Integrated care and outcomes in patients with atrial fibrillation and comorbidities

Integrated care for management of atrial fibrillation (AF) patients has been associated with a reduction in adverse events. The ‘Atrial fibrillation Better Care (ABC) pathway’ has been proposed to streamline such integrated management. In this paper, we analysed the impact of ABC pathway adherent clinical management on outcomes in AF patients with high?risk ‘metabolic’ comorbidities (i.e. diabetes mellitus [DM], chronic kidney disease [CKD], metabolic syndrome [MetS].

Effectiveness of integrated care on delaying chronic kidney disease progression in rural communities of Thailand (ESCORT-2) trials

In developing countries, renal specialists are scarce and physician-to-patient contact time is limited. While conventional hospital-based, physician-oriented approach has been the main focus of chronic kidney disease (CKD) care, a comprehensive multidisciplinary health care program (Integrated CKD Care) has been introduced as an alternate intervention to delay CKD progression in a community population. The main objective is to assess effectiveness of Integrated CKD Care in delaying CKD progression.

Medical and Old-Age Care Integration Model and Implementation of the Integrated Care of Older People (ICOPE) in China: Opportunities and Challenges

The demand for healthy old-age care is growing rapidly in China. The traditional old-age care model can no longer meet elderly patients’ demands for medical care and old-age care. To promote the development of medical care-integrated old-age care, a solution covering multiple aspects is necessary. In the context of the global development of healthy aging, China recently issued many policies to integrate old-age care with medical care, establishing protection for a large number of disabled elderly people. The Integrated Care of Older People (ICOPE) project is an international program developed by the World Health Organization. This paper reviews China’s ...

Applying Elinor Ostrom’s Design Principles to Guide Co-Design in Health(care) Improvement: A Case Study with Citizens Returning to the Community from Jail in Los Angeles County

Increased interest in collaborative and inclusive approaches to healthcare improvement makes revisiting Elinor Ostrom’s ‘design principles’ for enabling collective management of common pool resources (CPR) in polycentric systems a timely endeavour.

Ostrom proposed a generalisable set of eight core design principles for the efficacy of groups. To consider the utility of Ostrom’s principles for the planning, delivery, and evaluation of future health(care) improvement, the autors retrospectively applied them to a recent co-design project.

Three distinct aspects of co-design were identified through consideration of the principles. These related to: (1) understanding and mapping the system (2) upholding democratic ...

Physician Assistants and Nurse Practitioners in Primary Care Plus: A Systematic Review

Shifting specialist care from the hospital to primary care/community care (also called primary care plus) is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility.

The aim of this systematic review was to get insight in primary care plus provided by physician assistants or nurse practitioners.

A Conceptual Framework for Integrated Community Care

The various health and social care services provided in a given local area (i.e., place-based) must not only deliver primary care in proximity to the population, but act upstream on the social determinants of health. This type of care, when provided in a holistic and integrated manner, aims to improve the physical and mental health—but also the well-being and social capital—of individuals, families, groups and communities. This type of approach is known as Integrated Community Care (ICC).

This article was developed from a non-systematic review of scientific and grey literature followed by a qualitative analysis and researcher ...

Tackling COPD misdiagnosis in primary care through integrated care

COPD specific integrated care services have in the past been shown to improve patients’ outcomes and reduce costs. However, tackling the issue of COPD misdiagnosis within primary care is potentially an additional purpose integrated care can serve.

Integrating Primary and Secondary Care to Enhance Chronic Disease Management: A Scoping Review

In Ireland, as in many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of chronic disease.

Integrated care is an approach to healthcare systems delivery that aims to minimise fragmentation of patient services and improve care continuity. To this end, how best to integrate primary and secondary care is a challenge.

This paper aims to undertake a scoping review of empirical work on the integration of primary and secondary care in relation to chronic disease management.

Elements and Performance Indicators of Integrated Healthcare Programmes on Chronic Diseases in Six Countries in the Asia-Pacific Region: A Scoping Review

Globally, hospital-based healthcare models targeting acute care, are not effective in addressing chronic conditions. Integrated care programmes for chronic diseases have been widely developed and implemented in Europe and North America and to a much lesser extent in the Asia-Pacific region to meet such challenges.

This scoping review aims to examine the elements of programmes identified in the literature from select study countries in the Asia-Pacific, and discuss important facilitators and barriers for design and implementation.

A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting

While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them. 

This case study describes the development and implementation of a model utilizing student volunteer community resource navigators to help patients connect with community-based organizations. The authors then detail initial implementation outcomes and practical considerations for future work.