Showing papers on "Integrated care published in 1997"

Integrated care pathways

Abstract: Integrated care pathways (ICPs) offer a system of multidisciplinary care planning based around the principle of clinical audit and on the knowledge and practice of local clinical staff. The system offers a set of guiding principles, based on the fact that, because knowledge and practice change continually when caring for patients, clinical records should be flexible and dynamic to accommodate these changes. Benefits to be gained from implementing ICPs include improvements in communication between all disciplines involved, as well as between patients and carers. Optimal levels of free text are ensured through the pre-printed record having an outcomes-based focus and through incorporating the idea of exception-based recording. Issues to be considered include individuality and confidentiality. Benefits to be gained include increased patient satisfaction, a reduction in documentation and inappropriate lengths of stay.

Care for Canada's frail elderly population: Fragmentation or integration?

Abstract: Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.

Managed care: Disease management

Abstract: The disease management approach to patient care seeks to coordinate resources across the healthcare delivery system. The growing interest in evidence based medicine and outcomes, and a commitment to integrated care across the primary, secondary, and community care sectors, all contribute to making disease management an attractive idea. A combination of patient education, provider use of practice guidelines, appropriate consultation, and supplies of drugs and ancillary services all come together in the disease management process. But its effectiveness is largely untested, so evaluation is essential.

Gp budget holding in new zealand: lessons for Britain and elsewhere?

Abstract: The recent election in New Zealand resulted in the new coalition government rejecting key aspects of the National government's controversial, Treasury led health reforms implemented in 1993.1 2 Based on the largely successful economic and state sector reforms of the 1980s, the health reforms had two key goals: improved efficiencies and better access, especially to elective surgery.3 Superficial assessment of the hospital sector had led to expectations that savings of 20-30% could be achieved through competitive and commercial incentives.3 Yet actual expenditure has increased by this amount, and waiting lists have grown by 50% since 1993.1 4 The new government favours collaboration over competition, and its health policy is to abolish the market oriented CHEs (Crown health enterprises) and replace them with regional hospital and community service units, which will be required to improve the health of their communities.2 The four regional purchasers that have a contract with providers are to be replaced with a central funding authority. The funder-provider split remains, but “purchasing” has been rejected as being too commercial. The government now seems to recognise that health is primarily a social service, not a business. The bottom line is not profit; it is better health outcomes. The new government has recognised that collaboration may be much more effective than competition as an incentive in health care.5 6 Nowhere has this collaboration been more clearly demonstrated than in primary care through the formation of independent practice associations.7 The concept of independent practice associations, and their moves towards managed and integrated care, was borrowed from the United States. In practice, however, these associations have been much closer to British fundholding.7 8 Initial opposition to independent practice associations from the medical profession …

Postpartum depression: Proposal for prevention through an integrated care and support network

Abstract: Social science research and clinical literature concur with our experience as providers of psychoeducational and clinical services: Postpartum depression results from the interplay of a multitude of individual and contextual factors. In light of the extensive literature on postpartum depression, it is surprising that models for prevention have not been established. We propose a model for prevention through integrated care and support, in which a wide range of existing services are used. This model is similar to comprehensive prevention models proposed by advocates of integrated service systems, such as community mental health and family support. The article includes illustrative case material.

Integrated care management : the path to success?

Abstract: Introduction to integrated care management Introducing MPCs into an organisation through project, risk and change management (Jo Wilson) MPCs as a risk management tool - improving communication, documentation and collaboration of care delivery (Jo Wilson) The development and implementation of pathways within an acute setting (Sue Johnson) The purchasers' perspective - why are purchasers interested and how can they support the process? (Thoreya Swage) The development and implementation of a system of case management and managed care in orthopaedics (Claire Hale) Clinical guidelines and the law (John Tingle) Continuity of care - managing children with asthma across the healthcare network (Elaine Morris) Improving the urological flow through MPCs (Sylvia Nelson) Setting up pathways in mental health (Rosie Stephens) Developing and implementing pathways of care for patients with strokes (Elaine Morris and Richard Curless) The development, implementation and link to clinical audit with pathways for children with cardiac disease (Denise Kitchener) Joint approaches to implementing MPCs in orthopaedics (Dave McKie) ICPs within a quality health service (Louise Stead) Pathways to the future for community diabetic care (Carole Cairns and Gail Shepherd): Issues in the evaluation of MPCs (Claire Hale) The way forward - putting experiences into practice (Jo Wilson).

