Showing papers on "Integrated care published in 2002"
TL;DR: The authors explore the intellectual territory of integrated care, and underscore the need for a patient-centric imperative and meaning, and the practical applications and implications arising from their views.
Abstract: 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.
996 citations
TL;DR: From an historical and sociological perspective, integrated care has emerged as part of institutional efforts to break up professional fiefdoms, especially of subspecialists entrenched in hospitals, and to reorganise services around clinically integrated pathways and services for the patients as mentioned in this paper.
Abstract: From an historical and sociological perspective, ‘integrated care’ has emerged as part of institutional efforts to break up professional fiefdoms, especially of subspecialists entrenched in hospitals, and to reorganise services around clinically integrated pathways and services for the patients. It was the more enlightened part of what I have called the ‘buyers’ revolt’, which occurred in the 1980s when those who had long paid the bills (insurers, governments, employers) became so fed up by the waste, excesses, and variability of services delivered under professional dominance that they started to take forceful action w1x. This book is a masterpiece of historical work and organisational analysis of that revolt at its centre, the San Francisco Bay area.
773 citations
TL;DR: It was revealed that although integrated care pathways led to improved outcomes for the health care trust there was little evidence to suggest that interprofessional relationships and communication were enhanced and key factors in discharge delays appeared to be organizational rather than professional.
Abstract: This paper reports on the evaluation stage of an action research project on interprofessional collaboration in discharge planning Findings from interviews with health care professionals working in the acute sector had revealed concerns about discharge planning and multidisciplinary teamwork In the United Kingdom the National Health Service (NHS) Plan has reinforced the need for an integrated approach to health care Effective health care integration requires effective communication, teamwork and the commitment to deliver integrated care Integrated documentation is a key strategy for enhancing interprofessional collaboration and reducing the isolation of professionals, and has been successfully implemented in a range of health care settings Presented with the concerns about the collaborative process in discharge planning, an action research strategy was chosen to bring about change in an orthopaedic ward in one London teaching hospital This paper will evaluate the implementation of an integrated care pathway with fractured neck of femurs in one London teaching hospital Care pathways facilitate the management of defined patient groups using interdisciplinary plans of care The emphasis will be on understanding whether integrated care pathways enhance and develop interprofessional collaboration and enable effective information access and flow across the professions and the organization The criteria for evaluation, forming the hypotheses of the study, were that interprofessional nonverbal and verbal communication would be enhanced and that interprofesisonal collaboration would increase Methods of evaluation used were: (i) stakeholder interviews, (ii) interprofessional audit and (iii) analysis of the variances from the integrated care pathway The evaluation revealed that although integrated care pathways led to improved outcomes for the health care trust there was little evidence to suggest that interprofessional relationships and communication were enhanced Furthermore, key factors in discharge delays appeared to be organizational rather than professional
231 citations
TL;DR: A systematic review of published studies on depression in stroke found that the Beck Depression Inventory, Hamilton Depression Rating Scale and Zung Self-rating Depression Scale were most commonly used and have demonstrable validity in stroke patients but tend to exclude those with aphasia.
Abstract: Background: Depression is a common complication of stroke, leading to increased morbidity and mortality. It can impede the process of rehabilitation, and has been associated with poorer outcomes and increased length of stay in hospital. This systematic review was undertaken as a preliminary step to explore the available evidence on which to base an integrated care pathway (ICP) for the management of post-stroke depression (PSD) in a rehabilitation setting. It is divided into two parts.Aims and objectives: In part 1 we review the frequency of depression in stroke and its impact on functional recovery. Also the different methods for diagnosis and measurement.Methods: Data sources comprised a computer-aided search of published studies on depression in stroke and references to literature used in reviews.Main findings: PSD is common and is associated with cognitive, functional and social deficits which potentially limit the outcome from rehabilitation. However, diversity of assessment tools and diagnostic crit...
155 citations
TL;DR: The authors discuss barriers to implementing evidence-based practices in the mental health service delivery system for older adults and describes approaches to overcoming these barriers that are based on the findings of research on practice change and dissemination.
