Understanding and Evaluating the Implementation on Integrated Care: A "Three Pipe Problem"

Altought we have come a long way in being able to articulate the key building blocks of integrated care, the interplay between them is so complex and interwined that it seems an impossible challenge to create any simple implementation model. Yet, if integrated care is to advance, we must become better at smoothing over the many obstacles and challenges to implementation that have bedevilled the uptake and roll-out of even the most proven of integrated care interventions.

This is quite the "three-pipe problem" for integrated care since science has yet to make the real breakthrough to address how we might ...

Integrated Care: A Pill for All Ills?

There is an increasing policy emphasis on the integration of care, both within the healthcare sector and also between the health and social care sectors, with the simple aim of ensuring that individuals get the right care, in the right place, at the right time. However, implementin this simple aim si rather more complex. In this editorial, they seek to make sense of this complexity and ask: what does integrated care mean in practice? What are the mechanims by which it is expected to achieve its aim? And what is the nature of the evidence base around the outcomes delivered?

Space, time and demographic change: A geographical approach to integrating health and social care

The purpose of this paper is to explore the potential value of applying spatial science and technology to the issue of care integration across what are the often fragmented domains of health and social care provision. The issue of focus for this purpose is population ageing because it challenges existeing information and practice silos. Better integration, the author proposes, needs to adopt a geographic approach to deal with the challenges that population ageing present to health and social care as they currently function in many countries. 

Integrated care in practice- the South Eastern Sydney Experience

The purpose of this paper is to describe the recent efforts of a large publicly funded healthcare organisation in sidney, Australia to implement the IC "at scale and pace" in the messy, real world context of a District Health Service. The paper outlines the theoretical and practical considerations used to design and develop a localised IC Strategy informed by the “House of Care” model (NHS England, 2016). The need for cross-agency partnership, a shared narrative, joint leadership and an IC Strategy underpinned by proven theoretical models model is described. This paper highlights key factors relating to implementation and evaluation of ...

The Digital House of Care: Information solutions for integrated care

This paper draws on the recent experience of achieving large-scale data integration accross the boundaries of health and social care, to help plan and commission services more effectively. The purpose is to describe the development of a digital tool in an English county stiving towards a vision of integrated information that is used to underpin and increasingly integrated future of health and social care delivery. 

User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits.

Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits.

OBJECTIVE:

Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization.

METHODS:

We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care ...

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 ...

Integrated Diabetes Care: A Multidisciplinary Approach

Integrated care is an approach that seeks to improve the quality of care for people with diabetes by ensuring that services are well coordinated around their needs. Healthcare professionals, people with diabetes and the system must be aligned to support improvement both in the delivery of care and in achieving better outcomes for people with diabetes.

People-centred integration in a refugee primary care service: A complex adaptive systems perspective

Services for refugees and asylum seekers frequently experience gaps in delivery and access, poor coordination, and service stress. The purpose of this paper is to examine the approach to integrated care within Companion House (CH), a refugee primary care service, whose service mix includes counselling, medical care, community development, and advocacy. CH has created fluid links between teams, and encouraged open dialogue with client populations. There is a high level of networking between staff, much of it informal. This is underpinned by horizontal management and staff commitment to a shared mission and an ethos of mutual respect. The clinical teams ...

Tenacious assumptions of person-centred care? Exploring tensions and variations in practice.

In recent decades, the ‘tenacious assumptions’ of biomedicine regarding the neutrality and universality of its knowledge claims have been significantly challenged by the growth of new collaborative and patient-focused models of Healthcare delivery. In this article, we discuss and critically reflect upon one such alternative Healthcare model developed at the University of Gothenburg Centre for Person-Centred Care in Sweden. This centre uses three clinical routines of narrative, partnership and documentation to provide Healthcare to people recognized as unique individuals rather than patients. Person-centred care in Gothenburg and more broadly is based on the assumption that a person is independently capable ...