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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]

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]

Introduction: Observational data are increasingly seen as a valuable source for integrated care research. Especially since the growing availability of routinely collected data and quasi-experimental methods. The aim of this paper is to describe the potentials and challenges when using observational data for integrated maternity care research, based on our experience from developing and working with the Data-InfrAstructure for ParEnts and childRen (DIAPER). Methods and Results: We provide a description of DIAPER, which is a linked datainfrastructure on the individual level based on maternity care claims data, quality and utilization of maternity care and data from municipal registries, covering the life course from preconception to adulthood. We then discuss potentials and practical applications of DIAPER such as to evaluate alternative payment models for integrated maternity care, to set the policy agenda regarding postpartum care, to provide insights into value of care and into provider variation, and to evaluate (policy) interventions designed to promote and support integrated maternity care. This is relevant for several stakeholders: policy makers, payers, providers and clients/patients. Based on experiences with DIAPER, we identify remaining challenges: missing data sources (especially self-reported outcomes), suboptimal quality of data, privacy concerns and potential biases introduced during data linkage, and describe how these challenges were tackled within the applications of DIAPER. Conclusions: With DIAPER we demonstrated that using observational data can be of added value for integrated care research, but also that challenges remain. It is essential to keep exploring and developing the possibilities of observational data and continue the discussions in the scientific community. Learning from each other's successes and failures will be critical. [ABSTRACT FROM AUTHOR]

Introduction: China is promoting integrated care. However, incomplete payment methods led to medical insurance overspending and intensified service fragmentation. Sanming implemented Integrated Medicare Payment Methods (IMPM) in October 2017, which integrates multi-level payment policies. Sanming’s IMPM works well and has been promoted by the Chinese government. Therefore, in this paper, we aim to systematically analyze Sanming’s IMPM, and conduct preliminary evaluations of Sanming’s IMPM. Policy Description: IMPM integrates two levels of policy that are implemented simultaneously: (1) The payment policy for healthcare providers refers to how to calculate the global budget (GB) of the medical insurance fund paid to the healthcare providers and the policy guidance for the healthcare providers on how to use GB. (2) The payment policy for medical personnel refers to the adjustment of the evaluation index of the annual salary system (ASS) according to the IMPM’s purpose and the payment policy that adjust pay levels based on performance. Discussion and lessons learned: After the IMPM reform, county hospitals (CHs) may reduce over-providing dispensable healthcare, and cooperation between hospitals may increase. The policy guidance (Determining GB according to population; Medical insurance balance can be used for doctors’ salary, cooperation between hospitals, and promotion of residents’ health; Adjusting ASS assessment indicators according to IMPM purposes) increases CHs’ motivation to promote balances of medical insurance fund by cooperating with primary healthcare and increasing health promotion actions. Conclusion: As a model promoted by the Chinese government, the specific policies of Sanming’s IMPM are better matched with policy goals, which may be more conducive to promoting medical and health service providers to pay more attention to cooperation among medical institutions and population health. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This policy paper aims to compare what policies are developed in Italy for the management of chronic patients in order to improve population health, quality of care and patient experience and reduce per-capita cost. The paper also aims to identify the key trends and evolutionary trajectories across the Country. Methodology: The analysis focuses on 10 Italian Regions and the time span of observation is 7 years (from 2014 to 2020). Data collection and analysis adopts mixed methods in order to have a more in-depth picture of the contextual factors, mechanisms and outcomes. It includes a desk research of the literature and documentary analysis; semi-structured interviews; a theory driven evaluation of 12 programmes identified at the regional level; and a Consensus Conference to discuss and validate the results with an Expert Panel Group. Conclusions: The paper firstly describes the main policies developed in Italy in the last seven years; secondly, it discusses six main trends and clusters them into three strategies: demand management strategies; strategies to improve the management of comorbid and frail patients; and strategies to improve the coordination between levels of care and the patient journey; thirdly, it discusses eight trends and evolutionary trajectories which are now emerging. [ABSTRACT FROM AUTHOR]

