS) is providing this service using Kodak production scanning hardware and software to ensure high quality image capture. Data is then sent via a secure FTP link back to Aintree. 엯 282,000 patient files will be scanned which equates to 45 million pages. 엯 As outpatient case notes are used - on average - 21/2 times a year, once a person's file is scanned, the notes are available digitally for subsequent visits. Project management 엯 The project took 15 months and was completed on budget and to acceptable timescales. o A staggered rollout was adopted to: 엯 Minimise risk in contrast to a 'big bang' approach which would have meant the whole clinical community switching from paper to computers and changing working methods over night. 엯 Allow the project team to measure, learn, and improve each time a new department went live. 엯 Staff access the EDMS via the Trust's Patient Management System (PMS) when they login. Various IT solutions are integrated including pathology and radiology results, pharmacy, prescribing and theatre systems. o By linking the EDMS to other systems, Aintree University Hospital has ensured that information is sensibly integrated so that EDMS doesn't just become an archive, but directly improves sharing documents and collaboration among staff thereby enhancing organisational efficiency. 엯 Prior to starting the project, Aintree University Hospital ensured that its IT infrastructure was capable of supporting the new EDMS system and allowing remote access to it. Return on Investment: Financial & operational benefits 1. This is an 'invest to save' initiative and in line with the Government's QIPP agenda to improve the quality of care and make £20 billion of efficiency savings by 2014/2015. £1.5 million was spent on software, scanning hardware, and services with Aintree University Hospital saving £1 million annually based on reducing labour, transport and storage costs. 2. 30% space gain in a new £45 million building now used for clinical activities not paper storage - a £13.5 million estate benefit as a whole floor has become available. 3. 100% scanning of paper case notes by June 2012 which will allow Aintree University Hospital to close its records library. Paper files will not be provided to clinicians. 4. Headcount reduced by 50 with salary costs saved. Staff numbers have reduced through natural wastage and redeployment of some people to other vacancies. 5. The innovative use of forms recognition technology to index records automatically rather than having people do it is one of the reasons so much money is saved. 6. Aintree University Hospital measures the success of its medical records process using two metrics: a. Availability of records - 100% with the new EDMS solution. With paper, it was 97%. While a 3% non-delivery might appear low, this adds up to a considerable number of patient consultations given the thousands seen each year. b. Error rates converting paper to digital- 0. 4% working with Capita TDS to provide scanning services against a target of 1%. Clinical benefits 1. The fundamental principle of good records management is that the right patient file should be available at the right time for the right clinician. This has been achieved. Immediate access to the scanned notes improves the clinical experience and care provided to patients. 2. Integration with the Trust's PMS- clinicians don't have to use different systems to access historical records. 3. Innovative indexing means navigating is as quick or faster than with paper - the system allows "three or four clicks" to information. 4. Cleverly designed portal makes the record easy to use: a. Each section of the record is split by specialty; b. An innovative 'timeline' tool shows a patient's journey over time and what has happened to them. It lists all specialties seen with clinicians able to drill down to review what has occurred, when, treatment provided, by whom, and recent medical episodes - this is key for chronic disease management given patients tend to see more than one specialty; c. Fast access to actual test results such as X-rays, ECGs and respiratory function tests in addition to written notes. 5. Enhanced collaboration among clinicians who can access notes irrespective of their location using secure remote access technology. 6. Provision of all historical notes to clinicians whereas with paper only the current volume could be provided. This has helped clinicians diagnose patients who have had health issues spanning many years. 7. Easier exporting of information between Trusts if patients are referred elsewhere for specialist care. 8. Easier provision of medical information following legal requests as data can be provided electronically rather than via paper which has time/cost impact to process. An award-winning project The EDMS project at Aintree University Hospital has been recognised as being innovative winning a variety of industry awards over the past two years, as below: o Computer Weekly's European User Awards for Enterprise Software - public sector project of the year 2013; o eHealth Insider's Best use of IT to support healthcare business efficiency 2013; o Document Manager magazine's Gold project of the year 2012; o Techworld - shortlisted in the 2012 enterprise project of the year category; o UK IT Industry Awards 2012 - high commended in the best not for profit IT project category. Why should the King's Fund select Aintree to speak at the conference? o Digitising health records is not only an invest to save initiative, but it gets crucial patient information to the point of care automatically so people have a better clinical experience. The welldesigned solution deployed does just this and means Aintree University Hospital has stopped transporting paper files and trying to manage an unmanageable logistics operation. 