Showing papers in "International Journal of Integrated Care in 2022"
TL;DR: The review confirms that integrated HIV and NCD care services is by-and-large feasible, being both clinically effective and cost-effective.
Abstract: Introduction: Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. A scoping review mapped extant policy and evidence based literature on the feasibility of integrating NCD care with HIV in the region. Methods: A scoping review methodology was utilised to conduct a systematic search of peer-reviewed and grey literature published in English language and with no date limitation. A systematic search was conducted on PubMed, Embase, CINAHL, and the Cochrane library. The initial search identified 231 records considered for inclusion in this review. Twelve duplicate records were removed. The remaining 219 records were screened by title and abstract of which 165 records were excluded and 54 records were selected for full-text review. A further 16 records were excluded due to a lack of relevance or the unavailability of the full text article. Finally, 38 were charted and analysed thematically. Results: Thirty-eight studies were included. These comprised a range of different models to integrate NCD and HIV care in the region, reflecting differences in health system environments, and disease epidemiology. The studies provide a variety of evidence that integration of HIV and NCD care can be feasible and can improve clinical effectiveness and identify barriers and facilitators to integration and task shifting. The review confirms that integrated HIV and NCD care services is by-and-large feasible, being both clinically effective and cost-effective. Conclusion: The review may inform the understanding of how best to develop an integrated model of care service by reducing barriers to uptake, linkage and retention in HIV, diabetes and hypertension treatment in SSA countries.
9 citations
TL;DR: Components like a small sized care team, intensive follow-up, shared decision making and informal caregiver involvement are likely to be associated with reduced hospital readmission and ED visits.
Abstract: Introduction: Frail older adults frequently experience transitions from hospital to home due to their complex care needs. Transitional care models (TCMs) are recommended to tackle adverse outcomes in frail patients. This review summarizes the use of integrated care components in addressing transitional care from hospital to home, provides an overview on reported outcomes and describes the impact of identified components on the outcomes hospital readmission and emergency department visit. Methods: This study is part of the European TRANS-SENIOR project. PubMed, CINAHL and Embase were searched for studies in English, German and Dutch that describe a TCM for frail older patients including both pre- and post-discharge components. Results: Seventeen studies, covering 15 TCMs were included. All TCMs describe a person-centred, tailored, pro-active and continuous transitional care service. Components like a small sized care team, intensive follow-up, shared decision making and informal caregiver involvement are likely to be associated with reduced hospital readmission and ED visits. Twenty-seven transitional care outcomes were reported: 19 service outcomes, six patient outcomes and two provider outcomes. Conclusion: Heterogeneity in content and outcomes complicates between-study comparison, yet several components were identified that improved care outcomes. Patient and provider outcomes should be included in future research.
8 citations
TL;DR: Evidence-based co-creation, combining appropriate methodologies and a structured evaluation framework, was key to address challenges associated with sustainable prehabilitation service adoption, scalability and transferability.
Abstract: Introduction: The efficacy-effectiveness gap constitutes a well-known limitation for adoption of digitally enabled integrated care services. The current report describes the co-creation process undertaken (2016–2021) to deploy a prehabilitation service at Hospital Clínic de Barcelona with the final aim of achieving sustainable adoption and facilitate site transferability. Methods: An implementation research approach with a population-based orientation, combining experience-based co-design and quality improvement methodologies, was applied. We undertook several design-thinking sessions (Oct-Nov 2017, June 2021 and December 2021) to generate and follow-up a work plan fostering service scalability. The implementation process was assessed using the Comprehensive Framework for Implementation Research, leading to the identification of key performance indicators. Discussion: Personalization and modularity of the intervention according to patients’ surgical risk were identified as core traits to enhance patients’ adherence and value generation. A digitally enabled service workflow, with an adaptive and collaborative case management approach, should combine face-to-face and remotely supervised sessions with intelligent systems for patients’ and professionals’ decision support. The business model envisages operational costs financed by savings generated by the service. Conclusions: Evidence-based co-creation, combining appropriate methodologies and a structured evaluation framework, was key to address challenges associated with sustainable prehabilitation service adoption, scalability and transferability.
7 citations
TL;DR: The acute seizure care pathway for pediatric patients and barriers encountered by those involved in seizure care management are described and interventions to bridge these care gaps within this pathway are proposed.