Introduction: Primary healthcare (PHC) in Sweden is under transformation following an extensive governmental reform, called "Good quality, local health care". The reform aims to re-establish PHC as 'front-line care' and to strengthen the quality of PHC, largely by integrating person-centred solutions. Digital solutions are foreseen to play a significant part in the transformation as well as stronger coordination between municipalities and regions. The suggested focus of the reform indicates areas where policy makers think changes are needed. It is important to scrutinize the "solutions" proposed, as problem representations justify or legitimise certain policies or policy solutions. Aim and method: This policy analysis aims to explore problem representations in the Swedish healthcare reform. Four main policies underpinning the reform were identified and documentations of those retrieved. To unpack the 'problems' represented in the reform, the "What is the problem represented to be" (WPR) approach developed by Bacchi was applied (1). Guided by Bacchi, the proposed solutions in the policy documents were analysed and evolved into three preliminary themes, which form the basis for the problem formulations. This paper is work under progress. Key findings: Three overarching problem formulations unfolded. First, by proposing that the development of a modern, accessible, and effective healthcare system that focus on PHC will depend upon a new definition and a common roadmap, the reform represents the 'problem' as a 'nebulous care mission and narrow health system scope'. The second 'problem' was developed based on solutions concerned with strengthening the collaboration between regional and municipal care actors. The reform locates the 'problem' primarily within the organisational realm of the health system while representing it as the 'silos of differentiated care systems and processes'. The third 'problem' builds on solutions intended to bring services closer to people and ensuring that the services are relevant to the needs, wishes and preferences of the patient(s). In this regard, the 'problem' is represented as care that is 'distant and detached from (individual) patients'. Conclusion: The problem representations developed by the policy analysis can be traced to earlier PHC reforms aiming to give the municipalities the responsibility of elderly care (2) and individual patients more power to influence their care (3). The reform is silent on equity between social groups which warrants further scrutiny. Implications to the ICIC 2022 Conference: The paper suits the first theme since personcenteredness is at the core of the reform. Being a policy proposal, it adheres especially well to the sixth pillar which directly addresses policymaking. Knowledge-sharing from Swedish healthcare may thus be useful for other countries in transition. 1. Bacchi C, Eveline J. What's the problem represented to be Mainstreaming Politics: Gendering Practices and Feminist Theory. 2010;111. 2. Edebalk PG. Den dramatiska Ädelreformen. Äldre i centrum: tidskrift för aktuell äldreforskning, 2021, 35, 111-113 3. Burström, B., Burström, K., Nilsson, G., Tomson, G., Whitehead, M., & Winblad, U. (2017). Equity aspects of the Primary Health Care Choice Reform in Sweden-a scoping review. International journal for equity in health, 2017, 16(1), 1-10. [ABSTRACT FROM AUTHOR]

Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012-2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care. [ABSTRACT FROM AUTHOR]

Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development. [ABSTRACT FROM AUTHOR]

Introduction: Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identification of their specific barriers and facilitators to obtain an overarching generic view. Methods: 27 participants were purposefully selected, to include all important stakeholders involved on the macro-level in chronic care in Belgium. Semi-structured interviews were guided by a timeline of policies and an inductive thematic analysis was performed. Results: Barriers and facilitators were identified on both health care and policy level. The major factors restraining the scale-up of integrated care are the fee-for-service reimbursement system, limited data sharing and the fragmentation of responsibilities between different levels of government. Remarkably, these factors strongly interact. Discussion: This paper highlights the importance of homogenization of responsibilities of governments regarding integrated care and the interdependency of policy and health care system factors. A whole system change is needed instead of the current Belgian model of prolonged search for common ground between conflicting opinions. Political commitment and citizen participation will be crucial. [ABSTRACT FROM AUTHOR]