Abstract: The past decade has seen dramatic growth in research on treatments for the psychiatric problems of older adults. An emerging evidence base supports the efficacy of geriatric mental health interventions. The authors provide an overview of the evidence base for clinical practice. They identified three sources of evidence-evidence-based reviews, meta-analyses, and expert consensus statements-on established and emerging interventions for the most common disorders of late life, which include depression, dementia, substance abuse, schizophrenia, and anxiety. The most extensive research support was found for the effectiveness of pharmacological and psychosocial interventions for geriatric major depression and for dementia. Less is known about the effectiveness of treatments for the other disorders, although emerging evidence is promising for selected interventions. Empirical support was also found for the effectiveness of community-based, multidisciplinary, geriatric psychiatry treatment teams. The authors discuss barriers to implementing evidence-based practices in the mental health service delivery system for older adults. They describe approaches to overcoming these barriers that are based on the findings of research on practice change and dissemination. Successful approaches to implementing change in the practices of providers emphasize moving beyond traditional models of continuing medical education to include educational techniques that actively involve the learner, as well as systems change interventions such as integrated care management, implementation toolkits, automated reminders, and decision support technologies. The anticipated growth in the population of older persons with mental disorders underscores the need for a strategy to facilitate the systematic and effective implementation of evidence-based practices in geriatric mental health care.
133 citations
TL;DR: The Center for Case Management (CCM) has identified 11 major trends that, in one way or another, each country has or wdl experience in its application of the ICP methodolog.
Abstract: The reasons for which ICPs were developed as clinical paths and CareMap@ tools in the United States in 1985 remain the reasons they have been adopted and adapted by many countries over the following 17 years’ (see Figure 1). From hands-on experience in almost all of the countries listed,The Center for Case Management (CCM) has identified 11 major trends that, in one way or another, each country has or wdl experience in its application of the ICP methodolog. f a d i e s as partners.
119 citations
TL;DR: In this article, the authors argue that despite the many efforts that have been made to rationalize and improve the functioning and the quality of health care delivery in industrialized countries, too limited a degree of success has been achieved so far.
Abstract: Issue. In spite of the many efforts that have been made to rationalize and improve the functioning and the quality of health care delivery in industrialized countries, too limited a degree of success has been achieved so far. This paper argues that this limited success originates from a lack of coherence among the various strategies and instruments developed to rationalize and improve the delivery of health care.
Addressing the issue. This fact can be shown by reducing the complexity of today’s health care into three levels of decision making: the primary process of patient care, the organizational context, and the financing and policy context of health care systems. Distinct rationales exist on each of these three levels of decision making as actors have their own perspectives, cultures, disciplines, and traditions concerning the delivery of health care. These differences can often result in ambiguity of goals, conflicting interests between decision-makers, bureaucracy, poor information transfer, and limited use of the available scientific knowledge on all three levels. In such a context, rationalization and quality-improvement efforts are frustrated and will have limited effectiveness. Therefore, the various rationalization strategies and instruments on all three levels of decision making should be embedded in our health care systems in a synergistic way.
Demonstrating the proposed solution. Community-based integrated care is a promising approach to address this issue successfully. How this concept might function as a unifying concept for quality improvement will be illustrated by relevant developments in the Academic Medical Center, University of Amsterdam in The Netherlands.
93 citations
TL;DR: Ethnicity, education, income, and several chronic health complaints are consistent with civilian CAM use, but finding also suggest that physicians providing conventional medical care need to be aware of experiences unique to CAM-using military veterans.
Abstract: Background Complementary and alternative medicine (CAM) use and expenditures are on the rise in the United States. Although civilian users of CAM have been well described, little is known about military veteran users of CAM. Objective To describe military veteran CAM users in the southwestern United States. Methods The study population comprised 508 military veterans randomly selected from Southern Arizona Veterans Administration Health Care System (Tucson) primary care patient lists, who had agreed to participate in a telephone interview. The χ 2 test was used to analyze CAM use by demographic characteristics, military service, military-related health outcomes, and physician-diagnosed health complaints. Logistic regression was used to determine predictor variables. Results Of the 508 subjects, 252 (49.6%) reported CAM use. Military veteran CAM users were significantly more likely to be non-Hispanic white, earn more than $50 000 per year (both P P P Conclusions Ethnicity, education, income, and several chronic health complaints are consistent with civilian CAM use. Findings also suggest, however, that physicians providing conventional medical care need to be aware of experiences unique to CAM-using military veterans.
