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 ...

The Right Medicine: Improving Care in Care Homes.

The increase of polypharmacy together with the population aging is making care homes a central point to develop health care programmes, specially related to medicines management and integration of different health care proffessionals.

The Royal Pharmaceutical Society has recently published a report addressing the main issues of medicine use in care homes. The needs identified by the authors include developing better communication systems, reducing falls in care homes, decreasing inappropriate use of psychotropic medicines, improving coordinated end of life care and lowering waste of medicines at home.

The report includes some recommendations such as giving pharmacists a major role in care homes medicine management, strengthening coordination between physicians and pharmacists or developing programmes of regular medicines review and staff training in integrated teams with other practitioners.

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 ...

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.

Integrating health care and housing to promote healthy aging.

In recent decades, the influence between health status and social conditions has been broadly studied; one of the conditions that has been strongly linked to health status has been housing.

Population ageing and the increase of chronic conditions are two of the drivers that have made that housing conditions become an important factor influencing health.

Many different proposals have been made regarding home care, most of them trying to take hospital care to patient’s home; in this post, some different aspects are discussed, mainly related to what Medicare could do in order to improve housing conditions and its influence in patient’s health: (I) increasing the emphasis on vulnerable population covered by Medicare’s Publicly Assisted Housing Programme, (II) tackling elderly falls as a main health problem and striving to reach the Health People 2020 goal of a 10 percent reduction in the rate of emergency-department visits due to ...

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 ...

Reshaping the workforce to deliver the care patients need

Workforce structure is one of the most difficult things to modulate in health systems. Current transition to new models of care could be a good opportunity to make workforce structure match actual needs of systems and populations. In this report, published by the Nuffield Trust, it is analyzed how organizations could reshape their current workforce and what the benefits would be:

There is a need to evolve from an illness-based system to a patient-centred system.
Workforce should meet future needs by incorporating professionals with a vision aligned with future models of care.
There are opportunities to develop the current workforce at all grades: from redeploying support staff, extending the skills of registered professionals and training advanced practitioners.
There is good evidence that support workers can provide good-quality, patient-focused care as well as reduce the workload of more highly qualified staff. Investment here could provide a cost-effective and rapid solution to ...

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 ...

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 ...

Governance for new care models

Dr Rachael Addicott, Senior Research Fellow from The King’s Fund, discussed about her research into governance for new care models during the event on Multi-specialty community providers and primary and acute care systems (7 June 2016)

If you are interested in other presentations from this event, click here

Governance for new care models

Dr Rachael Addicott, Senior Research Fellow from The King’s Fund, discussed about her research into governance for new care models during the event on Multi-specialty community providers and primary and acute care systems (7 June 2016)

If you are interested in other presentations from this event, click here

Addressing the continuum of maternal and newborn care in Ghana: implications for policy and practice

In Ghana, nearly 50% of under-five mortality in 2014 could be attributed to deaths during the first 28 days after birth. This article analyses the data across a mixed-methods study of the factors impacting maternal and neonatal care in northern Ghana. Resulting recommendations include the need to improving clinicians’ understanding of and sensitization to local traditional practices, the need for policies to better address quality of care and coordination of training efforts, and the need for comprehensive, integrated programmes that ensure continuity of care from pre-pregnancy through the post-partum period.

Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities

Since the release of the Institute of Medicine report: From cancer patient to cancer survivor: lost in transition, in 2005, there has been a national call in the USA to provide coordinated, comprehensive care for cancer survivors, with an emphasis on the role of primary care. Several models of care have been described, which focus on primary care providers (PCPs) as receiving cancer survivors who are transferred after successful treatment, and who are given specific types of information from oncology-based care (eg, survivorship care plans), and not as active members of the cancer survivorship team. They provide recommendations for education, clinical practice, research, and policy initiatives that might advance the integration of PCPs in the care of cancer survivors in diverse clinical settings.

Digital Technologies Supporting Person-Centered Integrated Care – A Perspective

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 coordinate and individualized care. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to stregthen African health systems in order to address communicable and non-communicable diseases. The aim of this article was to assess the position of civil society-led community home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demand arise. 

