Showing papers in "International Journal of Integrated Care in 2000"

Fully integrated care for frail elderly: two American models.

Abstract: 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.

Integrated care for the elderly: the background and effects of the reform of Swedish care of the elderly.

Abstract: Integrated care for the elderly. : The background and effects of the reform of Swedish care of the elderly.

Integrated care for the elderly

Abstract: A complex system is one, where the parts or actors cannot fulfil the over-all aims without co-operation. Relations between people working in them at all levels create the systems and structures in all complex organisations. Interdependency between units and parts as well as the complementary role of each of them are important features (Scott 1961) w5, 29x. The need of frequent communication between different system units can be reduced by agreements on specific administrative activities and standardisation— guidelines. IT-systems are used to facilitate the integration (Channell 1998).

Primary health care in the Czech Republic: brief history and current issues

Abstract: The objective of this paper is to describe the recent history, current situation and perspectives for further development of the integrated system of primary care in the Czech Republic. The role of primary care in the whole health care system is discussed and new initiatives aimed at strengthening and integrating primary care are outlined. Changes brought about by the recent reform processes are generally seen as favourable, however, a lack of integration of health services under the current system is causing various kinds of problems. A new strategy for development of primary care in the Czech Republic encourages integration of care and defines primary care as co-ordinated and complex care provided at the level of the first contact of an individual with the health care system.

Can shared care deliver better outcomes for patients undergoing total hip replacement? A prospective assessment of patient outcomes and associated service use.

Abstract: Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been implemented: a shared care setting (experimental group) and a care as usual setting (control group). Patients: One hundred and fifteen patients undergoing total hip replacement: 56 in the experimental group and 59 in the control group. Main measures: Functional health status according to the sickness impact profile, hip function, patient satisfaction and use of health care services. Results: Two weeks before hip replacement both groups were comparable concerning patient characteristics, hip function and health status. The mean improvement of the total sickness impact profile score between two weeks before hip replacement and six months after was −1.92 in the shared care group, compared to −5.11 in care as usual group, a difference in favour of the control group (p=0.02). The mean length of hospital stay was comparable in both settings: 12.8 days in the shared care group and 13.2 days in the care as usual group. After hip replacement, compared to care as usual, patients in the shared care group received more homecare, with a higher frequency, and for a longer period of time. No differences in patient satisfaction between the two groups were found. Conclusions: Six months after hip replacement, the health status of patients in the care as usual group, using significantly less home care, was better than the status of patients in the shared care group. Discussion: The utilisation of home care after hip replacement should be critically appraised in view of the need to stimulate patients' independence