89 citations
TL;DR: A suggested regimen for the use of sertraline in PSD was put forward and may help to establish a more consistent approach to assessment and treatment of PSD, and form a basis for future comparison of different treatments as they become available.
Abstract: Background: Depression is a common complication of stroke, leading to increased morbidity and mortality. It can impede the process of rehabilitation, and has been associated with poorer outcomes and increased length of stay in hospital.This systematic review was undertaken as a preliminary step to the development of an evidence-based integrated care pathway (ICP) for the management of post-stroke depression (PSD) in a rehabilitation setting, and is divided into two parts. In part 1 we reviewed the frequency of depression in stroke, its impact on functional recovery and the different methods for assessment.Aims and objectives: In part 2, we discuss the rationale for treatment of PSD, appraise the evidence for effectiveness of the different antidepressant drugs, and consider whether we can identify a recommended ”rst-line treatment for use in our ICP.Methods: Data sources comprised a computer-aided search of published studies on depression in stroke and references to literature used in reviews.Main ” ndings...
86 citations
TL;DR: The results suggest that the introduction of team co-ordinated approaches to stroke care and rehabilitation do not improve attitudes to team working, and teams appear to take a long time to establish cohesion and develop shared values.
Abstract: BACKGROUND: Teamwork is regarded as the cornerstone of rehabilitation. It is recognized that the skills of a multiprofessional team are required to provide the care and interventions necessary to maximize the patient's potential to recover from his/her stroke. LITERATURE REVIEW: Critical evaluation of team working is lacking in the literature. Indeed, there is no consensus on a precise definition of teamwork or on the best way of implementing it, beyond a general exhortation to members to work to the same therapeutic plan in a cohesive manner. The literature has highlighted many problems in team working, including petty jealousies, ignorance and a perceived loss of autonomy and threat to professional status. AIM: To determine if the use of team co-ordinated approaches to stroke care and rehabilitation would improve staff attitudes to team working. METHOD: A pre-post design was adopted using 'The Team Climate Inventory' to explore attitudes to team working before and after introducing the interventions. Local Research Ethics Committee approval was obtained. RESULTS: Improvements in attitudes towards team working suggest that the introduction of team co-ordinated approaches (integrated care pathways and team notes) did not result in greater team working. LIMITATIONS: The introduction of an integrated care pathway and team notes is based on an assumption that they would enhance team working. CONCLUSIONS: The results suggest that the introduction of team co-ordinated approaches (team notes and care pathways) do not improve attitudes to team working, teams appear to take a long time to establish cohesion and develop shared values.
80 citations
TL;DR: Better quality of life in patients receiving conventional MDT care may be attributable to improved social functioning and greater attention to higher function and caregiver needs during rehabilitation.
Abstract: Background and Purpose— Integrated care pathways (ICP) may not reduce disability, institutionalization, or duration of hospitalization compared with conventional multidisciplinary team (MDT) care in organized stroke rehabilitation. Their potential to improve patient heath status or satisfaction with care is not known. Methods— A comparison of quality of life, caregiver strain, and patient/caregiver satisfaction at 6 months after stroke was undertaken in 152 stroke patients randomized to receive ICP or MDT care. Differences in processes of care were recorded with the use of a predefined schedule. Multivariate analyses were undertaken to identify the effect of age, sex, stroke severity, functional status, mood, and use of care pathway on quality of life score. Results— The 2 groups were comparable for baseline characteristics of age, sex, stroke severity, and initial disability. MDT care was characterized by greater emphasis on return of higher function and caregiver needs compared with ICP. EuroQol Visual ...
Book•
17 Jun 2002
TL;DR: The authors, trained in health psychology, psychiatry, family medicine, and marriage and family therapy, build a persuasive case for their holistic, biopsychosocial approach to the traditionally fragmented fields of primary care and mental health care.