엯 The challenge with any NHS IT project is getting computers to work the way medicine works rather than the other way round. Aintree University Hospital and its project partners have worked hard to successfully achieve this. 엯 To meet the QIPP agenda, the real temptation in a lot of NHS organisations is to find savings by not changing working methods. Aintree University Hospital has have not taken the easy route. It has completely re-engineered a mission-critical process, and saved money and improved patient care as result. In terms of a successful project, this is everything it could have wished for and what has been achieved. 엯 The project team would like to share its experiences within the health service both in the UK and internationally - health organisations who will have similar if not exactly the same issues with medical records management. KEY QUOTES CLINICAL: Professor Mike Pearson, consultant physician, says, "It's been hard work but now we've finished the project, we have a solution which is already saving the NHS money. The key innovation is the indexing so that data can be retrieved quickly and easily. This has defeated other projects in the past but we've managed to solve this working closely with our software partner. Our system is applicable to any hospital in the country and is a significant contribution to meeting the Government's target of hospitals being paper light. " Professor Pearson says, "Trusts must recognise that projects like this involve more than just buying a software package. It's implementing a system to process and digitise all your records while at the same time teaching staff how to manage them in the electronic new world. This must be done while keeping the service operational, so it's rather like changing an engine on an aircraft while it's flying." IT/OPERATIONS: Ward Priestman, the former IT lead on the project says, "This type of project is risky, difficult, and we went out on a limb to do it. We didn't just buy off-the shelf software, but created the solution in partnership with our IT suppliers such that we are at the vanguard of using this technology in the NHS. It means we are one of the first Trusts in the country to truly get legacy records management right - forms recognition, timeline view, and quick access to information to deliver a streamlined and modern solution which clinicians accept and like." [ABSTRACT FROM AUTHOR]
- Published
- 2014
39. Implementation and testing of a digital pen and paper tool to support patients with heart failure and their health care providers in detecting early signs of deterioration and monitor adherence.
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Lind, Leili, Klompstra, Leonie, Jaarsma, Tiny, and Strömberg, Anna
- Subjects
- *
HEART failure patients , *PATIENT compliance - Published
- 2011
40. Development of a Qualitative Data Analysis Codebook for Arterial Hypertension and Type-2-Diabetes Integrated Care Evaluation.
- Author
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ZAVRNIK, ČRT, STOJNIĆ, NATAŠA, LUKANČIČ, MAJDA MORI, MARTENS, MONIKA, DANHIEUX, KATRIEN, CHHAM, SAVINA, MIHEVC, MATIC, POTOČNIK, TINA VIRTIČ, KETIŠ, ZALIKA KLEMENC, VAN OLMEN, JOSEFIEN, and SUSIČ, ANTONIJA POPLAS
- Subjects
DOCUMENTATION ,QUALITATIVE research ,HYPERTENSION ,EVALUATION of medical care ,THEMATIC analysis ,TYPE 2 diabetes ,MEDICAL coding ,RESEARCH methodology ,INTEGRATED health care delivery - Abstract
Introduction: Non-communicable diseases, such as arterial hypertension (HTN) and type-2 diabetes (T2D), pose a global public health problem. Integrated care with focus on person-centred principles aims to enhance healthcare quality and access. Previous qualitative research has identified facilitators and barriers for scaling-up integrated care, however the lack of standardized terms and measures hinder cross-country comparisons. This paper addresses these gaps by presenting a generic codebook for qualitative research on integrated care implementation for HTN and T2D. Description: The codebook serves as a tool for deductive or deductive-inductive qualitative analysis, organizing concepts and themes from qualitative data. It consists of nine first level and 39 second level themes. First level codes cover core issues; and second level codes provide detailed insights into facilitators and barriers. Discussion: This codebook is more widely applicable than previously developed tools because it includes a broader scope of stakeholders across micro, meso, and macro levels, and the themes being derived from highly diverse health systems across highand low-income countries. Conclusion: The codebook is a useful tool for implementation research on integrated care for HTN and T2D at global scale. It facilitates cross-country learning, contributing to improved implementation, scale-up and outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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41. Access to Affordable Health: A Care Delivery Model of GNRC Hospitals in North-Eastern India.