Development and Testing of the Provider and Staff Perceptions of Integrated Care (PSPIC) Survey

This article discusses development and testing of the Provider and Staff Perceptions of Integrated Care Survey, a 21-item questionnaire, informed by Singer and colleagues’ seven-construct framework. Questionnaires were sent to 2,936 providers and staff at 100 federally qualified health centers and other safety net clinics in 10 Midwestern U.S. states. Item analyses, exploratory factor analysis, and confirmatory factor analysis were undertaken.

WHO launches an innovative package of tools to support person-centred and integrated care for older people

On the International Day of the Older Person (1st October) the World Health Organization (WHO) released a package of tools to support the implementation of the Integrated Care for Older People (ICOPE) approach.

ICOPE, based on the WHO Framework on integrated people-centred health services, has been developed in the context of populations around the world ageing rapidly. It enables health and long-term care systems-and the services within them-to respond optimally to the unique, varied and often complex needs of older people.

The package of tools includes: the ICOPE Implementation Framework (guidance for policy makers and programme managers to assess and measure the capacity of services and systems to deliver integrated care at the community level); the ICOPE Handbook, which describes practical care pathways to detect declines in intrinsic capacity and develop personalised care plans; and the ICOPE handbook App, which helps implement ICOPE in community care settings.

Access ICOPE tools ...

Integrated Care for Older People (ICOPE)

How to adapt person-centered health services to ageing populations?

Every older person, everywhere, should have access to high quality and person-centred health services. That's why the World Health Organization has published guidelines on Integrated Care for Older People.

Learn more here: https://www.who.int/ageing/health-systems/icope/en/ and here: https://www.who.int/ageing/publications/guidelines-icope/en/

Populations around the world are rapidly ageing. It will increase demand for primary health care and long-term care, require a larger and better trained health workforce and intensify the need for age-friendly environments. These investments can enable the many contributions of older people – whether it be within their family, to their local community or to society more broadly. Universal health coverage for older people means quality health services that are integrated and person-centered.

Societies that adapt to this changing demographic and invest in Healthy Ageing can enable individuals to live both longer and healthier lives and for societies to ...

Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems

Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals

The “Patient-centered coordination by a care team” questionnaire achieves satisfactory validity and reliability

Increasing prevalence of chronic conditions and multimorbidity challenges health care systems and calls for patient-centered coordination of care. Implementation and evaluation of health policies focusing on the development of patient-centered coordination of care needs valid instruments measuring this dimension of care. The aim of this validation study was to assess the psychometric properties of the French version of the 14-item Patient-Centered Coordination by a Care Team (PCCCT) questionnaire in a primary care setting. 

Families as Partners: Co-design of a localised model of care for children with medical complexity living in rural Australia and evaluation using the Paediatric Integrated Care Survey (PICS)

The number of children with medical complexity (CMC) residing in regional Australia is growing, challenging the health system to provide equitable care. Families of CMC experience problems in accessing appropriate care locally and they have high out-of-pocket costs and family disruptions because of long travel distances to access care in metropolitan paediatric hospitals.  The Murrumbidgee Local Health District (MLHD) in collaboration with the Sydney Children’s Hospitals Network (SCHN) partnered with families and local services to co-design a Model of Care (MoC) which better reflects the needs of CMC, their families and local services. The MoC was co-designed with families, local healthcare providers and the tertiary paediatric network.

Care coordination in the health-care service delivery: an elderly care perspective

The purpose of this study is to assess the relationship between patient-centricity, care coordination and delivery of quality care for older people with multiple chronic conditions. Care coordination is defined as a process where physicians, nurses and allied professionals work together to clarify responsibilities, care objectives, treatment plans and discharge plans for delivery of unified care. Patient-centricity is defined as an approach of delivering quality care to patients that focuses on creating a positive experience for them.

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.

Case Management - Making a Unique Contribution to Integrated Care

The International Foundation for Integrated Care Australia (IFIC Australia) is going to introduce their second Webinar series. The core mission of IFIC Australia is to develop capacity and capabilities in Australia and the Asia Pacific Region in the design and delivery of integrated care. IFIC Australia seeks to achieve this by providing a platform to develop and exchange ideas and promote activities in the region in keeping with IFIC’s mission.

In this case, this webinar will explain case management as a care coordination strategy for individuals. Quality analysis and macro to micro practice issues are explored through examples.