Abstract: One of the most significant events in the history of health care is the development of separate and parallel systems for mental health and medical care. Patients, however, want health care that is better coordinated, more personalized, more accessible, more timely, and less cumbersome to receive. These patient-wants reinforce what we know about patient needs for better integrated care and more collaborative health care, as shown by the following data: *50% of mental health care is delivered by primary care physicians. *67% of all psychopharmacological drugs are prescribed by primary care physicians. *50-70% of all primary care visits are for psychosocial concerns. This book illustrates the importance of taking an integrated approach to health care and outlines the skills that a mental health professional needs for working in a medical setting. The authors, trained in health psychology, psychiatry, family medicine, and marriage and family therapy, build a persuasive case for their holistic, biopsychosocial approach to the traditionally fragmented fields of primary care and mental health care.This is a primer for mental health professionals working in a medical setting. Part I discusses health care settings. Chapters 1 and 2 describe the specific cultures of primary care, specialty care, and mental health care, and Chapter 3 discusses ways to balance the clinical, operational, and financial perspectives of health care. Part II provides information on how to build collaborative medical care, including getting started (Chapter 4), expanding the therapist's identity and role in medical clinics (Chapter 5), working within the medical system's organizational framework (Chapter 6), working with the common problems that patients present in primary care (Chapter 7), and ways to promote healthy behavior change (Chapter 8). The book concludes by highlighting some of the opportunities that exist for therapists who want to be part of this important shift in how health care is provided.
TL;DR: The workshop of the EUPHA section Health Services Research took place on Thursday, December 8th, 2001 in Brussels at the annual conference of theEUPHA (European Public Health Association).
Abstract: The workshop of the EUPHA section Health Services Research took place on Thursday, December 8th, 2001 in Brussels at the annual conference of the EUPHA (European Public Health Association). The theme of the workshop was integrated care in an international perspective. Integrated care can be defined as a concept bringing together inputs, delivery, management and organisation of services related to diagnosis, treatment, care, rehabilitation and health promotion w1x.
TL;DR: Initial analysis of the first 500 variance sheets to be generated by the Wales-wide implementation of an ICP for the last two days of life indicates that the management of pain, agitation, excess respiratory secretions and mouth care may be problematic.
Abstract: Functional benchmarking assesses performance and practice across a broad range of settings and carries the potential to effect change in practice. An integrated care pathway (ICP) can assist in the benchmarking process, defining desired outcomes for specific patient groups over a designated time frame. Any variations to the agreed course of care are documented using the ‘variance sheet’. This article describes the Wales-wide implementation of an ICP for the last two days of life. The project has enabled an ongoing centralized collection and analysis of variance sheets, which reflect the care of the dying patient in four different care settings crossing the voluntary and statutory sectors. Initial analysis of the first 500 variance sheets to be generated by the ICP for the last two days of life indicates that the management of pain, agitation, excess respiratory secretions and mouth care may be problematic. The same problems were experienced across acute, hospice, specialist inpatient units and community c...
TL;DR: Nurses' practices in this study were a critical element in facilitating, or alternately constraining, family caregivers' ability to relinquish care and to take full advantage of the respite time.
Abstract: Aim. The aim of this study was to explore family caregivers' experiences of in-hospital respite care for people with dementia and the factors that influenced their perceptions of the service.
Background. The provision of respite care is based on the assumption that temporary relief from caregiving will relieve caregiver stress and may possibly extend the duration of home care. Research evidence suggests that this is a simplistic perspective which fails to account for families' concerns about the quality of institutional care and the impact of relocation on the person being cared for.
Design. Nine family caregivers, using four different hospitals sites were interviewed during a period of 3 years from 1994 to 1997. The research texts were analysed using a critical discourse analysis approach drawing on the work of Foucault.
Findings. Family caregiver texts were distinguished by difference rather than by homogeneity. Caregivers occupied a range of positions in terms of their ability to take advantage of the respite time intermittent care offered. My reading of these texts has highlighted the aspects of nurse–family relationships that ameliorated, or alternately exacerbated, the tensions felt by caregivers, as they were torn between the necessity to have a break and their anxieties about the impact of in-hospital respite care on the person with dementia.
Conclusion. Nurses' practices in this study were a critical element in facilitating, or alternately constraining, family caregivers' ability to relinquish care and to take full advantage of the respite time. The research findings highlight the need for nurses and other formal caregivers to locate themselves in a secondary and supporting caregiving role, to acknowledge the family caregivers as the primary caregiver, and use family caregivers in-depth and intimate knowledge of the needs of their relative to inform care within the institutional setting.
TL;DR: Integrated care pathways may improve assessment and communication, even in specialist stroke settings, according to a randomized controlled trial of acute stroke patients undergoing rehabilitation.
