This article presents a review of the book “Organizations: Rational, Natural and Open Systems,” by W.R. Scott.

Organizations: Rational, Natural and Open Systems

Integrated care is a burgeoning field. As is often the case in new areas of inquiry and action, conceptual clarification is demanded. Without such attention, it would be difficult to advance theory and practice in this increasingly important professional arena. In the following discussion paper, the authors explore the intellectual territory of integrated care, and underscore the need for a patient-centric imperative and meaning. They also examine the practical applications and implications arising from their views. The intention is to stimulate fruitful dialogue and debate about what ‘integrated care’ could and should be.

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Integrated care: meaning, logic, applications, and implications – a discussion paper

Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. Methods: The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. Results: The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. Discussion: The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.

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Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

Background
Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation.

Methods
Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health-care improvement was used to classify PCC domains into the categories of “Structure,” “Process” and “Outcome” for health-care quality improvement.

Discussion
The framework emphasizes the structural domain, which relates to the health-care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co-designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient-Reported Outcomes.

Conclusion
This conceptual framework provides a step-wise roadmap to guide health-care systems and organizations in the provision PCC across various health-care sectors.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/hex.12640

How to practice person-centred care: A conceptual framework

Inevitably, reading is one of the requirements to be undergone. To improve the performance and quality, someone needs to have something new every day. It will suggest you to have more inspirations, then. However, the needs of inspirations will make you searching for some sources. Even from the other people experience, internet, and many books. Books and internet are the recommended media to help you improving your quality and performance.

Primary Care: America's Health in a New Era

Purpose: Integrated care for the frail elderly and other populations with complex, chronic, disabling conditions has taken centre stage among policymakers, planners and providers in the United States and other countries. There is a growing belief that integrated care strategies offer the potential to improve service co-ordination, quality outcomes, and efficiency. Therefore, it is critical to have a conceptual understanding of the meaning of integrated care and its various organisational models, as well as practical examples of how such models work. This article examines so-called “fully integrated” models of care in detail, concentrating on two major, well-established American programs, the social health maintenance organisation and the program of all-inclusive care for the elderly. Theory: A major challenge to understanding the performance and outcomes of fully integrated care and other organisational models is the lack of a meaningful, analytical paradigm. This article builds upon the work of Walter Leutz, to develop a framework by which new and existing programs can be analysed. This framework is then applied to the two American models that are the focus of this article. Methods: Existing data about integrated care in general, and the two model programs in particular, were collected and analysed from reports published by governmental and non-governmental organisations, and journal articles retrieved from Medline, HealthStar and other sources. Results and conclusions: This analysis strongly suggests that fully integrated models of care, such as the social health maintenance organisation and program of all-inclusive care for the elderly, are not only feasible, but offer significant potential to improve the delivery of health and social care for frail elderly patients. In addition, the authors identify the factors that are the most critical to the success of fully integrated care, and offer lessons for their development and implementation. Finally, issues are raised concerning the transferability of this complex model to other countries, as well as the vital importance of evidence-based evaluation research in furthering the evolution of integrated care.

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Fully integrated care for frail elderly: two American models.

The challenge of an increasing elderly population, particularly with respect to frail older persons in need of long-term care, has coupled with ever-present budget constraints to make the financing, organization and delivery of elder care a major priority in North America, Europe and elsewhere in the developed world. Despite obvious cross-national differences in health and social care arrangements for the frail elderly, evidence of poorly coordinated services, disjointed care, less than optimum outcomes, system inefficiency, inadequate accountability, and uncontrolled costs can be found in all countries. There is a growing belief that more comprehensive approaches are needed to effectively address these problems. One such strategy, so-called integrated systems of care, shows great promise. The author critically examines the concept of integrated systems of care for the frail elderly, including the theoretical benefits and drawbacks of the model. At the policy and practice levels, descriptions are presented of, and evidence and lessons are summarized from a representative sample of such projects in the US (Social HMO and PACE), Canada (SIPA), Italy (Rovereto) and Australia (Coordinated Care Trials). The introduction of prototypes such as these raises a number of significant issues for policymakers, payers, providers, consumers and researchers. These are briefly examined in concluding remarks on the important potential of integrated systems of care for vulnerable older people.

The quest for integrated systems of care for frail older persons

This article examines the challenges and opportunities inherent in the idea that home care organizations may be able to reinvent themselves into managed care systems for the frail elderly and chronically ill. Data come from three sources: (a) existing literature, (b) a survey with experts, and (c) insights from an organization with direct experience in designing and implementing first- and second-generation managed care programs. The authors conclude that although even the best-positioned home care organizations will face significant challenges in transitioning to managed care systems (e.g., establishing medical linkages, building managed care capacity, securing funding, dealing with regulatory hurdles), changes in the environment may enable these challenges to be overcome. Home care organizations are beginning to use innovative techniques to manage care, and those with a strong commitment to the chronically ill may be interested and capable of pursuing the option of becoming home-based managed chronic care programs.

Bringing managed care home to people with chronic, disabling conditions: prospects and challenges for policy, practice, and research.

The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries-primarily older persons-with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a "whole systems" approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing structure, standards of practice, collaborative approach to care transitions and information technology tools that were used in the original demonstration project.

https://www.ijic.org/articles/10.5334/ijic.2245/galley/3021/download/

Dennis L. Kodner

Papers

Integrated care: meaning, logic, applications, and implications – a discussion paper

Fully integrated care for frail elderly: two American models.

The quest for integrated systems of care for frail older persons

Bringing managed care home to people with chronic, disabling conditions: prospects and challenges for policy, practice, and research.

Managing high-risk patients: the Mass General care management programme