Abstract: Objective: We aimed to describe the acute seizure care pathway for pediatric patients and identify barriers encountered by those involved in seizure care management. We also proposed interventions to bridge these care gaps within this pathway. Methods: We constructed a process map that illustrates the acute seizure care pathway for pediatric patients at Boston Children’s Hospital (BCH). The map was designed from knowledge gathered from unstructured interviews with experts at BCH, direct observation of patient care management at BCH through a quality improvement implemented seizure diary and from findings through three studies conducted at BCH, including a prospective observational study by the pediatric Status Epilepticus Research Group, a multi-site international consortium. We also reviewed the literature highlighting gaps and strategies in seizure care management. Results: Within the process map, we identified twenty-nine care gaps encountered by caregivers, care teams, residential and educational institutions, and proposed interventions to address these challenges. The process map outlines clinical care of a patient through the following settings: 1) pre-hospitalization setting, defined as residential and educational settings before hospital admission, 2) BCH emergency department and inpatient settings, 3) post-hospitalization setting, defined as residential and educational settings following hospital discharge or clinic visit and 4) follow-up BCH outpatient settings, including neurology, epilepsy, and primary care provider clinics. The acute seizure care pathway for a pediatric patient who presents with seizures exhibits at least twenty-nine challenges in acute seizure care management. Significance: Identification of care barriers in the acute seizure care pathway provides a necessary first step for implementing interventions and strategies in acute seizure care management that could potentially impact patient outcomes.
6 citations
TL;DR: The staffs’ educational level influenced what was perceived as barriers to inter-organisational collaboration, and may guide future development of integrated care programmes.
Abstract: Introduction: Inter-organisational collaboration is challenging but essential in managing the complex and comprehensive needs of frail older people. Therefore, there is a need to investigate the influence of different barriers to inter-organisational collaboration when implementing an integrated care programme. The aim of this study was to investigate both inpatient and outpatient staff views on the factors they deemed to be influential to inter-organisational collaboration for an integrated care programme. Methods: The study was a cross-sectional study and included staff from hospitals, primary care and municipal health and social care. Results: There were no significant differences between staff from inpatient and outpatient care in measuring factors that may cause difficulties for inter-organisational collaboration. Staff views diverged significantly on all factors, such as educational level at long physical distances, laws and regulations, knowledge of each others work settings, experience from inter-organisational collaboration, different professions, variations in professional status and power, psychosocial factors such as positive work environment and interpersonal chemistry. Discussion: A multidisciplinary team culture and avenues for inter-organisational collaboration need to be developed for improved care continuity. Conclusion: The staffs’ educational level influenced what was perceived as barriers to inter-organisational collaboration, and may guide future development of integrated care programmes.
5 citations
TL;DR: It seems feasible to set up an intervention to coordinate outpatient appointments through enhanced collaboration across medical specialties for patients attending several hospital outpatient clinics, although the patient selection needed refinement.
Abstract: Background: Many patients with multimorbidity have appointments and parallel trajectories in several outpatient clinics across medical specialties. This organisation may disintegrate care and challenges the navigation of the healthcare system. Methods: This study explored the feasibility of an intervention targeting patients seen in several outpatient clinics for multiple diseases. The intervention aimed to coordinate outpatient appointments through enhanced collaboration across medical specialties. Feasibility and process were assessed through mixed methods by tracking the intervention through prospectively collected data and through semi-structured interviews with patients and healthcare professionals. Results: A multidisciplinary outpatient pathway was established as an intervention. Appointments for different medical specialties were scheduled on the same day, information was rapidly transferred to the receiving outpatient clinic, and a multidisciplinary conference resulted in the circulation of a joint summary. In the first year, 20% of eligible patients were enrolled. Appointments were aligned in 15% of patients, and blood samples were reduced by 29%. Overall, intervention components were delivered as intended and seemed acceptable, although the patient selection needed refinement. Conclusion: It seems feasible to set up an intervention for patients attending several hospital outpatient clinics. Future interventions should focus on selecting patients in greatest need for alignment of appointments.
5 citations
TL;DR: The SLHD’s progress towards a ‘whole of health’ approach, empowered and enabled the district to effectively work within and across sectors to address the pandemic in a people-centred manner, to inform a sustainable system transformation.
Abstract: Introduction: Australia has been comparatively effective in preventing the transmission of COVID-19. The Sydney Local Health District [SLHD] used a “whole of health” integrated approach to respond to the pandemic. The aim of this study was to understand for whom, how and why this response worked, to inform a sustainable system transformation. Methods: A critical realist qualitative study was conducted with 20 purposively selected key informants. Data were collected through in-depth interviews and analysed using thematic analysis guided by abduction and retroduction. The five strategies of the WHO integrated people-centred health services framework was used to guide the overall study. Results: An enabling environment of a strong governance, emergency preparedness, a committed and adaptable workforce, and a strong core infrastructure underpinned SLHD’s effective response. With a culture of embracing innovation, the district adapted virtual care to effectively quarantine people through their special health accommodation, and coordinate care across tertiary and community services. The established interagency relationships prior to the pandemic, enabled service directors to quickly integrate their services, which empowered and engaged the community [and staff], working across relevant sectors to provide care “where the people are”; reaching marginalised populations, and reducing community transmission. Discussion and Conclusion: The SLHD’s progress towards a ‘whole of health’ approach, empowered and enabled the district to effectively work within and across sectors to address the pandemic in a people-centred manner. Sustaining the contextual conditions and mechanisms, that facilitated effective integration, will be beneficial beyond the pandemic.