African American families and HIV/AIDS: caring for surviving children.

Abstract: This article presents the preliminary findings of a national project undertaken to examine the medical/health, social service, and legal needs of African American children who have experienced or will experience the death of one or both parents as a result of HIV/AIDS. The project seeks to guide the development of culturally competent policies and practices across delivery systems responsible for managing the care of these children and their families. Services have expanded for the children but much remains to be accomplished to achieve culturally competent, integrated care systems for surviving children and their caregivers.

Behavioral medicine, complementary medicine and integrated care. Economic implications.

Abstract: Health care concepts and practices are changing dramatically because of demographic and economic factors. The routine integration of behavioral and biomedical care is completely compatible with these changes and such integration would provide clinical and economic benefits to patients and to society.

Integrated care management.

Abstract: Some clinicians are at the leading edge of good practice in the introduction of integrated care management (ICM) (Wilson, 1996) based on partnership, quality and driven by performance. The new Government White Paper (Department of Health, 1997) outlines proposals for integrated care with all care planners and providers working collaboratively. A number of health and social care organizations have worked collaboratively to develop care programmes based on patient-centred care. One of the vehicles is multidisciplinary pathways of care (MPCs) which is the risk management tool for monitoring jointly agreed quality and patient outcome criteria from the performance of planning and providing individual patient care. ICM views the multidisciplinary approaches to collaborating care delivery by activity, cost and quality, and using a process approach to problemand outcome-based care delivery. Involving patients and their carers in determining the process and outcomes of care provides a route to better communication...

Primary care: opportunities and threats. Broader teamwork in primary care.

Abstract: The new white papers on primary care present opportunities for general practices to extend and develop their services to patients. These could enhance professional roles within practices and lead to new partnerships with secondary care, community health services, and social services. Two examples of new services are outlined: a practice led proposal to develop an integrated service for people with learning disability across a whole district, and a community health trust9s contribution to extended primary care in an inner city area. For patients, the potential advantages of the reforms include more comprehensive and more integrated care in the community. The possible pitfalls of changing contractual arrangements include threats to the gatekeeping function of the referral system and, more fundamentally, to the central role general practice currently has in primary care in the United Kingdom.

Integrated care pathways: evaluating inpatient rehabilitation in stroke

Abstract: Integrated care pathways (ICPs) map the predicted course of an episode of patient care. This paper describes an ICP combined with outcome measurement to audit the goal-oriented neurorehabilitation of patients with stroke. Reasons for departure from the pathway and failure to achieve goals are evaluated. Analysis of this variance and its causes allows the development of more efficient and effective patient care.

Trends in aging care in Scotland and Scandinavia.

Abstract: The proportion of older adults in Western European countries, as in the United States, continues to increase rapidly. Faced with geriatric care dilemmas decades earlier, however, these countries have had more experience on which to base the development of community-based, integrated care systems for the elderly. This article provides observations from a 1993 World Health Organization Fellowship study of long-term care facilities in four European countries: Scotland, Sweden, Norway and Denmark. Several emerging trends in geriatric care documented in the literature were confirmed. These included: moratoria on institutional long-term care, emphasis on informal care and support, provision of 24-hour assistance in the home, care management to individualize care, and an expanded set of providers within integrated delivery systems.