Abstract: Objective: to evaluate whether integrated care pathways improve the processes of care in stroke rehabilitation. Design: comparison of processes of care data collected in a randomized controlled trial. Participants: acute stroke patients undergoing rehabilitation randomized to receive integrated care pathways management (n=76) or conventional multidisciplinary care (n=76). Measurements: proportion of patients meeting recommended standards for processes of care using a validated stroke audit tool. Results: integrated care pathways methodology was associated with higher frequency of stroke specific assessments, notably testing for inattention (84% versus 60%; P=0.015) and nutritional assessment (74% versus 22%, P-0.001). Documentation of provision of certain information to patients/carers (89% versus 70%; P=0.024) and early discharge notification to general practitioners (80% versus 45%; P-0.001) were also more common in this group. There were no significant differences in the processes of interdisciplinary co-ordination and patient management between the integrated care pathways group and the control group. Conclusion: integrated care pathways may improve assessment and communication, even in specialist stroke settings.
TL;DR: A modified version of integrated care is proposed that is believed to optimize modality distribution and patient outcomes, while reducing the relative costs per patient treated, compared to the current situation in most countries.
Abstract: The concept of integrated care advocates a planned approach to predialysis care. Its components include timely referral to a renal care team, timely preparation for dialysis, and timely initiation of dialysis, with peritoneal dialysis (PD) as the initial therapy for suitable patients. This initial therapy may then be followed by timely transfer to hemodialysis (HD) when residual renal function declines or when other PD-related problems occur. We argue that at least three problems exist with the integrated care approach as it is currently being articulated. They are (1) an under emphasis on slowing the rate of progression of chronic kidney disease, aggressive management of cardiovascular risk factors and other comorbidities, and pre-emptive live donor transplantation; (2) a lack of consideration of home HD as an alternate initial therapy; and (3) a lack of discussion about patient choice. We propose a modified version of integrated care that we believe will optimize modality distribution and patient outcomes, while reducing the relative costs per patient treated, compared to the current situation in most countries.
TL;DR: Insurance parity in mental health care would make depression and other mental illness more legitimate in the eyes of patients, family members, employers, and physicians.
TL;DR: This article compares policy approaches to integrated care in England and The Netherlands using the concepts of hierarchy, market and network to review the last decade’s relevant policy processes.
Abstract: The concept of integrated care has assumed growing importance on the policy agendas both in England and The Netherlands and elsewhere. It is characterized as health and health care-related social care needed by patients with multi-faceted needs. This article compares policy approaches to integrated care in England and The Netherlands. Differing political strategies and conditions for integrated care correspond to the dissimilarities in the institutional structure and culture of their health care systems. Health care systems are understood as specific national and historical configurations. We review the last decade’s relevant policy processes, using the concepts of hierarchy, market and network. The state health care system in England relies mainly on hierarchical steering, thus creating tight network structures for integrated care on the local level. The Netherlands, with its health care system in a public-private mix, has set incentives for voluntary, loosely coupled and partly market-driven cooperation on the local level. Implications for success or failure are mixed in both configurations. Policy recommendations have to be tailored to each systems’ characteristics.
TL;DR: Performance showed improvements in assessment and documentation of pain and in initial care, including analgesia and application of positioning/handling protocols, however, review and response to continuing or changing symptoms were poorly documented.
Abstract: Purpose: To improve clinical management of patients with hemiplegic shoulder pain through development of an evidencebased multidisciplinary integrated care pathway (ICP), and to use this to audit quality of care against predefined standards. Methods: The ICP was developed by a team of medical, paramedical and nursing staff. The evidence base was established through a systematic literature review supplemented by clinical consensus to ensure best practice where scientific evidence was lacking. Following development, performance was assessed against standards in a cohort of stroke patients with hemiplegia (n=32) consecutively admitted to a regional unit providing in-patient rehabilitation for young patients with complex disabilities. Results: Performance showed improvements in assessment and documentation of pain and in initial care, including analgesia and application of positioning/handling protocols. However, review and response to continuing or changing symptoms were poorly documented. Changes to the ICP were introduced to improve this. Conclusions: Principal benefits have been to raise awareness of shoulder pain, to educate staff and prompt management in line with recommended best practice, but strong leadership is essential to ensure continuity in clinical practice. Future research is needed to establish whether improved quality of care offsets the substantial investment of staff time in ICP development.