4 citations
TL;DR: The International Journal of Integrated Care (IJIC) is an open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis as mentioned in this paper .
Abstract: The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.
4 citations
TL;DR: The Common Understanding of Social Prescribing (CUSP) conceptual framework as mentioned in this paper was developed by a three-round Delphi study to establish internationally accepted conceptual and operational definitions of social prescribing.
Abstract: Objective The aim of this study was to establish internationally accepted conceptual and operational definitions of social prescribing. Design A three-round Delphi study was conducted. Setting This study was conducted virtually using an online survey platform. Participants This study involved an international, multidisciplinary panel of experts. The expert panel (n=48) represented 26 countries across five continents, numerous expert groups and a variety of years of experience with social prescribing, with the average being 5 years (range=1–20 years). Results After three rounds, internationally accepted conceptual and operational definitions of social prescribing were established. The definitions were transformed into the Common Understanding of Social Prescribing (CUSP) conceptual framework. Conclusion This foundational work offers a common thread—a shared sense of what social prescribing is, which may be woven into social prescribing research, policy and practice to foster common understanding of this concept.
4 citations
TL;DR: Which barriers that might reduce the potential for integrated care in the Norwegian FACT system are investigated, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration.
Abstract: Introduction: To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration. Methods: Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis. Results: Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams’ way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system. Conclusion: The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems.
4 citations
TL;DR: This editorial considers the global move towards population health management in the context of Singapore's HealthierSG initiative, which was announced by the Minister for Health in March 2022 and is a step forward in Singapore’s population health journey.
Abstract: Healthcare systems across high-income economies [1] are plagued by similar challenges, including an aging population, the increasing burden of chronic disease, and spiraling healthcare costs. David Kindig and Greg Stoddart defined population health as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” [2], and there has been a deliberate move towards population health management to address much of these challenges. Population health management efforts do not just target populations that are sick or the hospitalized (“patient” population). It also involves ensuring that healthy populations receive preventive services to avoid onset of disease. In this editorial we consider this global move towards population health management in the context of Singapore’s HealthierSG initiative. HealthierSG was announced by the Minister for Health in March 2022 and is a step forward in Singapore’s population health journey [3].
TL;DR: Policymakers, practitioners and researchers around the globe should work on overarching solutions that try to keep a broad perspective, as piecemeal reforms addressing only one aspect of the system at a time have been proven to fall short of the sustainable change necessary to address the complex problems the authors face today.
Abstract: The world is in a hurry, but change is slow. Agendas are fully booked, labour markets are tense, and we seem already (too) late to alter the course of climate change. We have faced a crisis situation which has led us towards working on more ‘pandemic preparedness’. In many countries, evaluation programs try to draw lessons from the pandemic and its impact, yet at the same time try to speed up research activities, the provision of expert advice, and policy making in an attempt to reduce health damage and stabilize tensions in societies through rapid decision-making. However, these decisions themselves are eventually followed up by deep discussions about what the ‘right’ directions should be. These directions are deeply debated given how people’s perspectives for ‘what is right’ differ significantly. As we have learned in dealing with the pandemic, solutions are not simply healthbased, but must be addressed from a wider spectrum of responses to deal with the ‘wicked problem’ [1]. Integrated care and services are an important component for addressing such complex problems since multiple stakeholders, independent organisations, (conflicting) regulations and non-aligned values all play a role in making a collective response harder. Policymakers, practitioners and researchers around the globe have for many years tried to ‘solve’ fragmentation and increase coherence in approaches that support better health and healthcare. For example, caring communities, citizens as partners, and intensifying prevention and primary care-based services are frequently mentioned as ingredients for future health systems. Countries should work on overarching solutions that try to keep a broad perspective, as piecemeal reforms addressing only one aspect of the system at a time have been proven to fall short of the sustainable change necessary to address the complex problems we face today. The recent policy papers in IJIC about the last decade of integrated care in 19 countries including Belgium, Italy, the UK, Switzerland, Canada, the USA and so on, describe examples of these long term efforts. Yet, these policy experiences are often characterized by temporary impulses for ‘quick fixes’ rather than addressing broad spectrum interventions on mixed levels (local, regional, national) and, potentially as a result, in general have achieved mixed results [2–6]. Schroeder and Cutler recently highlighted the complexity of financial reforms needed to incentivize integrated care [7]. It is not only the healthcare system that is fragmentated, also other system issues like legislation or financial mechanisms are fragmented in itself. This increases the complexity for alignment and transformation even more.