- Author
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BORAH, NOMAL CHANDRA, BORAH, PRIYANKA, BORAH, SATABDEE, BORAH, MADHURJYA, and SARKAR, PURABI
- Subjects
HEALTH services accessibility ,HUMAN services programs ,SELF-efficacy ,MEDICAL quality control ,MEDICAL care ,PRIMARY health care ,TELEMEDICINE ,MEDICAL research ,PUBLIC health ,INTEGRATED health care delivery ,SPECIALTY hospitals ,MEDICAL care costs ,TRANSPORTATION of patients - Abstract
Introduction: The healthcare delivery system of Assam faces several challenges to provide affordable, accessible and quality care services. GNRC (Guwahati Neurological Research Center) is the first super-speciality hospital to address many of these gaps by delivering integrated affordable healthcare services to the populations of Assam and other parts of North-eastern India. Description & Discussion: This paper describes the implementation of a care delivery model which provides integrated care delivery services through linking hospitals to primary healthcare services, including preventive, promotive, and curative care, along with delivering easily accessible and affordable care to the people of Assam and other parts of North-eastern India. Conclusion: The proposed model is the first innovative approach from Northeastern India, Assam, to deliver affordable, accessible and patient-centric hospital led community-based preventive, promotive, and primary, secondary, and tertiary hospital-based care. It is anticipated that GNRC's "Affordable Health Mission" will help redesign and integrate the way primary, secondary and tertiary healthcare is delivered to the population of Assam in helping patients manage their own health and reduce the numbers that needs to be admitted to secondary care and tertiary care by improving patients' independence and well-being as well as dramatically reducing the cost to the overall health system. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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42. Integration of Dementia Systems in Central America: A Social Network Approach.
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CURRERI, NEREIDE A., GRIFFITHS, DAVE, and MCCABE, LOUISE
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DIAGNOSIS of dementia ,HEALTH services accessibility ,SELF-evaluation ,MEDICAL quality control ,COMPUTER software ,RESEARCH funding ,INTERVIEWING ,STATISTICAL sampling ,GOVERNMENT agencies ,DESCRIPTIVE statistics ,SOCIAL networks ,RESEARCH methodology ,DEVELOPING countries ,PUBLIC administration ,COMPARATIVE studies ,INTEGRATED health care delivery ,DEMENTIA patients ,ACTIVE aging - Abstract
Introduction: Action 3 of the UN Decade of Healthy Ageing plan is to deliver integrated care to improve older adults' lives. Integrated care is vital in meeting the complex needs of people with dementia but little is known about how this is or could be delivered in low and middle income countries (LMIC). This paper provides insights into previously unknown care system structures and on the potential and reality of delivering integrated care in Central America for people with dementia. Methods: A social network analysis (SNA) methodology was adopted to engage with providers of services for older adults and families with dementia in Guatemala, El Salvador, Honduras, Costa Rica and Panama. Sixty-eight (68) semi-structured interviews were completed, 57 with organisations and 11 with families. Results: Across the five countries there was evidence of fragmentation and low integration within the dementia care systems. A variety of services and types of providers are present in all five countries, and high levels of diversified connections exist among organisations of differing disciplines. However, unawareness among network members about other members that they could potentially form active links with is a barrier on the path to integration. Conclusion: This innovative and robust study demonstrates SNA can be applied to evaluate LMIC care systems. Findings provide baselines of system structures and insights into where resources are needed to fortify integration strategies. Results suggest that Central American countries have the building blocks in place to develop integrated care systems to meet the needs of people with dementia, but the links across service providers are opportunistic rather than context based coordinated integration policies. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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43. Disentangling Population Health Management Initiatives in Diabetes Care: A Scoping Review.
- Author
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GEURTEN, ROSE J., STRUIJS, JEROEN N., BILO, HENK J. G., RUWAARD, DIRK, and ELISSEN, ARIANNE M. J.