Introduction: Literature reveals that integrated care is perceived to be the answer to the many issues faced by health systems in in the OECD. Research has also identified many difficulties in its implementation1. In Ireland, it has been observed that there is a disconnect between the trend of patient centred policy making and the organisational support available to health professionals and patients at the frontline in its implementation2 Description of Policy context and Objective: The context for this paper is the introduction of integrated care in Ireland through the implementation of Community Health Organisations (CHOs) in 2015/16 as outlined in the report- Report and Recommendations of the Integrated Service Area Review Group' also referred to as the Healy Report (HSE 2014). A similar policy development was introduced in Northern Ireland since 2011; with the development of an integrated health and social care policy (Transforming Your Care, Review of Health and Social Care, 2011). This paper reports on a comparative review of integrated health and social care policy in both Ireland and Northern Ireland and identifies themes that emerge from a comparative policy document analysis. It examines the contents and specific aspects of both sets of policy documents including; implementation plans, structures and governance arrangements and their potential influence on professional practice. This paper will serve as a contribution to a future study on the process of implementation of integrated care in the Republic of Ireland. Highlights: Northern Ireland has implemented structural integration of its health and social care since the 1970s. Existence of similarity in policy goals and objectives, the reform programmes, guiding principles and agenda's set out in policy documents in Northern Ireland and Republic of Ireland. The Republic of Ireland runs a risk of facing the same policy issues observed in the Northern Ireland experience of implementation based on policy recommendations. Sufficient resources need to be in place in order to have sustainable integrated care in the Republic of Ireland. Transferability: This paper describes the relevance of Northern Ireland experience and serves as a useful guide to the implementation of integrated health and social care in the Republic of Ireland. Conclusion: (Key findings, discussion and lesson learned) The main themes that emerged from the comparative review include; policy process, structural composition, governance, management and accountability, clarity of professional roles and policy goals, localism agenda and standardised pathways, frontline autonomy and decision making, stakeholder inclusion and configuration. Implementing integrated care is expensive, requires balanced configuration of management, structures and governance arrangements that supports exchange of information across professionals, shared services, involvement of users, promotion of strong working relationships and collaborations as well as more research in bridging gaps between policy aims and frontline professional practice which on the long run produces sustainable health delivery outcomes. [ABSTRACT FROM AUTHOR]

This paper introduces an empirically-grounded theory of change in health care systems. It draws on three research projects focusing on the implementation of a mental health care reform. These projects include two evaluation studies commissioned by Belgian public health authorities and a scientific, PhD research supported by the Belgian National Fund for Scientific Research. They are based on qualitative methods, including document analysis, semi-structured interviews and focus groups. The generalisation of these research findings has recently started through ongoing projects devoted to the implementation of an integrated care model in the field of chronic diseases. This paper first draws on a realistic approach to health policy implementation (1). A particular attention is consequently paid to the context of implementation and to identify explicit and implicit mechanisms combining to give a particular direction to the change process. Moreover, the theory of change outlined in this paper importantly borrows from system and process theories (2). It emphasises the pivotal role fulfilled by repeated sequences of interactions, most of which take the form of meeting communication, between differentiated and interdependent social systems. Belgian policymakers started supporting a shift from an institution-based towards an integrated care model in the field of mental health in 2010. This shift was expanded to the field of chronic diseases in 2015. The Belgian health care system combines characteristics of the Bismarkian and Beveridgian models. It is decentralised, highly differentiated, and recognises the autonomy of health care providers and professionals. Moving towards integrated care is all the more challenging in that context. This challenge explains the preference of Belgian policymakers for soft regulation mechanisms, that is, pilot projects making room for local adaptations and depending on a phased approach to organisational change. In this framework, local coordinators are responsible for steering the implementation process, in a way to ensure consistency between local translations and global policy objectives. In-depth analysis of the mental health reform implementation evidenced a significant discrepancy between the policy programme and local adaptations. Professional cultures, organisational strategies and ideological pillars specific to the Belgian society have been identified as the main factors accounting for these discrepancies. Furthermore, inter-organisational meetings emerged as the very spaces where such influential logics of action are expressed and articulated with one another. In this respect, the main challenge lies in the stakeholders' ability to create hinges (3), defined as visions of the situation which enable to coordinate the action of different systems, without preventing them from preserving their cognitive structure. Coordinators, acting as boundary spanners (4), play a strategic role in organising and reporting on these meetings. However, coordinators lack power, managerial skills and knowledge of innovation process to cope with social influence in a way consistent with policy objectives. Therefore, this paper outlines a theory of health system transformations which put professional culture, organisational strategies and social ideologies at the forefront. It argues that assuming the social nature of these transformations would enable to improve both the design of health policy and the training of change managers. [ABSTRACT FROM AUTHOR]

This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the Palliare project supported through the Erasmus+ K2 Strategic Partnerships funding programme. [ABSTRACT FROM AUTHOR]

Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat Valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector. Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat Valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy. Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy. [ABSTRACT FROM AUTHOR]