TL;DR: This work highlighted the potential of big data analysis in the context of the model of people-centred and integrated health services, whereby the role model of the person- centered health platform can be used as a blueprint to support strategies to improve person-centered health care.
Abstract: Introduction: Health systems in high-income countries face a variety of challenges calling for a systemic approach to improve quality and efficiency. Putting people in the centre is the main idea of the WHO model of people-centred and integrated health services. Integrating health services is fuelled by an integration of health data with great potentials for decision support based on big data analytics. The research question of this paper is “How can big data analytics support people-centred and integrated health services?” Methods: A scoping review following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Review (PRISMA-ScR) statement was conducted to gather information on how big data analytics can support people-centred and integrated health services. The results were summarized in a role model of a people-centred and integrated health services platform illustrating which data sources might be integrated and which types of analytics might be applied to support the strategies of the people-centred and integrated health services framework to become more integrated across the continuum of care. Additional rapid literature reviews were conducted to generate frequency distributions of the most often used data types and analytical methods in the medical literature. Finally, the main challenges connected with big data analytics were worked out based on a content analysis of the results from the scoping literature review. Results: Based on the results from the rapid literature reviews the most often used data sources for big data analytics (BDA) in healthcare were biomarkers (39.3%) and medical images (30.9%). The most often used analytical models were support vector machines (27.3%) and neural networks (20.4%). The people-centred and integrated health services framework defines different strategic interventions for health services to become more integrated. To support all aspects of these interventions a comparably integrated platform of health-related data would be needed, so that a role model labelled as people-centred health platform was developed. Based on integrated data the results of the scoping review (n = 72) indicate, that big data analytics could for example support the strategic intervention of tailoring personalized health plans (43.1%), e.g. by predicting individual risk factors for different therapy options. Also BDA might enhance clinical decision support tools (31.9%), e.g. by calculating risk factors for disease uptake or progression. BDA might also assist in designing population-based services (26.4% by clustering comparable individuals in manageable risk groups e.g. mentored by specifically trained, non-medical professionals. The main challenges of big data analytics in healthcare were categorized in regulatory, (information-) technological, methodological, and cultural issues, whereas methodological challenges were mentioned most often (55.0%), followed by regulatory challenges (43.7%). Discussion: The BDA applications presented in this literature review are based on findings which have already been published. For some important components of the framework on people-centred care like enhancing the role of community care or establishing intersectoral partnerships between health and social care institutions only few examples of enabling big data analytical tools were found in the literature. Quite the opposite does this mean that these strategies have less potential value, but rather that the source systems in these fields need to be further developed to be suitable for big data analytics. Conclusions: Big data analytics can support people-centred and integrated health services e.g. by patient similarity stratifications or predictions of individual risk factors. But BDA fails to unfold its full potential until data source systems are still disconnected and actions towards a comprehensive and people-centred health-related data platform are politically insufficiently incentivized. This work highlighted the potential of big data analysis in the context of the model of people-centred and integrated health services, whereby the role model of the person-centered health platform can be used as a blueprint to support strategies to improve person-centered health care. Likely because health data is extremely sensitive and complex, there are only few practical examples of platforms to some extent already capable of merging and processing people-centred big data, but the integration of health data can be expected to further proceed so that analytical opportunities might also become reality in the near future.
TL;DR: Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.
Abstract: Introduction: Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was ‘enhanced’ by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model). Methods: A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together with ad hoc data collected on referral-type, staff inputs and patient experience (N = 72). Results: Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%–12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%–3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%–11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6–10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179–0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%). Discussion and conclusion: Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.
TL;DR: In this paper , the authors empirically explored how dimensions of proximity that support integrated care emerge from deliberate actions within a cancer network in Quebec (Canada), and they conducted a supplementary analysis of qualitative data from a primary multi-case study focused on collaborative governance and cancer care integration.