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HEALTH literacy ,MEDICAL information storage & retrieval systems ,SELF-evaluation ,MEDICAL quality control ,POPULATION health management ,DESCRIPTIVE statistics ,SYSTEMATIC reviews ,MEDLINE ,PATIENT-centered care ,TYPE 2 diabetes ,LITERATURE reviews ,HEALTH promotion ,ONLINE information services ,NEEDS assessment ,QUALITY assurance ,DATA warehousing ,MEDICAL care costs - Abstract
Introduction: Population Health Management (PHM) focusses on keeping the whole population as healthy as possible. As such, it could be a promising approach for longterm health improvement in type 2 diabetes. This scoping review aimed to examine the extent to which and how PHM is used in the care for people with type 2 diabetes. Methods: PubMed, Web of Science, and Embase were searched between January 2000 and September 2021 for papers on self-reported PHM initiatives for type 2 diabetes. Eligible initiatives were described using the analytical framework for PHM. Results: In total, 25 studies regarding 18 PHM initiatives for type 2 diabetes populations were included. There is considerable variation in whether and how the PHM steps are operationalized in existing PHM initiatives. Population identification, impact evaluation, and quality improvement processes were generally part of the PHM initiatives. Triple Aim assessment and risk stratification actions were scarce or explained in little detail. Moreover, cross-sector integration is key in PHM but scarce in practice. Conclusion: Operationalization of PHM in practice is limited compared to the PHM steps described in the analytical framework. Extended risk stratification and integration efforts would contribute to whole-person care and further health improvements within the population. [ABSTRACT FROM AUTHOR]
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- 2024
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44. Health and Social Care Integration in Scotland: Evidence vs Rhetoric.
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DONALDSON, CAM, KNIGHT, PETER, NOBLE, ALASTAIR L., and STRATHEARN, SANDY
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DIFFUSION of innovations ,HEALTH policy ,GOAL (Psychology) ,HEALTH care reform ,ENDOWMENT of research ,SOCIAL support ,QUALITY assurance ,INTEGRATED health care delivery - Abstract
In this perspective paper we use publicly-available data to show that, despite much positive rhetoric in support of reforms in Scotland to integrate health and social care, these reforms, in their current state, have failed to meet their stated objectives. Rather than regress to the previous system, we propose continued evaluation of even more radical forms of such integration. This analysis, and set of future proposals, are timely given current considerations with respect to a National Care Service in Scotland and recent similar reforms in England and in other countries. [ABSTRACT FROM AUTHOR]
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- 2024
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45. Creating an Enabling Political Environment for Health and Social Care Integration
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Anne Hendry
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Health (social science) ,Knowledge management ,Sociology and Political Science ,Parliament ,media_common.quotation_subject ,Legislation ,03 medical and health sciences ,Politics ,0302 clinical medicine ,Perspective Paper ,Political science ,National Policy ,030212 general & internal medicine ,health care economics and organizations ,media_common ,lcsh:R5-920 ,business.industry ,030503 health policy & services ,Health Policy ,Perspective (graphical) ,Public relations ,Integrated care ,System transformation ,Social care ,0305 other medical science ,business ,lcsh:Medicine (General) - Abstract
Introduction The Scottish Parliament recently passed legislation on integrating health and social care in Scotland. In this perspective paper, the clinical lead who supported the development and implementation of national policy on older people, long term conditions and integrated care in Scotland describes how political, policy and professional leaders have together created the right conditions to enable this ambitious change. The author reflects on the respective contributions from innovation, improvement, co-production, financial incentives, and through a clear focus on outcomes for people – whether patients, clients, carers, staff or citizens. The paper discusses how Scotland adapted Kotter’s eight steps for managing change and explores the transferable learning for other regions embarking on system transformation for integrated care.
- Published
- 2016
46. The impact on ambulance mobilisations of an increasing age profile of telecare service users receiving advanced proactive, personalised telecare in Spain - a longitudinal study 2014-2018.