TL;DR: This article argues that using Activity Based Costing (ABC) and integrated care pathways provides the best information possible for decision–making by health care managers, insurers, care suppliers and governments.
Abstract: In recent years, health care demand has become increasingly complicated and care has had to be integrated. The main reasons for this are a rising number of chronically ill patients and ageing of populations. Integrated health care is processual so there are continuous changes in care delivery; it incorporates many co-ordinating and co-operative activities which can produce uncertain outcomes; and activities are directed at delivering tailor-made care so there are no standardized or generalized outcomes. These characteristics mean that it is difficult to determine and compare the costs of different integrated care structures. This article argues that using Activity Based Costing (ABC) and integrated care pathways provides the best information possible for decision-making by health care managers, insurers, care suppliers and governments.
TL;DR: In this paper, the authors examine the origin and nature of these alternative approaches and the political furore accompanying the change is examined and an attempt is made to apply an evidence-based approach to the main vehicle for structural change - Care Trusts.
Abstract: Integrated care for vulnerable people is a target of governments throughout the world, but one that is thwarted by organizational and professional divisions. The 'New Labour' government in Britain came to power in 1997 with a brief to secure integrated support across health and social care through the development of partnership working - part of its much-vaunted 'Third Way'. However, just as new legislation on partnerships came into effect, the government attempted a volte-face and sought an alternative policy - the imposition of structural change. This article looks at the origin and nature of these alternative approaches. The political furore accompanying the change is examined and an attempt is made to apply an evidence-based approach to the main vehicle for structural change - Care Trusts. Ten reasons are suggested for treating the proposed model with caution. The analysis has relevance for the debate elsewhere between the relative merits of partnership working and structural integration as alternativ...
TL;DR: This proposal integrates sexual and domestic violence assistance and hospital and primary care, providing comprehensive care and intersectorial response for women.
TL;DR: Specialists are not very motivated to use the guidelines themselves, and negative outcomes at the organizational and financial levels must be minimized or compensated for in an implementation programme.
Abstract: Objective. To identify factors that may hinder or facilitate specialists’ use of joint treatment guidelines for primary and secondary care.
TL;DR: An appraisal instrument for ICPs — the integrated care pathway appraisal tool (ICPAT) — is described which has been developed within the West Midlands region of the UK and which can provide a framework for assessing the quality of I CPs.
Abstract: Integrated care pathways (ICPs) are being introduced as a tool to improve the quality of health care. Their local development usually involves some consensus-based approach which engages clinical s...
TL;DR: A review of the Polish experience in integration/disintegration of health care systems is the main part of the article, which discusses the typologies, expected outcomes and forces aiming at health care integration.
Abstract: At the beginning of the article the typologies, expected outcomes and forces aiming at health care integration are discussed. Integration is recognised as a multidimensional concept. The suggested typologies of integration are based on structural configurations, co-ordination mechanisms (including clinical co-ordination), and driving forces. A review of the Polish experience in integration/disintegration of health care systems is the main part of the article. Creation of integrated health care management units (ZOZs) in the beginning of the 1970s serves as an example of structural vertical integration missing co-ordination mechanisms. ZOZs as huge, costly and inflexible organisations became subjects of public criticism and discredited the idea of health care integration. At the end of the 1980s and in the decade of the 1990s, management of public health care was decentralised, the majority of ZOZs dismantled, and many health care public providers got the status of independent entities. The private sector developed rapidly. Sickness funds, which in 1999 replaced the previous state system, introduced “quasi-market” conditions where health providers have to compete for contracts. Some providers developed strategies of vertical and horizontal integration to get a competitive advantage. Consolidation of private ambulatory clinics, the idea of “integrated care” as a “contracting package”, development of primary health care and ambulatory specialist clinics in hospitals are the examples of such strategies. The new health policy declared in 2002 has recognised integration as a priority. It stresses the development of payment mechanisms and information base (Register of Health Services – RUM) that promote integration. The Ministry of Health is involved directly in integrated emergency system designing. It seems that after years of disintegration and deregulation the need for effective integration has become obvious.