Politicians in Ireland aim to radically transform access to healthcare by changing the current two-tiered system to a single-tier, universal healthcare service ensuring access to healthcare on the basis of medical need; not ability to pay. Successful implementation of this vision requires enabling a health system with the capacity to deliver in fact. Bedevilled with long waiting lists, emergency department bottlenecks, path dependent fragmentation and chronic under-resourcing of the primary and community care domains (to name a few of the challenges apparent), the Irish health system needs to forge practical paths to a level of integration greater than (although encompassing) the integrated care programmes already in train. This paper, based on initial findings of a systematic review of the 'organisational challenges of implementing universal healthcare policies in countries with a GDP per capita greater than $22,000' is oriented towards policy-makers, health system designers, enablers and providers - particularly those working in a context where health reform is focussed on implementing universal and integrated care models. Our initial search identified 1,784 papers (having removed duplicates) and after 5 screening stages resulted in 9 papers for review. These include a range of study types, and report findings from the USA, Australia, Canada, UK, Italy and Taiwan. Findings highlight the variety of policy instruments used to deliver universal healthcare, these include legislation, social health insurance and Medicare subsidies at the policy level; they also note service implementation processes, design, performance evaluation and leadership programmes aimed at greater system cohesion and integration at the practice level. The challenges and opportunities identified from our analysis relate primarily to provider practice and collaboration - both themes central to the development of integrated care. We find that providers experience better continuity of care and hence job satisfaction in some universal access settings, but also come up against systemic barriers to the shared decisionmaking, information flows and new role requirements necessary for integrated and universal access to care. The difficulty of changing role definitions and expectations is also apparent in our theme of collaboration. Getting stakeholders to engage in transparent peer-review, shifting fixed mind-sets and behaviours, optimum pacing of policy implementation for engagement, and systemic constraints that disable the renegotiation of professional differences on teams (for example) are also identified as important challenges. These findings can inform politicians and policy-makers as they express a vision and plan for the 'Future of Healthcare in Ireland' over the next 10 years (http://www.oireachtas.ie/parliament/oireachtasbusiness/committees_list/future-ofhealthcare/). More broadly they offer pertinent evidence for those eager to better understand the processes of health system transition and transformation through a practical lens. We conclude on the basis of our review that universal healthcare implies a health system designed for integrated care. Making the explicit link between universal healthcare and integrated care on the basis of the organisational challenges and opportunities inherent to both policy directions is innovative and useful for health system reformers generally. [ABSTRACT FROM AUTHOR]

Policy and System Change Context: The paper describes insights into implementation challenges associated with integrated care as a national policy component of Universal Health Care in Ireland. It addresses an international audience by linking universal and integrated care development with the policy implementation literature in complex adaptive health and social care systems. Study Design and Methods: It outlines findings from two literature reviews on change in complex health and social care systems, one of them a systematic review that situates integrated care in the universal health care policy context. We also present findings, including operational and strategic insights on the challenges and opportunities of implementing integrated care from a) a participant online survey across seven pioneer sites and at national programme level, and b) an indepth case study of integrated care implementation in Ireland over three pioneer sites. Case-data generated from November 2017 to June 2018 at national and pioneer-site levels include initial research co-design discussions, exploratory and elite interviews, workshops, documentary review, participant observation and feedback. Outline Findings: Systematic and literature review findings address methodologies, conditions and competencies for implementation (including collaboration, distributed decision-making, mindsetshifts and leadership styles in complex systems). System-level mechanisms for better patient access, information sharing, and effective functionality are also highlighted. The survey and case study research evidences similar challenges around provider skills and competencies, managing patient access and pathways, and the creation of organisational systems to underpin new service delivery designs. The question of organisational adaptability is critical here for successful system reform outcomes such as positive change management, quality of care and sustained learning for person-centered care. Practical and Policy Relevance: Learning how demonstrator (pioneer) site initiatives and discrete programmes can grow locally, as well as scale more broadly for translation as common discourses, approaches, and buy-in is critical to meet the challenges of integrated care as a key plank of universal healthcare. The paper usefully describes policy implementation challenges from a grounded, complex, wholeof- system perspective. [ABSTRACT FROM AUTHOR]