Abstract: Introduction: This study empirically explores how dimensions of proximity that support integrated care emerge from deliberate actions within a cancer network in Quebec (Canada). Methods: We conduct a supplementary analysis of qualitative data from a primary multi-case study focused on collaborative governance and cancer care integration. Data from semi-structured interviews, documents and observation are analysed to find out how relationships take shape through actions that create different dimensions of proximity, and how these contribute to integrated practices. Results: Deliberate actions at different levels within the network create dimensions of proximity. The creation of committees and communities of practice at national and local level establish geographic proximity. Relational proximity among actors emerges to different degrees in these venues. Cognitive proximity is generated by consistent promotion of the national cancer plan and person-centred care. The priority of cancer care at policy level and prescription of common standards enhance organizational proximity. Synergy between dimensions of proximity appears essential to the emergence of integrated practices. Insufficient efforts to create technological and institutional proximity contribute to inconsistent clinical and professional integration. Conclusion: The concept of proximity appears a promising complement to existing models of integration, especially in complex contexts such as cancer networks. Highlights Deliberate actions at different levels within the cancer network create a number of dimensions of proximity Geographic proximity, be it objective or subjective, facilitates relational, cognitive and institutional proximity A national cancer plan sustained by shared leadership enhances organizational proximity, facilitating integrated practices Activation of different dimensions of proximity among network actors likely underpins and sustains functional, normative and organizational integration Insufficient efforts to create technological and institutional proximity contribute to inconsistent clinical and professional integration The multiple dimensions of proximity appear a promising complement to existing models of integration, especially in complex contexts such as cancer networks.
TL;DR: Integrated care may be supported by a generalist health workforce, through cross-cutting organizations that work across silos, and legislation that balances standardization with flexibility.
Abstract: Introduction: Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. Methods: A study was conducted following Arksey and O’Malley’s method for scoping reviews, using Valentijn’s Rainbow Model of Integrated Care as an organizing framework. Qualitative content analysis was done on clinical, professional, organizational, system, functional and normative aspects of integration. Common patterns, challenges and gaps were documented. Results: After literature search and screening, 137 documents with 108 unique programs were analysed. Paramedics bridge reactive and preventative care for a spectrum of population needs through partnerships with hospitals, social services, primary care and public health. Programs encountered challenges with role delineation, segregated organizations, regulation and tensions in professional norms. Discussion: Five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value. Conclusion: Integrated care may be supported by a generalist health workforce, through cross-cutting organizations that work across silos, and legislation that balances standardization with flexibility.
TL;DR: Current evidence suggests positive effects of SP on a variety of relevant endpoints, and scope for conclusions concerning clinical relevance and sustainability is limited because of quality deficits in the available studies.
Abstract: Introduction: Social prescribing (SP) aims to provide targeted psychosocial support and close the gap between medical and non-medical services. This review assesses the effectiveness of community-based SP interventions. Methods: We performed a systematic review and qualitative synthesis of interventional studies of community referral interventions focused on facilitating psychosocial support. We considered health-related endpoints, other patient reported outcomes, or health care utilization. Six databases, grey literature, and additional trials registers were searched. Results were screened in a two-step process, followed by data extraction, each by two independent reviewers. If data permitted such, effect sizes were calculated. Risk of bias was assessed with the EPHPP and the Cochrane RoB2 tools. Results: We identified 68 reports from 53 different projects, three were controlled studies. Uncontrolled studies with shorter time frames frequently reported positive effects. This could largely not be seen in controlled settings and for longer follow-up periods. Designs, populations, and outcomes evaluated were heterogeneous with high risk of bias for most studies. Discussion and conclusion: Current evidence suggests positive effects of SP on a variety of relevant endpoints. Due to quality deficits in the available studies, scope for conclusions concerning clinical relevance and sustainability is limited. Further methodologically rigorous controlled trials are needed.
TL;DR: The CC’s tasks in an integrated care pathway for older adults showed that the CC‘s overall workload was greater than expected and appreciated by healthcare professionals.
Abstract: Background: Although integrated care and care coordination are known to be beneficial for older adults’ population, the specific tasks of a Care Coordinator (CC) for integrated care pathways for this population have not been studied in detail. Setting & Subjects: The French national pilot program PAERPA provided an integrated care pathway for older adults. In North France, a CC was recruited to support patients and professionals. Objectives: (i) To analyse the CC’s tasks in an integrated care pathway for older patients, and (ii) to record perceptions on the CC’s tasks among the participating general practitioners (GP) and community pharmacists. Design & Methods Qualitative, two-phase study: (i) Task analysis of the CC’s tasks, to compare the planned and actual tasks; (ii) semi-structured interviews among GPs and community pharmacists involved in the pathway. Results: (i) The task analysis showed that the CC’s actual tasks differed from planned tasks. The CC was only meant to be involved in the early stages of the process; actually, the CC undertook more or even unforeseen tasks in coordination, communication, and administrative support throughout the care pathways. (ii) The 28 interviewed healthcare professionals considered the CC’s tasks to be essential to the success of pathways. They appreciated the CC’s administrative support. However, CC’s tasks related to interprofessional communication, and patient and family information, were controversially perceived among GPs and pharmacists. Conclusions: The CC’s tasks in an integrated care pathway for older adults showed that the CC’s overall workload was greater than expected and appreciated by healthcare professionals.
TL;DR: Given the importance of ICPs in advancing clinical integration, it is critical to continuously adjust their design to align with providers’ realities in order to optimize their potential in real life contexts.
