How High-Need Patients Experience the Health Care System in Nine Countries

In this study, high-need patients are defined as those aged 65 and older with at least three chronic conditions or a functional limitation in activities of daily living. The brief analyses data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults to investigate health care use, quality, and experiences among high-need patients in nine countries (Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United States) compared with other older adults. The study found that high-need adults use more health care – especially avoidable Emergency Department visits –, experience more cost-related barriers to care, and poorly coordinated care. Given that high-need adults consume a much greater proportion of health services than other adults – for example, five percent of the U.S. adult population accounts for 50 percent of the nation’s health care costs – the brief suggests that the comparative success of some countries, particularly in reducing ...

My life, my support, my choice

In March 2015 National Voices and Think Local Act Personal issued the report titled My Life, my support, my choice, which outlines what children and young people with complex lives want coordinated care to look like. The document uses the term "complex lives” to include all children and young people who are likely to need care and support from multiple services throughout their life. The report reveals that central to their needs and preferences is the right to live the way they want, so the publication also looks at what exactly children and young people want from their lives. It does this by including a series of ‘I Statements’. For example, “I am confident that my voice is clearly heard, as distinct from those of the adults around me”. The report also outlines many interesting case studies of services which are better at reflecting the preferences of children and young ...

Physical and mental health: a new frontier for integrated care.

Traditionally, integrated care has been focused on closing the gaps between social and health care. Nevertheless, integrating mental and physical care should also be seen as a way to develop integrated care. In this report published by the King’s Fund, this topic is addressed, describing the current situation of mental and physical care and identifying ten areas where this kind of integration would be most needed:

1. Incorporating mental health into public health programmes.

2. Promoting health among people with severe mental illness.

3. Improving management of medically unexplained symptoms in primary care.

4. Strengthening primary care for the physical health needs of people with severe mental illnesses.

5. Supporting the mental health for people with long-term conditions.

6. Supporting the mental health and wellbeing for carers.

7. Supporting mental health in acute hospitals.

8. Addressing physical health in mental health inpatient facilities.

9. Providing integrated support for perinatal mental health.

10. Supporting the mental health needs of people ...

National Framework for Children and Young People’s Continuing Care

This Framework (reviewed) is intended to provide guidance for clinical commissioning groups (CCGs) when assessing the needs of children and young people whose complex needs cannot be met by universal or specialist health services. CCGs have a legal responsibility for securing to a reasonable extent the health care which an individual needs, and this guidance is about the process which should be followed for the equitable discharge of that responsibility for children and young people with complex needs. This revision takes account of the new structures of NHS commissioning created by the Health and Social Care Act 2012 and the new integrated approach to the commissioning of services for children and young people with special educational need or disability (SEND) which the Children and Families Act 2014 introduced. In particular, where a child or young person has a SEND, which will often be the case, then CCGs and local authorities ...

Integrated care – taking specialist medical care beyond the hospital walls

The Royal College of Physicians has published in 2016 a document titled “Integrated care -  taking specialist medical care beyond the hospital walls”.

In the first part of this document they are described some of the main topics about integrated care, how it is conceptualize and what it really implies for patients, professionals and for the whole system.

Afterwards, some study cases are shown as examples to go deeper into different dimensions of integrated care such as the need for sustainable models of integrated care, leadership, management and governance or self-management and care.

Finally, the document lists five key areas where physicians should focus in order to improve integrated care: (I) Ensure that the patient’s and carer’s perspective is the organising principle of service delivery across organisations, (II) Support population health and wellbeing outside the hospital walls, while offering specialist care within the hospital and being an advocate for ...

Experiencing Integrated Health: Ontarians’ views of health care coordination and communication

Health Quality Ontario (HQO) has published an analysis using data from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults in order to identify, from a patient perspective, how well different parts of health system are working together.

The HQO extracted a sample with the population from Ontario; Ontarians reported similar results as top-ranking countries in some indicators related to coordination of care; about 80% of Ontarians said they received help from their regular physicians to coordinate their care with other providers.

The sample from Ontario population made able to identify some key points where Canadian Health System can improve in order to get better communication and coordination of care.

Ten actions required to improve health, social care and well-being in Wales

Health and social care organizations from Wales joined in the Welsh NHS Confederation’s 2016 Challenge Policy Forum and the published  a document called “Ten actions required to improve health, social care and well-being in Wales", trying to establish their priorities in order to get a better system.

The ten priorities described are: long term vision, ensuring financing, planning workforce, person centred and integrated care, public health perspective, improve preventive measurements, creating a culture of honest and open communication with population, improving mental health support, ensuring equal access to health and social care and improving the use of technology.

Developing care for a changing population: Learning from GP-led organisations

The way a health system is organized may influence the care this system provides. In this Nuffield Trust report some GP-led experiences are described, analyzing what are the internal characteristics and external context that have affected GP-led progress.

The intra-organizational characteristics listed are: (I) strong links between clinical leaders and GP member practices, (II) sophisticated strategic and operational management support, (III) use of multiple forms of peer-led improvement, (IV) organizations are both entrepeneurial and pragmatic, (V) linked data between the organization’s own services and other providers.

In what concerns to external context, the three characteristics listed are: (I) a receptive context for change, (II) capability to transfer some of the commissioner role to providers through capitated budgets, (III) slow pace and short-term nature of decision-making.

The slow pace and short-term nature of decision-making in clinical commissioning groups may drive emerging organisations to focus on service developments outside of their ...

CMMI’s New Comprehensive Primary Care Plus: Its Promise And Missed Opportunities

The Center for Medicare and Medicaid Innovation (CMMI) has recently announced an initiative called Comprehensive Primary Care Plus (CPC+), evolved from the previous Comprehensive Primary Care (CPP) initiative. The initiative mainly consists on paying a fee to those primary care practices willing to introduce organizational changes centered in five primary care functions:  (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and, (5) planned care and population health.

In this post, the authors outline some of the promises and downsides of the PCC+. On the bright side, the authors analyse how financial incentives can make primary care practices introduce innovations that may lead to improvements in the quality of their clinical performance. On the other side, two main downsides are mentioned: (I) the lack of incentives to achieve good results in the care that takes place beyond the primary care services -hospital admissions ...

Development, implementation and evaluation of a nurse led integrated, person-centred care with long term conditions

This proposal outlines a conceptual plan for innovative, integrated care designed for people living with long term condicions. This conceptual plan delivers a partnership between the health system, the person with long-term conditions (chornic), their family, and the community. The partnership aims to support people at home with access to effective treatment, consistent with the New Zealand Government Health Strategy. This concept of people-owned care is provided by nurses with advance practice skills, who co-ordinate care across services, locations and multiple long-term conditions. 

Defining Coordinated Care for People with Rare Conditions: A Scoping Review

To coordinate care effectively for rare conditions, we need to understand what coordinated care means. This review aimed to define coordinated care and identify components of coordinated care within the context of rare diseases; by drawing on evidence from chronic conditions. Coordinated care is multi-faceted and has both generic and context-specific components. Findings can help to develop and eventually test different ways of coordinating care for people with rare and common chronic conditions.

Putting the ‘I’ Back into Integrated Care

Charlotte Augst, CEO of National Voices, reflects on progress with integrated care since the charity co-produced the I statements with people with lived experience of health and social care services.