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 Care and Geriatrics: A Call to Renovation from the COVID-19 Pandemic

We are experiencing an unprecedented demographic change, in terms of speed. The population over 65 years of age corresponds to approximately 9% of the world population (Population Division of the Department of Economics and Social Affairs of the United Nations).
We know that the elderly population has a high risk of suffering from serious diseases.

Long-term care facilities (LTCFs) of geriatric care has been traditionally marginalized within healthcare networks. LTCFs have constantly been living in the ambiguity that their residential nature does not fit with the relevant clinical burden of care of their frail and complex residents.

Covid 19 presents us with a challenge: to establish an integrated system that includes LTFCs. This editorial makes a call to which we must go.

Canadian Quality and Patient Safety Framework for Health Services: Communications Toolkit

The Canadian Patient Safety Institute (CPSI) and Health Standards Organization (HSO), with the dedicated support of hundreds of stakeholders across Canada, recognized the need for a greater commitment to quality and safety improvement. We are pleased to share the Canadian Quality and Patient Safety Framework for Health Services, the first of its kind in Canada. By committing to improving quality and patient safety, we can achieve better health care for all.

Be sure to take full advantage of all the communications tools and resources in this package:

Five Goals to Align Canada on Patient Safety and Quality Improvement

This people-centred framework defines five goal areas designed to drive improvement and to align Canadian legislation, regulations, standards, organizational policies, and public engagement on patient safety and quality improvement.

Goal 1 | People-Centred Care

People using health services are equal partners in planning, developing, and monitoring care to make sure it meets ...

The long-term impacts of new care models on hospital use: An evaluation of the Integrated Care Transformation Programme in Mid-Nottinghamshire

In this briefing, the Improvement Analytics Unit – a partnership between the Health Foundation and NHS England and NHS Improvement – has found evidence that integrated care programmes have the potential to reduce hospital utilisation and that the best results are delivered when new ways of working start to become embedded.   

It is important that the analysis was?able to?look?at the impact of the programme?over such a long time. Integrated care programmes usually aim to reduce hospital admissions, however previous?evaluations?were not able to demonstrate?whether reductions in hospital use might begin to materialise over a longer period.?This briefing?provides?promising evidence that integrated care programmes have the potential to reduce hospital use over the longer?term, even if there are increases in the short-term.? 

The briefing also underlines the importance of ongoing evaluation when implementing new ways of delivering care. Having a mechanism for robust evaluation ...

Developing family medicine and primary care worldwide through global collaboration and co-learning

The COVID-19 pandemic represents one of the rare health emergencies that all humans on our planet have experienced simultaneously.   Global news feeds provide us with near instantaneous updates regarding case numbers and disease impacts that not only affect our immediate community, but also other communities and contexts worldwide.  In this sense, COVID-19 has truly highlighted our experience as global citizens.

Primary care (in its various global iterations, such as family medicine and general practice) is increasingly recognized as a keystone for improving health outcomes worldwide.  Most certainly, we are beginning to see the converse impact that the pandemic has had on the practice of primary care.  Earlier this year the Canadian Family Physician blog highlighted this experience through a podcast series developed by Dr. Christine Gibson with the support of the Besrour Centre for Global Family Medicine.  Representing family physicians and primary care educators from 11 countries, these podcast narratives ...

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.  

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.

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 ...

Social workers coordination in primary healthcare for patients with complex needs: A scoping review

Care coordination has been part of social work for some time. It has been recognized as contributing to care coordination for long-term care for the elderly and mental health but less is known about their contribution in primary care with patients with complex health and social needs. As social workers are increasingly present in primary healthcare, this scoping review aims to provide a synthesis of social workers’ coordination activities for patients with complex needs in primary healthcare.

Primary Care for Everyone: An Urgent To-Do List for Reform

Worldwide, the health systems with the best outcomes are the ones that get primary care right. Canada’s federal, provincial and territorial governments are recognizing the critical importance of improving primary care in their recent funding agreements.

The time for bold action is now. New federal funding is entering the system as bilateral agreements are being signed with provinces and territories. “Family health” is front and centre, with all levels of government and people across the country on the same page. It’s time to supercharge the reform.

The Public Policy Forum’s Taking Back Health Care project is a year-long initiative to assemble and promote the best thinking about actions necessary to address Canada’s health-care crisis. This paper is the second in a series of commentaries that the project is producing. The first paper, Taking Back Health Care: How to Accelerate People-Centred Reform Now, was an overview of ...