Abstract: Background: Integrated care pathways (ICPs) could improve the organisation and delivery of care for community dwelling older adults. An ICP was developed and implemented in Québec to support home care processes. This study explores the perspectives of home care staff on the use of an ICP to support the organisation and delivery of health and social care to community-dwelling older adults with complex needs. Theory and Methods: A case study based on eleven semi-structured interviews and analysis of documents was carried out in an urban home care unit. The Normalization Process Theory was used for mixed thematic analysis. Results: While its capacity to store data and enhance interprofessional information exchange was appreciated by home care staff, the broad scope, and automated features of the ICP tool were often problematic. Concerns about increased provider workloads, disruption to provider-client relationships during clinical encounters, and difficulties engaging clients in decision-making were main obstacles in the use of the ICP. Conclusion: Given the importance of ICPs in advancing clinical integration, it is critical to continuously adjust their design to align with providers’ realities in order to optimize their potential in real life contexts.
TL;DR: This case study highlights the extensive design process used to develop this guideline, with a focus on the participatory design (PD) approach used throughout, that was Alberta’s first guideline for supporting patients through TiC.
Abstract: Introduction: Patients worldwide experience fragmented and uncoordinated care as they transition between primary and acute care. To improve system integration and outcomes for patients, in 2017/2018 Alberta Health Services (largest health services delivery organization in Canada) called for a coordinated approach to improve transitions in care (TiC). Healthcare leadership responded by initiating the development of a province-wide guideline outlining core components of effective transitions in care. This case study highlights the extensive design process used to develop this guideline, with a focus on the participatory design (PD) approach used throughout. Methods: An iterative, mixed methods PD approach was used to engage over 750 stakeholders through the following activities to establish Guideline content: i) learning collaborative; ii) design-team; iii) targeted online surveys; iv) primary care stakeholder consultation; v) modified Delphi panel; and vi) patient advisory committee. Results: The result was Alberta’s first guideline for supporting patients through TiC: “Alberta’s Home to Hospital to Home Transitions Guideline”. Conclusion: The extensive design process used to create the Guideline was instrumental in establishing content, encouraging system integration, and creating conditions to support provincial implementation. While intended to improve and standardize patient care in Alberta, the methods used and lessons learned throughout the development of the Guideline are applicable internationally.
TL;DR: Results suggest hubs incorporating effective integration dimensions could improve mental health outcomes for children experiencing adversity; however, further robust studies are required.
Abstract: This review assesses the effectiveness of integrated primary health and social care hubs on mental health outcomes for children experiencing adversity and describes common integration dimensions of effective hubs. PubMed, OVID Medline and PyschINFO databases were systematically searched for relevant articles between 2006–2020 that met the inclusion criteria: (i) interventional studies, (ii) an integrated approach to mental health within a primary health care setting, (iii) validated measures of child mental health outcomes, and (iv) in English language. Of 5961 retrieved references, four studies involving children aged 0–12 years experiencing one or more adversities were included. Most children were male (mean: 60.5%), and Hispanic or African American (82.5%). Three studies with low-moderate risk of bias reported improvements in mental health outcomes for children experiencing adversity receiving integrated care. The only RCT in this review did not show significant improvements. The most common dimensions of effective integrated hubs based on the Rainbow Model of Integrated Care were clinical integration (including case management, patient-centred care, patient education, and continuity of care), professional integration, and organisational integration including co-location. These results suggest hubs incorporating effective integration dimensions could improve mental health outcomes for children experiencing adversity; however, further robust studies are required. Registered with Prospero: CRD42020206015.
TL;DR: An overview of the pathways followed by stroke patients during in-hospital treatment in Germany is provided, showing that most direct staff-patient interactions are focussed within one phase, with a smaller number of interactions extending to other phases.
Abstract: Introduction: Patients experiencing acute ischemic stroke should access treatment as soon as possible to increase their chances for survival without severe disability. Given the increased complexity of stroke treatment from the provider and patient perspective, this study provides an overview of the pathways followed by stroke patients during in-hospital treatment. Methods: This qualitative study combined twenty-seven observations and fifteen staff interviews at a German comprehensive stroke center providing endovascular treatment (“EVT hospital”). Analysis was based on the COMIC Model for the comprehensive evaluation of complex health care interventions and a grounded theory approach. Results: The patient pathways during in-hospital treatment span the phases (1) admission to hospital, (2) receiving recanalization therapies, and (3) in-patient treatment. Before admission to the EVT hospital, interactions between staff members from the EVT hospital and patients take place as part of the telestroke consultations during which the EVT hospital’s ED neurologist meets the patient via a video- and audio-based connection. During the second phase, when IVT and/or EVT are provided to the patient, three teams (ED, neuroradiology and ICU team) with direct patient interactions intersect at the angiography suite until mechanical recanalisation treatment ends and the patient is transferred to the SU or ICU. In the third phase, the patients are treated on the SU or ICU and staff members interact with them according to a pre-defined schedule as well as based on individual needs. Discussion: Our results show that most direct staff-patient interactions are focussed within one phase, with a smaller number of interactions extending to other phases, and no professional (group) with direct patient interactions cover more than two phases of the acute stroke pathway. Future research should investigate how the pathways described here are experienced from the patient perspective, including how the organisation of visible care processes may influence patient satisfaction. Findings can be translated to accessible patient information resources as well as input for digitalisation efforts, provider orientation and training.