Evaluación de los servicios de promoción de la salud de la mujer: el cliente interno, el cliente externo

Abstract: OBJECTIVES To find the opinion of internal and external customers of the Women's Health Promotion Services; to obtain information about the perceptions and suggestions of both midwives and users of the service. DESIGN An observational study of the qualitative evaluation of a service provided in Primary Health Care, through an open questionnaire to midwives and focus groups with users. SETTING Health Area 4 in the Community of Valencia. PARTICIPANTS 15 midwives from Health Area 4, 3 groups of women using the Pregnancy Follow-up Programme and 3 groups from the Programme of Integrated Care for climacteric women, coming from two Health Districts, one urban and one rural. MAIN RESULTS For midwives, coordination with general practitioners was better in the urban setting, and with Family Planning Centres in the rural one. Absence of team work with gynaecologists, and gynaecologists' failure to value midwives' work, were identified as problems. CONCLUSIONS Different patterns for the organisation and use of women's health promotion services were identified between the urban and rural setting. The problems of coordination identified by the midwives are not perceived as such by the service's users, who evaluated as satisfactory the Primary Care services received.

Managed care: Development of an integrated care pathway in neurosciences:

Abstract: The concept of managed care is emerging as a multidisciplinary approach to health care in the United Kingdom. It is implemented through an integrated care pathway (ICP) or care map which is created by the multidisciplinary team around a specific diagnostic group. The ICP consists of key interventions which can be evidence-based, incorporating clinical guidelines where appropriate. The aim of managed care is to improve quality of care while reducing length of stay, thus reducing costs. A pilot project was carried out in the neurosciences unit of a London teaching hospital over a six-month period. Lumbar disc surgery was chosen as the diagnostic group. Outcomes were better coordination of care and less variation in length of stay as well as improved communication and collaboration between the multi-professionals involved. Drawbacks were poor compliance by some clinicians and the time-consuming nature of creating the care map. Recommendations are that where ICPs are used this should be a single record replac...

Can Clinical Practice Guidelines Increase the Effectiveness and Cost- Effectiveness of Poststroke Rehabilitation?

Abstract: This article discusses the poststroke rehabilitation clinical practice guideline developed by expert panel for the Agency for Health Care Policy and Research in the Public Health Service, U.S. Department of Health and Human Services. Emphasis is on the need for the guideline, methods, and recommendations having the strongest base of scientific support. The importance of systematic assessment, rehabilitation referrals, and monitoring of the results of rehabilitation interventions receives particular attention. The article concludes with a brief discussion of some policy and research challenges facing stroke rehabilitation. Among these challenges, the most important are reorganization of rehabilitation facilities into integrated care systems and changes in insurance coverage to facilitate access and to create financial incentives for cost-effective use of resources.

Assertive Community Treatment for the Severely Mentally Ill in West Lambeth

Abstract: The prime duty of specialist mental health services is to provide effective care to often non-compliant and unstable severely mentally ill (SMI) patients. Society expects such care to be humane and effective, but also demands that the severely ill are closely supervised to minimise risk to the public. Sadly, specialist services all too often fail on both counts. In part, this is due to the sheer complexity of care that is needed, going far beyond purely medical or therapeutic interventions. SMI patients have profound difficulties accessing and using everyday services and opportunities. Negative symptoms of apathy, self-neglect and low motivation, coupled with irrational beliefs and compounded by inadequately resourced and tightly rationed provision of social care, require mental health care services to be constantly active across areas of both medical and social provision. Services that ignore the importance of long-term, integrated care do so at their peril. A steady stream of disasters has been blamed on a lack of communication and coordination between agencies (Spokes, 1988; Ritchie et al, 1994), and follow-up studies of SMI patients managed by traditional hospital out-patient services repeatedly note a mismatch between levels of need and service uptake, with the least needy consuming the greater amount of service (Goering et al, 1984; Melzer et al, 1991).

Home health care: pediatric education in the community.

