Evaluation of health care delivery integration: The case of the Russian Federation

This case study explores the current state of affairs within Russia's health system providing care for increasingly complex chronic conditions from the perspective of providers, namely physicians. A survey was developed by a group of experts and later distributed by the Russian center for public opinion research in August 2012. It focused on the interactions between providers at different levels of the health system often working in different organizational models such as primary care offices, polyspecialty clinics as well as hospitals. The survey focused on three areas crucial to integration, namely: teamwork, coordination and continuity of care. The results from the survey showed that the level of integration was low by nearly every measure across the different levels of the health system. The authors note that little emphasis has been placed on this issue since the 60/70's "when quite a lot of regulation was issued on district ...

Integrated care: the importance of ICT in data sharing

In this post by Health IT Central it is analyzed how different experiences regarding people centered and integrated health systems have been developed across the world. Some studies have been able to identify what are the key elements to succeed when performing integrated health care; these factors are rethinking clinical models, achieving a cultural change, enforcing collaborative multidisciplinary working and improving the way patient information is shared. In this post, the author focuses on how important patient information sharing is to make integrated services experiences succeed, being a core factor in continuity of care and becoming a barrier when data sharing is not successfully achieved. According to the author’s opinion, the regulation recently approved by the European Union regarding data protection will make easier data sharing, allowing care to be delivered in a more effective and integrated manner.

Understanding integrated care: a complex process, a fundamental principle

Recent Editorial in the International Journal on Integrated Care, written by Nick Goodwin, emphasising the importance of the Framework. Around the past year Nick Goodwin has been involved in a range of research and development activities that seek to understand and/or promote the successful adoption of integrated care. In each of these, a common opening statement from protagonists is to typically say that “there is no universally accepted definition of integrated care, no one model of care that can be replicated locally, and little evidence to tell us that it works”. Whilst the latter might be disputed it remains true that people struggle with what integrated care means and particularly how it can be applied.

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The Value of Continuity between Primary Care and Surgical Care in Colon Cancer

Improving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs.Receiving primary care and surgical care at the same hospital, compared to different hospitals, was associated with lower costs but still similar survival among stage I-III colon cancer patients. Nonetheless, health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will need to address the significant proportion of patients receiving health care across more than one hospital.

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 

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 across the spectrum of care. 

New models of home care

Policy-makers have outlined their ambitions to provide joined-up care closer to home and enable people to remain independent and in their own homes. Home care will be a central component of realising these ambitions. However, there are serious concerns about the state of the home care market
and the quality of care service users receive.
In this case, the present report summarises the evidence on innovations and models of home care that demonstrate potential in the following key opportunity areas:
1. Technology and digital
2. Co-ordinated care planning
3. Recruitment and retention
4. Autonomous team working
5. Alternative approaches to commissioning
6. Personalisation
7. Integrated care approaches
8. Community assets and connections
9. Family-based support and communal living
.

Continuity of care and referral rate: challenges for the future of health care

Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties. The aim was to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

Continuity of care and referral rate: challenges for the future of health care

As health care costs rise, an increasingly greater proportion of the gross domestic product is spent on health care. In this context, Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties.

The aim of this study was to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

Integrated care for healthcare sustainability for patients living with rare diseases

The increasingly complex and multidimensional care request, combined with the presence of increasingly aware and demanding patients, accentuates the need for new strategies to preserve health systems economic sustainability. Therefore, integration mechanisms reveal an essential condition for ensuring continuity of care. The paper reviews the main literature available on the integration of heal services and relates it to rare diseases.

The literature identifies several system levers for the effective design and implementation of integrated care frameworks, namely: political support and commitment, governance, stakeholder engagement, organisational change, leadership, collaboration and trust, workforce education and training, patient empowerment, financing and incentives, ICT infrastructure and solutions, monitoring and evaluation system.

Thinking outside the system: the integrated care experience in Queensland, Australia

Health policy-makers are faced with a demand for health care that exceeds supply, driven in part by an ageing population and an increased prevalence of chronic disease. An integrated ‘people-centred’ model of care across primary, secondary and tertiary health care can strengthen the health system by streamlining services to improve the patient journey and outcomes.

Driving and Accelerating a ‘One System’ Response: Why COVID-19 has Shone a Spotlight on Integrated Care

Building integrated care as the cornerstone of our new reality

This webinar allowed decision makers and managers in health and health care to learn about the integrated care approaches that have been implemented and the considerations that have been made to address the continuum of care and support needs of individuals, beyond public health issues and crisis management.

Communication, Collaboration and Care Coordination: The Three-Point Guide to Cancer Care Provision for Aboriginal and Torres Strait Islander Australians

Pathways for accessing cancer care for Indigenous Australians can be more complex than for other Australians, with additional challenges for them relating to culture, language, and lack of familiarity with navigating services and institutions in the wider health care system. Besides coming to terms with a cancer diagnosis, accessing diagnostic and cancer treatment often involves travel and being away from home for extended periods of time. Cancer care also often involves accessing multiple healthcare providers (e.g. radiation oncologists, surgeons, pathology services) and across a range of settings.

The World Health Organisation (WHO) developed the framework on integrated people-centred health services (IPCHS) recommending a fundamental shift of health systems from being disease-focused to people-focused. The framework identifies the primary drivers of continuity and coordination of care. Continuity of care promotes an environment to develop ongoing relationships that support seamless interactions between service providers within and across sectors that enable coordination ...