Introduction: Collaboration was legislated in the delivery of integrated care in the early 2000s in the UK. This research explored how the reality of practice met the rhetoric of collaboration. Theory: The paper is situated against a theoretical framework of structure, agency, identity and empowerment. Collectively and contextually these concepts inform the proposed model of 'collaborative agency' to sustain integrated care. The paper brings sociological theory on structure and agency to the dilemma of collaboration. Methods: Participative action research was carried out in collaborative teams that aspired to achieve integrated care for children, young people and families between 2009 and 2013. It was a part time, PhD study in collaborative practice. Results: The research established that people needed to be able to be jointly aware of their context, to make joint decisions, and jointly act in order to deliver integrated services, and proposes a model of collaborative agency derived from practitioner's experiences and integrated action research and literature on agency. The model reflects the effects of a range of structures in shaping professional identity, empowerment, and agency in a dynamic. The author proposes that the collaborative agency model will support integrated care, although this is, as yet, an untested hypothesis. [ABSTRACT FROM AUTHOR]

Background: Integrated care has gained popularity in recent decades. This study aims to explore its global progress, current foci, and future trends. Methods: We conducted a scientometric analysis. Data (including subject categories, countries/territories, institutions, journals, citations, and author keywords) were exported from the Web of Science database. Publication number and citations, co-authorship between countries and institutions, co-occurrence of author keywords and cluster analysis were calculated with Histcite12.03.07 and VOSviewer1.6.4. Results: A total of 6127 articles were retrieved from 1997 to 2016. Results indicate the following: (1) The USA, UK, and Canada led research with the most publications, citations, and productive institutions. (2) The top 10 cited papers and journals (such as BMC Health Services Research) are crucial for the knowledge distribution. (3) The 50 author keywords were clustered into five groups, including digital medicine and e-health, community health and chronic disease management, primary health care and mental health, health care system for infectious diseases, health care reform and qualitative research, social care and health policy services. Conclusions: This paper confirmed that integrated care is undergoing rapid development with more categories involved and additional collaboration networks established. Various research foci are forming like economic incentives mechanism for integration, e-health data mining, systematically quantitative study. Moreover, an urgent need exists for the development of the performance measurement for policies and models. [ABSTRACT FROM AUTHOR]

Introduction: Long-term neurological conditions are a major cause of disability in the UK and internationally. Their successful management, in order to enhance health and well-being, requires both sophisticated organisation across a number of health, social care and other service boundaries, and the real involvement of people with neurological conditions and members of their support networks. Policy development: This paper reports on part of the preliminary scoping phase of a study designed to evaluate the impact of the National Service Framework for long-term neurological conditions on integrated care. It describes current policies in England and reports on discussions with a range of people involved in the planning, provision or use of services, which took place during the scoping exercise. These interviews inform how policy affecting people with long-term neurological conditions has been received and implemented so far. Conclusion and discussion: Findings suggest that progress towards integrated service provision is patchy and slow. In the competing priorities within government policy, neurological conditions have tended to be marginalised, within healthcare policy generally and in initiatives to support people with long-term conditions in particular. The reasons for this are explored and will inform the next stages of the research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. Data sources: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. Conclusion: We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. Discussion: We conclude with suggestions for strategies that may facilitate more integrated working. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. Data sources: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. Conclusion: We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. Discussion: We conclude with suggestions for strategies that may facilitate more integrated working. [ABSTRACT FROM AUTHOR]

Community-based primary health care describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for community-based primary health care have stimulated local initiatives and influenced the design of policy solutions. However, the ways in which these ideas and influences find their way into policy and practice is strongly mediated by policy settings and institutional legacies of particular jurisdictions. This paper seeks to compare the key institutional and policy features of Ontario, Québec and New Zealand that shape the 'space available' for models of community-based primary health care to take root and develop. Our analysis suggests that two key conditions are the integration of relevant health and social sector organisations, and the range of policy levers that are available and used by governments. New Zealand has the most favourable conditions, and Ontario the least favourable. All jurisdictions, however, share a crucial barrier, namely the 'barbed-wire fence' that separates funding of medical and 'non-medical' primary care services, and the clear interests primary care doctors have in maintaining this fence. Moves in the direction of system-wide community-based primary health care require a gradual dismantling of this fence. [ABSTRACT FROM AUTHOR]