Abstract: The purpose of this paper is to describe a curricular innovation involving a community home health care (HHC) experience for third-year medical students as an integral part of a pediatric clerkship. Students at George Washington University are required to participate in an afternoon of HHC visits, one of which requires their reviewing a patient's record before the visit. They then do a pertinent history and a focused physical examination, followed by an assessment and plan, and provide integrated care with the home health care professional. They record this information on a consultation form that is reviewed and evaluated by the clerkship director. Most students have rated this experience positively. A questionnaire before and after the HHC experience and a wrap-up session at the conclusion of the rotation revealed that students are becoming more informed about aspects of home health care and have more positive attitudes about their identified role as future physicians in this important area.

Integrating women's healthcare--serving the whole woman.

Abstract: Health systems across the country are setting up centers to serve all the health needs of women The driver for comprehensive care programs, they say, is expert intuition, not hard data, that integrated care will result in better outcomes than traditional fragmented care has produced They point to women's preferences for "one-stop shopping" and government initiatives that encourage integration And they offer six keys to successfully launching a comprehensive care program--insights gained in developing their programs

White paper puts GPs in the driving seat of the new NHS

Abstract: The British government views its new 10 year plan, outlined this week, as a turning point for the NHS. The white paper The New NHS gives control of most of the NHS budget to GPs and community nurses, writes John Warden The new NHS, foreshadowed in the white paper, will build on what has worked and discard what has failed. It is the basis of a 10 year programme of “evolutionary change rather than organisational upheaval.” There will be no return to Labour's old command and control system. But there will be an end to the competitive internal market, introduced by the Conservatives; in its place will be a system of “integrated care” based on partnership driven by performance. The government believes that “what counts is what works.” Many features of the internal market will survive. For example, the separation between the purchase and provision of hospital care will be retained; cooperation, however, will replace competition. Local doctors, nurses, and health authorities will have new powers to commission services and ensure that the local NHS is built around the needs of patients. Health authorities will have a powerful supervisory role with greater input …

The continuum concept comes of age.

Abstract: The ideal of integrating long-term care with acute, community-based services and home care can be best realized by adopting a new paradigm of aging and a vision of integrated networks that focus on wellness, prevention, geriatric education and research, and integrated care delivery systems. The continuum of care concept should no longer be seen as provider offering an array of services. Rather, the continuum should be viewed as a lifetime care plan for each individual, prepared and managed by a primary care physician and a team of health caregivers appropriate to the individual's ever-changing health care needs and desires. Long-term care organizations are challenged to accept this new paradigm and vision by integrating themselves with other health care organizations and developing information systems that support integration and improved care outcomes.

An Integrated “Care Path” Approach: Useful for Implementation and Coordination of New Care Guidelines for Treatment of HIV Infections

Abstract: Recently, the 1997 revised guidelines were published for the treatment of HIV-infected patients. These guidelines, while having a dramatic effect on the morbidity and mortality associated with HIV infection, will require the implementation of a coordinate interdisciplinary “Care Path” for each patient. This review presents updated information on the HIV life cycle and the latest approach to antiretroviral therapy. The new approach to therapy is to utilize combination antiretroviral therapy including two retroviral inhibitors with a protease inhibitor. Further, the importance of viral load has become a primary indicator of prognosis and therapy efficacy. The CD4 cell count is important, but it is of secondary significance in treatment effectiveness measurement and indication of disease progress. The complexity of the new guidelines increases the need for a well-planned interdisciplinary “Critical Path” which is then utilized for development of a patient-specific “Care Path.”

Bridging the chasm : Incorporating the medically compromised patient into psychiatric practice

Abstract: 1. In response to health care reform, psychiatric nursing has identified an expanded role that includes providing care to patients with complex health problems. 2. Conceptual changes of role responsibilities and time commitments to individual and milieu care are vital in supporting a change in the traditional psychiatric milieu. 3. Acknowledging and helping staff accept the unpredictability of certain medical conditions is key to success in providing quality integrated care to the medically compromised psychiatric patient.