TL;DR: This ICP raised staff awareness of depression, leading to improved documentation and possibly also standards of care, and to assess its impact on Standards of care and documentation.
Abstract: Objective: To develop an evidence-based multidisciplinary integrated care pathway (ICP) for the management of depression following brain injury in a rehabilitation setting, and to assess its impact on standards of care and documentation.Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with complex disabilities mainly resulting from brain injury.Methods and design: A completed cycle of audit including:standards set for documentation, assessment, management and review; L an initial retrospective audit of documented patient management against those standards during a five-year period (26 patient records);ICP development by a multidisciplinary team of doctors, psychologists and nurses based on clinical opinion and systematic review of the literature;re-audit from the ICP documentation (48 patient records) over a period of 15 months.Results: The initial audit demonstrated borderline acceptable documentation of baseline mood state and start of medication (54–...
TL;DR: This study compared 200 Elder Health patients with a closely matched group of dually eligible older individuals receiving care in fee‐for‐service practices, finding that the patients' health and functional status, their satisfaction with care, rates of use of medical services, and costs to Medicaid were similar.
Abstract: Older individuals receiving both Medicare and Medicaid benefits are known to have a disproportionate burden of illness and high medical care costs. Elder Health, Inc., a private, for-profit managed care organization operating in Maryland under capitation rates from both Medicare and Medicaid, has tailored a medical practice to these individuals, with the stated objective of providing integrated care. This study compared 200 Elder Health patients with a closely matched group of dually eligible older individuals receiving care in fee-for-service practices. There was a baseline in-home structured interview with the patient, followed 1 year later with a telephone interview. Other data sources were Medicaid claims data and Elder Health's utilization records. The outcomes of interest were the patients' health and functional status, their satisfaction with care, rates of use of medical services, and costs to Medicaid. Elder Health patients had similar general health status, better functional status, and greater satisfaction with access to care but less satisfaction with information giving than the fee-for-service group. They received more primary care and preventive services and had less than half the number of hospital days. Costs to Medicaid were nearly identical. Institutional and community-based long-term care costs were not included in the analysis.As pressures mount for the Health Care Financing Administration to expand its prepaid contracts with private health plans and the need for integrated programs increase, quantitative assessment of innovative delivery models such as Elder Health, Inc. will be essential to ensure that patients' and the publics' interests are well served.
TL;DR: How the joint project was successfully established, was instrumental in breaking down existing barriers across the traditional boundaries and developed a uniform system of assessing and managing chronic cancer pain with ICP documentation held in a patient-held record is discussed.
Abstract: Throughout the palliative care journey, the patient encounters many different health professionals in a variety of settings so good channels of communication between these professionals is a prerequisite for successful continuity of care (Scottish Partnership Agency for Palliative and Cancer Care (SPA), 1994). Pain control has also long been documented as being ineffective and it has been indicated that pain affects up to 88% of cancer patients in the last year of their life (Addington-Hall and McCarthy, 1995). In order to attempt to resolve these important issues, a joint project was established between primary, secondary and tertiary care in the south sector of Glasgow to establish an integrated care pathway (ICP) for the management of chronic cancer pain. This article discusses how the joint project was successfully established, was instrumental in breaking down existing barriers across the traditional boundaries and developed a uniform system of assessing and managing chronic cancer pain with ICP documentation held in a patient-held record.
TL;DR: The new Quebec policy on services for frail older persons advocates a different concept of organization of services for this population group and presupposes major changes in the ways in which services are delivered.
Abstract: Since the early 70s, Canada has had a public health care system that guarantees all Canadians universal access to hospital and medical services free of charge. The same values and principles have governed the organization of health and social services in Quebec, including long-term care and services. Over time, changes have occurred within the Quebec system in order to adapt services to new realities more effectively; such changes involve a diversification of services oriented towards helping individuals remain in the community, and services provided close to clients' own environments. Mechanisms have also been established to improve clinical assessment of clients' needs, in order to make service orientation and admission to residential facilities more systematic. Nonetheless, reform is required in order to respond to certain trends related to client needs, i.e., greater needs due to the significant increase in the number of older persons, but also needs that differ from those of a younger population, for whom the system was designed. The new Quebec policy on services for frail older persons advocates a different concept of organization of services for this population group and presupposes major changes in the ways in which services are delivered.