TL;DR: Concerted action at national and municipal level is needed to successfully implement digital tools to facilitate collaboration in health and social services for vulnerable children and adolescents in eight Norwegian municipalities.
Abstract: Introduction: The paper discusses the implementation of a digital workspace to facilitate collaboration in health and social services for vulnerable children and adolescents in eight Norwegian municipalities. The purpose of the workspace is to enhance collaboration independent of space and time. Collaborating services are schools, kindergartens, school health services, educational services and child welfare services. Methods: The data analysed are from semi-structured interviews with project leaders in primary care, responses of primary care professionals to open questions in a survey, and results from two questions in three subsequent surveys. Results: Project leaders held great expectations of increased collaboration. Variations were found regarding how far the implementation of a new workspace precluded previous methods of collaboration and whether retaining a familiar workspace necessitated strengthening resources to negotiate using the workspace. Organisational and professional cultures hindered the implementation of the workspace. Discussion: Interrelated barriers to collaboration were found at the professional, organisational and systemic levels. Some professionals could adapt the workspace to their existing tasks while others could not. Primary care providers need to strengthen their organisations while implementing the workspace. Conclusion: Concerted action at national and municipal level is needed to successfully implement digital tools.
TL;DR: In this article , the authors have shown that despite the potential of mHealth to improve respite care coordination, little research has been conducted to map and assess available mHealth apps.
Abstract: Introduction: Respite care is one of the support services most frequently requested by family caregivers. Yet, currently accessible services remain underutilized. This underutilization is due partly to challenges in scheduling and coordination. With billions of smartphone users worldwide, mHealth applications (“apps”) have the potential to ameliorate remote communication and care co-ordination between health providers and patients. Thus, mHealth innovations could lead to faster and more accessible respite service delivery. However, despite the potential of mHealth to improve respite care coordination, little research has been conducted to map and assess available respite care apps.
TL;DR: The findings provide a feasible path for other countries to strengthen integrated care for the aged population, particularly for those confronting rapid population ageing but with fragmented health care and elderly care systems.
Abstract: Introduction: Implementing integrated care for the aged population has been regarded as a mechanism to achieve healthy ageing. However, evidence from undeveloped nations has been scant. This study aims to explore the integrated care experience in Anhui and Fujian Province of China based on the Rainbow Model of Integrated Care (RMIC). Methods: The qualitative study was conducted in Anhui (in the middle area) and Fujian Province (in the eastern area) between May and September in 2018. The interviewees included twenty-eight policy makers working at departments of health and civil affairs at different levels and seventeen heads of medical and elderly care institutions. Results: The preliminary progress of integrated care in the sample cities of two provinces are mainly shown at solid policy basis by multiple key government agencies and political commitment achieved (system integration); preliminary coordination mechanism established between medical and elderly care institutions (organizational integration); consolidation of multi-disciplinary collaboration (professional integration); and reinforced role of family doctor teams for community-home dwelling elderly (service integration). Main challenges are also identified at insufficient inter-agency coordination, weak service capacity, lack of sustainable funding schemes, low level of information integration, and shortage of professional supply. Conclusion: Our findings provide a feasible path for other countries to strengthen integrated care for the aged population, particularly for those confronting rapid population ageing but with fragmented health care and elderly care systems.
TL;DR: The International Journal of Integrated Care (IJIC) is an open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis as mentioned in this paper .
Abstract: The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.
TL;DR: The roles of nurses have ‘emerged differently’ from their traditional counterparts in an integrated Regional Health System in Singapore, and the important balance between formal structural practices and informal processes in facilitating and supporting the nurses in their role development was emphasised.
