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

Objective: in the past decades, many studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of predictors of NHP in the general population of developed countries. Design: relevant articles were identified by searching the databases MEDLINE, Web of Science, Cochrane Library and PSYNDEXplus. Studies based on population-based samples with prospective study design and identification of predictors by multivariate analyses were included. Quality of studies and evidence of predictors were determined. Results: thirty-six studies were identified; one-third of the studies were of high quality. Predictors with strong evidence were increased age, low self-rated health status, functional and cognitive impairment, dementia, prior NHP and a high number of prescriptions. Predictors with inconsistent results were male gender, low education status, low income, stroke, hypertension, incontinence, depression and prior hospital use. Conclusions: findings suggested that predictors of NHP are mainly based on underlying cognitive and/or functional impairment, and associated lack of support and assistance in daily living. However, the methodical quality of studies needs improvement. More theoretical embedding of risk models of NHP would help to establish more clarity in complex relationships in using nursing homes.

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Prediction of Institutionalization in the Elderly. A Systematic Review

Because persons with disabilities (PWDs) use health and social services extensively, both the United States and the United Kingdom have begun to integrate care across systems. Initiatives in these two countries are examined within the context of the reality that personal needs and use of systems differ by age and by type and severity of disability. The lessons derived from this scrutiny are presented in the form of five “laws” of integration. These laws identify three levels of integration, point to alternative roles for physicians, outline resource requirements, highlight friction from differing medical and social paradigms, and urge policy makers and administrators to consider carefully who would be most appropriately selected to design, oversee, and administer integration initiatives. Both users and caregivers must be involved in planning to ensure that all three levels of integration are attended to and that the borders between medical and other systems are clarified.

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Five laws for integrating medical and social services: lessons from the United States and the United Kingdom.

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.

aeo Introduction aeo The Five Factors aeo Consistent HR Practices: The Whole Can Be More Than the Sum of the Parts aeo Employment and Economics aeo Employment as a Social Relation aeo Voice: Unions and Other Forms of Employee Representation aeo Employment, Society, and the Law aeo Internal Labor Markets aeo High--Commitment HR aeo Performance Evaluation aeo Pay for Performance aeo Compensation Systems: Forms, Bases, and Distribution of Rewards aeo Job Design aeo Staffing and Recruitment aeo Training aeo Promotion and Career Concerns aeo Downsizing aeo Outsourcing aeo HRM in Emerging Companies aeo Organizing HR Appendix A: Transaction Cost Economics Appendix B: Reciprocity and Reputation in Repeated Interactions Appendix C: Agency Theory Appendix D: Market Signaling and Screening

战略人力资源 : 总经理的思考框架 = Strategic human resources : frameworks for general managers

Purpose: The purpose of this study was to investigate (a) whether certified nursing assistants (CNAs) are more committed to nursing home jobs when they perceive their jobs as enhanced (greater autonomy, use of knowledge, teamwork), and (b) whether CNA job commitment affects resident satisfaction. Design and Methods: A qualitative exploration of management philosophy and practice and of CNAs’ views of their jobs in 18 Massachusetts nursing homes formed the basis for a survey administered to 255 CNAs in 15 homes. A quality-of-life questionnaire was administered to 105 residents. Logistic regression accounting for clustering estimated the effect of personal characteristics, satisfaction with tangible job rewards, and aspects of job design on CNAs’ intent to stay in current jobs. A general linear model estimated the effect of job commitment on residents’ satisfaction with their relationship to nursing staff. Results: After we accounted for satisfaction with wages, benefits, and advancement opportunities, good basic supervision was most important in affecting CNAs’ intent to stay in their jobs. Job enhancements were not significantly related to intent to stay. Residents were more satisfied with their relationships to nursing staff and their quality of life on units where a higher proportion of CNAs were committed to their jobs. Implications: The finding that greater job commitment of CNAs is associated with better quality of relationships and life for residents implies that better jobs lead to better care. Culture change transformation that increases CNA autonomy, knowledge input, and teamwork may not increase workers’ commitment to jobs without improvements in basic

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Nursing Assistants' Job Commitment: Effect of Nursing Home Organizational Factors and Impact on Resident Well-Being

This paper reviews, rethinks, expands and applies the author's ‘laws’ of integration, which were first published six years ago. This approach both introduces the laws to readers who don't know them, and tests their utility for those who do. In retrospect, real‐world integration efforts mix and match the original components of linkage, co‐ordination and full integration. But the message remains to work at all levels, keep it simple, make finances supportive and empower social care.

Reflections on Integrating Medical and Social Care: Five Laws Revisited

Prologue: One of many legacies left by the late Rep. Claude Pepper (D-FL) was the concept of integrating acute and long-term care. His Medicare Long-Term Care Catastrophic Protection Act of 1987—th...

Integrating acute and long-term care

Objective. To test the substitution hypothesis, that community-based care reduces the probability of institutional placement for at-risk elderly.Research Design. The closure of the Social Health Maintenance Organization (Social HMO) at HealthPartners (HP) in Minnesota in 1994 and the continuation of

Walter Leutz

Papers

Five laws for integrating medical and social services: lessons from the United States and the United Kingdom.

Nursing Assistants' Job Commitment: Effect of Nursing Home Organizational Factors and Impact on Resident Well-Being

Reflections on Integrating Medical and Social Care: Five Laws Revisited

Integrating acute and long-term care

Community-based care and risk of nursing home placement