- Author
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Contreras, Wendy Hugoosgift, Sarquella, Ester, Binefa, Eva, Entrambasaguas, Mar, Stjerne, Anette, and Booth, Peter
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AMBULANCES ,PATIENT-centered care ,CONFERENCES & conventions ,TELEMEDICINE - Abstract
Introduction: Spain is one of the leading countries in the application of proactive and personalised telecare to help support frail and vulnerable service users to live independently in their own homes for longer*. Concern was however noted regarding potential impacts on ambulance mobilisations as time in the service, and mean age at cessation, increased by 1.3 years. Aims, Objectives, Theory and Methods: The purpose of this study was to investigate these impacts. A longitudinal study of a telecare service user population in Spain (n=202.1k to 247.9k) was undertaken using anonymised operational data collected in the delivery of proactive and personalised telecare services by Televida Servicios Sociosanitarios over the period 2014-18. The population was subject to change over time as new service users became eligible to register for the service, and others ceased the service. Each of these factors were also studied to assess potential confounding or covariate factors in the population also influencing the mobilisation of ambulances. Key Findings: For the studied population, ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced over the period despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. Overall mobilisations reduced by 27.9% (0.665 to 0.479 pp/pa) over the period whilst for ambulances there was a reduction of 33.3% (0.461 to 0.307 pp/pa). There were also smaller reductions in the number for family and state security mobilisations. The study identified the positive correlation coefficient between ambulance mobilisations and service user's dependency levels, and marginal negative correlation in older age bands. We are aware of no other studies which have investigated the impact on ambulance mobilisations of advanced proactive telecare and the increasing age of the services users supported to continue living independently. We believe this paper, therefore, contributes new insight which extends the existing research literature. Conclusions: The increasing age at cessation has not correlated with an increased proportion of higher dependency service users. The share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service contributing to increased time living independently may also have helped service users remain in lower risk bands. Limitations: There is a risk that use of mean annual measures may obscure important variations within the data. Changes in levels of proactivity, personalisation and increased use of sophisticated monitoring sensors of the telecare services are not the subject of this paper, but addressed in part in allied research. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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47. Coordinating care around patients' needs: Exploring the emergence and change of core dimensions of integrated care.
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Mitterlechner, Matthias and Bilgeri, Anna-Sophia
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CONFERENCES & conventions ,HEALTH care teams ,INTERPROFESSIONAL relations ,INTEGRATED health care delivery - Abstract
Addressing new population needs, many countries are moving toward tighter integration of health and social care. Research has made considerable progress in identifying the core dimensions of integrated care, emphasising, for instance, the need for close provider relationships and coordinating care practices around patients' needs [1]. While these dimensions are widely known, we lack insight into how they emerge and change over time. Without a deep understanding of these dynamics, however, we cannot explain why initiatives fail or succeed. This paper explores the dynamics of integrated care, addressing an important gap in the literature [2]. To explore the dynamics of integrated care, the paper draws on pragmatist organisation studies [3]. Adopting a process ontology, pragmatism is well suited for this purpose. From this perspective, core dimensions of integrated care emerge and change as inter-dependent actors experience local break-downs, problems, or opportunities in their everyday work and care practices and continuously adapt these practices in communication-based deliberation [3]. The paper draws on a longitudinal single-case study conducted in the Swiss healthcare sector. It describes the emergence and change of a cutting-edge outpatient primary care centre, in which legally autonomous primary care and specialist providers jointly refer, diagnose and care for patients with complex needs. It includes data from 19 interviews, three days of non-participant observation, and 37 archival records, analysing how provider relations and care coordination emerged and changed over thirteen years. The data show that inter-dependent actors included not only a paediatrician turning quality problems in his practice into an opportunity to found the centre, but also architects, investors and other service providers. Over time, they experienced a series of problems including fragmented care, restrictive land use regulations, sceptical peers, cash drain, and rapid growth. They addressed this steady stream of problems in cycles of deliberation, recurrently restoring order from disruption, gradually building relationships, and increasingly coordinating care around patients' needs. Deliberation was typically based on bilateral conversations between the founder and other actors. While this communicative practice was initially helpful, it started impairing actors' problem-solving capacity as the founder became overwhelmed by the rapid growth of the centre, stalling advances in care coordination and straining provider relationships. The paper contributes to research by exploring the dynamics of integrated care, theorising the emergence and change of its core dimensions as grounded in inter-dependent actors' everyday work and deliberation practices amid a steady stream of problems and opportunities. The findings are relevant for theorists and policy makers alike, offering new glimpses into the "black box" of complex care integration [1, 2]. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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- View/download PDF
48. Digital Technologies Supporting Person-Centered Integrated Care – A Perspective
- Author
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Øvretveit, John
- Subjects
Health (social science) ,Knowledge management ,Clinical informatics, health information technology, organisational studies, quality improvement, communications studies ,Sociology and Political Science ,Health information technology ,media_common.quotation_subject ,Digital data ,Person centered ,03 medical and health sciences ,0302 clinical medicine ,Perspective Paper ,Medicine ,Quality (business) ,030212 general & internal medicine ,integrated care ,media_common ,clinical care coordination ,communication ,quality ,Service (business) ,lcsh:R5-920 ,business.industry ,030503 health policy & services ,Health Policy ,Perspective (graphical) ,Information technology ,Integrated care ,lcsh:Medicine (General) ,0305 other medical science ,business - Abstract
Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning “digitalisation” of services that gives a glimpse of the potential of digital technology and systems for building coordinated and individualized integrated care. Yet the promise has been greater than the benefits, and progress has been slow compared to other industries. This paper describes for non-technical readers how information technology was used to support integrated care schemes in six EU services, and suggests practical ways forward to use the new opportunities to build person-centered integrated care.
