Acute hospitals and integrated care

In March 2015, the King’s Fund published a report regarding the progress made by five acute hospital providers in England towards developing more integrated models of care. According to the report, becoming more closely integrated with primary care has proved a considerable challenge for these hospitals. This is partly due to the lack of alternatives to building relationships on a practice-by-practice basis. As the report explains, GP provider groups or federations “are still at an early stage of development in many areas of the country, and where they do exist it is not always clear that they are sufficiently cohesive to represent local practices and have leverage over them”. 

However, the report identifies a number of factors which facilitate the coordination between hospitals and primary care. These include strong clinical leadership in general practice; employing people with a primary care background at a senior level within the acute provider ...

Reaching the poor with health interventions: programme-incidence analysis of seven randomised trials of women’s groups to reduce newborn mortality in Asia and Africa

Background Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa.

Methods We conducted a secondary analysis of seven randomised trials of participatory women’s groups to reduce newborn mortality in India, Bangladesh, Nepal and Malawi. We analysed data on 70 574 pregnancies. Socioeconomic and sociodemographic differences in group attendance were tested using logistic regression. Qualitative data were collected at each trial site (225 focus groups, 20 interviews) to understand our results.

Results Socioeconomic differences in women’s group attendance were small, except for occasional lower attendance by elites. Sociodemographic differences were large, with lower attendance by young primigravid women in African as well as in South Asian sites. The intervention was considered relevant ...

Can hospital services work in primary care settings?

In this post, the author analyzes how recent changes in primary care in the National Health Services could face the purpose of moving some services from hospital to primary care settings.

The author bases her discussion on a report published by RAND corporation (“Outpatient Services and Primary Care”) that identifies five main areas to be considered when moving services from hospital to primary care:

1. Transfer: The substitution of services delivered by specialists for services delivered by primary care clinicians.
2. Relocation: Shifting the venue of specialist care from hospitals to primary care settings.
3. Liaison: Joint working between specialists and primary care clinicians to provide care to individual patients.
4. Professional behaviour change: Changing the way GPs refer patients to specialists.
5. Patient behaviour change: Helping patients make informed decisions about their care.

There is not a unique way of moving these services; many studies suggest that patients’ satisfaction usually grows when services are ...

Generate a New Conversation: Healthy Homes in Iowa Shares Goals with Housing and Healthcare Providers

Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was held in May 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health.

One highlight of the meeting was interviewing community collaborations funded by The BUILD Health Challenge. The BUILD Health Challenge is a national awards program designed to support community collaborations that are working to give everyone a fair chance to be healthy.

Video Overview

Healthy Homes Des Moines is working to prevent and manage pediatric asthma caused by deteriorating homes, below standard HVAC systems, and pests. In these case, the key health problem is the condition of the housing.

About the Practical Playbook National Meeting

Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the Practical Playbook National Meeting to help catalyze a national movement, accelerate collaborations ...

Generate a New Conversation: Healthy Homes in Iowa Shares Goals with Housing and Healthcare Providers

Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was held in May 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health.

One highlight of the meeting was interviewing community collaborations funded by The BUILD Health Challenge. The BUILD Health Challenge is a national awards program designed to support community collaborations that are working to give everyone a fair chance to be healthy.

Video Overview

Healthy Homes Des Moines is working to prevent and manage pediatric asthma caused by deteriorating homes, below standard HVAC systems, and pests. In these case, the key health problem is the condition of the housing.

About the Practical Playbook National Meeting

Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the Practical Playbook National Meeting to help catalyze a national movement, accelerate collaborations ...

Better transfers of care for older people: How to improve transitions from hospital

Drawing on the findings from recent reports by The King’s Fund, Healthwatch England, the National Audit Office, the Care Quality Commission and the Parliamentary and Health Services Ombudsman (PHSO), this event will explore new ways of ensuring older people experience a safe, appropriate and timely discharge that is right for them and their health needs. In this event you will discover good practice examples in health, local government, social care, community services and housing and learn how services can plan ahead across their whole populations to proactively manage those most at risk.

People powered primary care: learning from Halton

A community-centred approach to health called Community Wellbeing Practices (CWP) is being to patients at all 17 GP Practices in Halton in order to respond more appropriately to patients´social needs which are often an underlying reason for their presentation at primary care services. 

Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care

This study analysed the clinical impact of a home-based intermediate Care model in the Catalan health system, comparing it with usual bed-based care to check if the extended CGA-based hospital-at-home programme has an association with shorter stay and favourable clinical outcomes and if is needed to do studies to test this intervention to the whole Catalan integrated care system. 

Digital Health and Care Congress 2017. Embedding technology in health and social care.

NHS England's Next steps on the five year forward view outlines the plan to harness technology and innovation over the next two years but what's really happening on the ground? Join us at this two-day event to hear the latest policy updates and learn from case studies showcasing best practice from around the country.

An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa

A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome and articulation with other services acrross the spectrum of care 

Developing accountable care systems: lessons from Canterbury, New Zealand

The health system in Canterbury, New Zealand, has undertaken a significant programme of transformation over the past decade. As a result of the changes, the health system is supporting more people in their homes and communities and has moderated demand for hospital care, particularly among older people. Change was achieved through developing a number of new delivery models, which involve better integration of care across organisational and service boundaries, increased investment in community-based services, and strengthening primary care. The experience in Canterbury offers useful lessons for the NHS in terms of how to redesign care in this way. Key approaches include the development of a clear, unifying vision of ‘one system, one budget’; sustained investment in giving staff skills to support them to innovate and giving them permission to do so; and developing new models of integrated working and new forms of contracting to support this. The transformation has taken ...

Community health services: Shifting the focus to out-of-hospital care (The Kings Fund)

This one day conference will look at how the health and care system can make the best possible use of community health services to meet the changing needs of the population.

The conference is aimed at:

people working at a local strategic level who want to know how they can shift the focus of care from hospitals to community services – in line with the requirements set out in the NHS five year forward view

people working in community health services that have responsibility for designing services for their population.

Despite a long history of policy initiatives about moving care from hospital to community services, there has not yet been a step-change in the focus of delivery.

Come to the event to find out what new changes are happening nationally to enable community services to take up their role in an integrated health and care system.

Learn from evidence-based examples and ...

How to assess and prepare health systems in low- and middle-income countries for integration of services—a systematic review

Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle- income countries (LMICs). This article adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for capacity to implement integrated services. 

Reimagining community services: making the most of our assets

The purpose of this research was to understand the current state of community services and to explore how the health and care systems needs to change to enable these to meet the needs of the population now and in the future

Communities and health

The role of communities in improving health is receiving increasing, and long overdue, attention in health policy and practice. Stronger recognition of the role communities can play and greater involvement are needed if there is to be a successful move to population health systems. As part of this shift in focus, sustainability and transformation partnerships and integrated care systems need to take the role communities can play in improving and sustaining good health seriously. 

Coordinating Mental and Physical Health Care in Rural Australia: An Integrated Model for Primary Care Settings

The "GP Clinic" providers primary health care to people using community mental health services in a small town in Australia. This article examines the factors that have driven successful integration in this rural location. Integrated physical and mental health service models that focus on building local service provider relationships and are responsive to community needs and outcomes may be more beneficial in rural settings than top down approaches that focus on policies, formal structures, and governance. 

Scaling community-based services in Gauteng, South Africa: A comparison of three workforce-planning scenarios

The introduction of community-based services through community health workers is an opportunity to redefine the approach and practice of primary health care. Based on bestpractice community oriented primary care (COPC), a COPC planning toolkit has been developed to model the creation of a community-based tier in an integrated district health system

Why high tech needs high touch: Supporting continuity of community primary health care

Integrated care through community-oriented primary care (COPC) deployed through municipal teams of community health workers (CHWs) has been part of health reform in South Africa since 2011. The role of COPC and integration of information and communication technology (ICT) information to improve patient health and access to care, require a better understanding of patient social behaviour. These study sought to understand how COPC with CHWs visiting households offering health education can support antenatal follow-up and what the barriers for access to care would be

The King's Fund integrated care summit 2018

As the national rhetoric focuses on supporting the delivery of population health and integrated care, different models of care and new ways of working are being implemented across England. While integrated care systems (ICSs) are emerging to lead on planning and commissioning care for their populations, providers are also working together to deliver integrated care locally. 