Integrated delivery and continuity of care in times of crisis

Ensuring continuity of care in response to the Covid-19 crisis has been a key issue for public health and social care services across Europe. Whilst the implementation of local partnerships for integrated care delivery have been identified as a success factor, in many cases the reality on the ground has been one of a fragmented market. One, where providers of home care, residential care and supported living have been under pressure due to the lack of protective equipment, the fear of infection, and a reduction in the number of professionals.

Still a fragmented un-resourced system

In light of the Covid-19 crisis, care services have been reaping a bitter harvest of years of failure to invest adequately in public health and social care systems. While older people’s care services have been affected across Europe, the situation has been particularly difficult in two countries: the UK and Spain.

In Spain, the ...

Learning from Gothenburg model of person centred healthcare

Providing person centred care is a growing imperative across healthcare. The core component of person centred care is the co-creation of care through partnership between patients, their families and carers, and health professionals. While much of the recent literature has focused on why we need to change to a more person centred approach with greater involvement of patients and the public in health and healthcare, little information is available on how to do it and whether it makes any difference. Over the past 10 years a model of person centred care has been studied and implemented in Sweden and has shown promising results. By providing practical insights from a successful initiative that has spread both nationally and internationally, we hope to offer lessons for readers elsewhere.

Integrated older people care and advanced practice nursing: an evidence-based review.

The world's population is aging rapidly. This is a fact, and the demand for services adapted to this new reality is increasingly necessary. The World Health Organization has proposed an integrative strategy centered on people. Here present a systematic review of strategies that address the care of older adults with the integrated care-centered approach to people.

Telemonitoring and continuity of care for older subjects: comparing experience an identifying common solutions

The COVID19 pandemic highlighted some structural – organizational and cultural – limitations of our dominant model of (health)care. One of these is the need to identify and adopt newer instruments for the continuity of care for the large number of patients with chronic disease who live in low-density population areas  (200 million or 27% of EU population) and experience inequality to access (health)care because of the distance between community and healthcare structures. Notably, the onset of multimorbidity occurs 10–15 years earlier in people living in the most deprived areas compared with the most a?uent.

The Workshop aims at facilitating knowledge acquisition (including existing Projects and adopted solutions) and at fostering collaboration and standardization of best practice, including health literacy and patients and caregivers empowerment, in order to impact on the adoption of innovative digital solutions able to boost people's health and quality of life and enable more ...

Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study

Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home.

This protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning ...

Factors supporting the implementation of integrated care between physical and mental health services: an integrative review

In Australia and internationally there is a strong policy commitment to the redesign of health services toward integrated physical and mental health care. When executed well, integrated care has been demonstrated to improve the access to, clinical outcomes from, and quality of care while reducing overtreatment and duplication. Despite the demonstrated effectiveness and promise of integrated care, exactly how integrated care is best achieved remains less clear. The aim of this review study was to identify factors that support the implementation of integrated care between physical and mental health services. An integrative review was conducted following the framework developed by Whittemore and Knafl, with quantitative and qualitative evidence systematically considered. To identify studies, Medline, PubMed, PsychINFO, CINAHL were searched for the period from 2003 to 2018, and reference lists of included studies and review articles were examined. Nineteen studies were included. Synthesis of study findings identified seven key factors supporting ...

Addressing Common Challenges in the Implementation of Collaborative Care for Mental Health: The Penn Integrated Care Program

The purpose of this article was to develop and implement a new model of collaborative care that includes a triage and referral management system. The authors present initial implementation metrics using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.  

Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review

Millions of people worldwide have complex health and social care needs. Care coordination for these patients is a core dimension of integrated care and a key responsibility for primary healthcare. Registered nurses play a substantial role in care coordination.

This review draws on previous theoretical work and provides a synthesis of care coordination interventions as operationalized by nurses for complex patient populations in primary healthcare.

Transitional Care Experiences of Patients with Hip Fracture Across Different Health Care Settings

Transitions of care often result in fragmented care, leading to unmet patient needs and poor satisfaction with care, especially in patients with multiple chronic conditions.

This project aimed to understand how experiences of patients with hip fracture, caregivers, and healthcare providers differ across different points of transition.

What matters to older adults? Exploring person-centred care during and after transitions between hospital and home

Although facilitating person-centred care (PCC) has gained increasing importance globally over the last few decades, its practical implementation has been challenging. This has caused difficulties in determining its core elements and best practices. Person-centred care aims to deliver healthcare services based on individuals' preferences. To participate in their own health issues, older people need to be empowered and better informed about the importance and scope of person-centred care. 'What Matters to You?' is a good focus for the direction of care but can lead to a simplified understanding of individuals' preferences. Increased focus on how care recipients' capabilities and resources affect their responding is needed.

Continuity of Care and Healthcare Costs among Patients with Chronic Disease: Evidence from Primary Care Settings in China

Though critical to primary care, continuity of care has rarely been examined in China. This study aims to assess the relationship between continuity of care and healthcare costs among patients with chronic diseases within primary care settings in China.

Components and Outcomes in Under-and Postgraduate Medical Education to Prepare for the Delivery of Integrated Care for the Elderly: A Scoping Review

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.

Primary health care case studies in the context of the COVID-19 pandemic

Overview