- Published
- 2017
49. Don’t Blame the System; They’ve Chosen the Wrong One
- Author
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Tony Brauer
- Subjects
Health (social science) ,Sociology and Political Science ,Relation (database) ,Computer science ,media_common.quotation_subject ,logic models ,0211 other engineering and technologies ,Psychological intervention ,02 engineering and technology ,Ideal (ethics) ,Blame ,03 medical and health sciences ,0302 clinical medicine ,Perspective Paper ,markets ,Systems thinking ,030212 general & internal medicine ,media_common ,integrated care ,lcsh:R5-920 ,021103 operations research ,business.industry ,communication ,Health Policy ,Public relations ,National health service ,systems ,Integrated care ,Holism ,business ,lcsh:Medicine (General) - Abstract
While trying to represent patients in the design of integrated care, I have heard the words 'system', 'systemic' and 'holism' used frequently. Few of those using the words seem to be aware of the history of systems thinking, or its principles. Health interventions are instead designed using logic modelling, which is aholistic and disintegrative. This concern is illustrated in relation to the UK’s Better Care Fund, which was an attempt to reduce hospital admissions by co-ordinating care. Systems thinking is then used to provide a possible distinction between three operating systems for the UK’s National Health Service (NHS). The first, an ideal market operating system, is inherently fantastic, and doubly so when it is impossible to determine who has contributed what to which outcomes. The accountable professional operating system may re-emerge as the rational option. However, weak analysis can lead to the emergence of a quasi-market operating system, which lacks the capacity to integrate the essential elements of a viable system. The fault lies not with systems thinking, but with the failure to study how viable systems are constructed.
- Published
- 2018
50. Policies Make Coherent Care Pathways a Personal Responsibility for Clinicians: A Discourse Analysis of Policy Documents about Coordinators in Hospitals
- Author
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Aslak Steinsbekk, Gro Berntsen, Deede Gammon, and Audhild Høyem
- Subjects
Health (social science) ,Sociology and Political Science ,Policy Paper ,media_common.quotation_subject ,Discourse analysis ,coordinated care ,03 medical and health sciences ,0302 clinical medicine ,continuity of care ,Statutory law ,Health service research ,Political science ,Moral responsibility ,030212 general & internal medicine ,Set (psychology) ,media_common ,integrated care ,lcsh:R5-920 ,business.industry ,030503 health policy & services ,Health Policy ,VDP::Medical disciplines: 700::Health sciences: 800 ,Public relations ,Integrated care ,VDP::Medisinske Fag: 700::Helsefag: 800 ,Rhetoric ,care pathway ,complexity ,hospitals ,lcsh:Medicine (General) ,0305 other medical science ,business ,Diversity (politics) ,Qualitative research - Abstract
Introduction: In response to increase of patients with complex conditions, policies prescribe measures for improving continuity of care. This study investigates policies introducing coordinator roles in Norwegian hospitals that have proven challenging to implement. Methods: This qualitative study of policy documents employed a discourse analysis inspired by Carol Bacchi’s ‘What‘s the problem represented to be?’. We analysed six legal documents (2011–2016) and selected parts of four whitepapers presenting the statutory patient care coordinator and contact physician roles in hospitals. Results: The ‘problem’ represented in the policies is lack of coherent pathways and lack of stable responsible professionals. Extended personal responsibility for clinical personnel as coordinators is the prescribed solution. Their duties are described in terms of ideals for coherent pathways across conditions and contexts. System measures to support and orchestrate the individual patient’s pathway (e.g. resources, infrastructure) are scarcely addressed. Conclusions and Discussion: We suggest that the policies’ construction of the ‘problem’ as a responsibility issue, result in that neither diversity of patients’ coordination needs, nor heterogeneity of hospital contexts regarding necessary system support for coordinators, is set on the agenda. Adoption of rhetoric from diagnosis-specific standardized pathways obscures unique challenges in creating coherent pathways for patients with complex needs. © 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
- Published
- 2018
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