Public involvement in health research systems: a governance framework

Growing interest in public involvement in health research has led to organisational and policy change. Additionally, an emerging body of policy-oriented scholarship has begun to identify the organisational and network arrangements that shape public involvement activity. Such developments suggest the need to clearly conceptualise and characterise public involvement in health research in terms of governance.

Civil society participation in global public private partnerships for health

The growth of global public-private partnerships for health has opened up new spaces for civil society participation in global health governance. Such participation is often justified by the claim that civil society organizations, because of their independence and links to communities, can help address democratic deficits in global-level decision-making processes. This article examines the notion of ‘civil society engagement’ within major public–private partnerships for health, where civil society is often said to play a particularly important role in mediating between public and private spheres.

The core components of Community Paramedicine – integrated care in primary care setting: a scoping review

Since the beginning of 2000, the primary healthcare services around the globe are challenged between demands of home care and number of staff delivering it. The delivery of healthcare needs new models to reduce the costs, patient's readmission and increase their possibilities to stay at home. Several paramedicine programmes have been developed to deliver home care as an integral part of the local healthcare system. The programmes varied in nature and the concept of Community Paramedicine (CP) has not been established, demanding clarity. The aim of this review was to identify and describe the core components of CP, and identify research gaps for the further study.

Integrated care workforce development: university-community collaboration

Behavioral health workforce shortages to provide quality care services for children, adolescents, and transitional age youth are well established. This paper highlights the workforce shortage and the need to infuse interprofessional education to engage in integrated care for children, adolescents and transitional age youth with behavioral health needs. 

Towards Integrated People-centered Maternal, Newborn, and Child Health Care in Mali

The World Health Organization (WHO), through its Framework on integrated people-centred health services adopted by Member States in 2016, has called for a fundamental shift in the way health services are funded, managed, and delivered.

In Mali, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project has been working with the Ministry of Health since 2013 to contribute to reducing maternal, neonatal, and child mortality and morbidity. As part of ASSIST’s larger partnership with WHO to contribute to the development of IPCHS in different contexts and settings to promote learning, the project proposed to conduct a pilot project in Mali to assess the promotion of people-centered approaches in clinical consultations by health providers during pregnancy and delivery at peripheral health centers.

Evaluating Integrated Care for Children: A Clarion Call or a Call for Clarity?

“Integrated care” is often used to describe concepts such as coordinated and seamless care instead of the often fragmented and episode care that patients receive. Integrated care reflects the aspirations of modern health care systems and receives significant academic attention. 

This review is about what extent integration is an intervention in need of evaluation or simply a key health system outcome, as has been proposed for the medical home.

General practitioners’ views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study

Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented.

The aim of this study was to investigate how PROMs are currently being used in primary care, the barriers and facilitators of this use and if appropriate how it might be optimised.

More that unites us than divides us? A qualitative study of integration of community health and social care services

The integration of community health and social care services has been widely promoted in the UK as a vital step to improve patient-centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors.

This study describes how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities.

The aim of this research was to identify the context and the factors enabling and hindering integration from a qualitative process evaluation.

1st All-Ireland Conference on Integrated Care “Transforming Health and Social Care across Ireland: Delivering Lifelong People-centred Care”

IFIC Ireland in association with the International Foundation for Integrated Care (IFIC) presents “Transforming Health and Social Care across Ireland: Delivering Lifelong People-centred Care” on Thursday, 10 March 2022 in O’Reilly Hall University College Dublin. 

The forum is attended by up to 300 delegates from across the island of Ireland and includes Health and Social Care Services Mangers, Clinicians and System leads, Academics leading in the field of integrated care, and a wide range of not for profit patient representative organisations and private sector providers of care services. 

A number of policy frameworks have recently been developed to support the movement towards a more coordinated and holistic approach to improving population across the island of Ireland. The?Sla?intecare?report, a ten-year strategy for health care and health policy in Ireland, emphasises the importance of integrated care and shifting care out of hospitals and into the primary and community ...

Integrated Care Matters: Webinar Series 7: Proactive, Personalised Digital Care and Support in collaboration with Scotland’s Digifest22

IFIC Scotland and partners are delighted to announce the first webinar in our Integrated Care Matters Series 7. This series will consider innovations in holistic and personalised approaches to integrated care and support.

Each webinar will be accompanied by a topic resource with links to further information. All who register will receive links to the recordings and topic resources.