Abstract: Purpose: To examine the roles of transitional care nurses in an integrated healthcare system and how the integrated healthcare system influences their evolving roles. Background: Transitional care teams have been introduced to enable the seamless transfer of patients from acute-care to the home settings. A qualitative case study of the transitional care team was conducted to understand the changing roles of these nurses in an integrated Regional Health System (RHS) in Singapore. Methods: A hospital transitional team of an integrated RHS was studied. Purposive sampling was used. Non-participant observations and follow-up interviews were conducted with four nurses. Data were triangulated with the interviews of two managers and three healthcare professionals, and the analysis of documents. Within-case thematic analysis was carried out. Results: Three themes were identified: ‘Coming together to meet the needs of all’; ‘Standing strong amidst the stormy waves’; and ‘Searching for the right formula in handling complexity’. These themes have explained on the atypical roles taken on by nurses in their attempts to close the gaps and meet the patients’ needs. Various factors influencing the evolving roles were revealed. Conclusion: The roles of nurses have ‘emerged differently’ from their traditional counterparts. Various nursing roles have been undertaken to facilitate care integration. The findings emphasised the important balance between formal structural practices and informal processes in facilitating and supporting the nurses in their role development.
TL;DR: In this article , a sequential mixed methods single case study design was used, in three phases: a Social Network Analysis (SNA) based on data from questionnaires, explorative interviews with network partners and a focus group with network coordinators to explore the conceptual generalisability of the single case of the IDC-network.
Abstract: Introduction: Cooperation is key to provide integrated dementia care. However, different kinds of (personal and organisational) interests will affect collaboration in integrated dementia care (IDC) networks. Hence, it is crucial to understand how interests influence relations in IDC-networks in order to shape future policies. Methods: A sequential mixed methods single case study design was used, in three phases: a Social Network Analysis (SNA) based on data from questionnaires (n = 24–26), explorative interviews with network partners (n = 14) and a focus group with network coordinators (n = 7) to explore the conceptual generalisability of the single case of the IDC-network. Results: The SNA revealed that highly connected organisations were often established care organisations that deliver case management, while smaller care organisations or welfare organisations tend to be less connected. Care-related, strategic, and financial interests influence participation of organisations in the IDC-network, while personal intrinsic motivations determine a representative’s contribution to the network. Especially conflicting interests strongly influence the network structure. Discussion and conclusion: We conclude that conflicting interests in IDC-networks stand in the way of reaching the collective goal of an IDC-network, i.e., optimising the wellbeing of people with dementia and their informal caregivers in the region. Thus, IDC-networks should act to manage, resolve and prevent disputes arising from conflicting interests.
TL;DR: The results suggest that the IPCT model is tailored to the needs of its target populations, resulting in improved Patient Reported Experience Measures, and imply that broader implementation of innovative and flexible community-based care models should be considered by policymakers.
Abstract: Background: Integrated Primary Care Teams (IPCTs) have four key characteristics (intensive interdisciplinary practice; advanced nursing practice with an expanded role; group practice; increased proximity and availability) aimed at strengthening primary care in Quebec, Canada. The purpose of this paper is to examine the care experience over time of patients who have an IPCT as their primary source of care. Methods: We used a quasi-experimental longitudinal design based on a pre-and-post administered survey at a 2-year interval without a control group. We measured patient-reported accessibility, continuity, comprehensiveness, responsiveness and outcomes of care. Results: Results showed that patients who were newly registered with an IPCT had a significant increase in reported care experience, whereas patients who have been registered with an IPCT for 2 years prior to the first round of data collection had already high reported care experience that was maintained over time. Moreover, linear regression models showed statistically significant different increases in the dimensions of care experience by site and patients’ characteristics. Conclusions: Our results suggest that the IPCT model is tailored to the needs of its target populations, resulting in improved Patient Reported Experience Measures. These results imply that broader implementation of innovative and flexible community-based care models should be considered by policymakers.
TL;DR: The pandemic measures generated challenges of safe discharge of patients and care continuity in the community and shed light on the need to proactively assess care pathways and catalyse novel models to improve care transition beyond the pandemic.
Abstract: Introduction: The COVID-19 pandemic affects the process of care transition for patients with underlying chronic conditions. This study aims to explore the impact of the pandemic measures on discharge planning and continuum of care for vulnerable older patients from multi-stakeholder perspectives. Methods: We conducted focus group discussions and individual interviews with healthcare workers, community partners, government officials and family caregivers in Singapore. All interviews were audio-recorded, transcribed verbatim and thematically analysed. Results: A total of 53 individuals participated in the study. Discharge planning and care continuity in the community were affected primarily by the limited step-down care options and remote assessment of discharge needs. Participants felt a need to revisit the decision of ‘essential’ community services through engagement of all stakeholders to enhance care community. To improve better care transition, participants suggested the need for clearer communication of guidelines, improved intersectoral collaboration, shared responsibility of patient care through community engagement and employment of novel models of care. Conclusion: The pandemic measures generated challenges of safe discharge of patients and care continuity in the community. Findings shed light on the need to proactively assess care pathways and catalyse novel models to improve care transition beyond the pandemic.