Integrated care

About: Integrated care is a research topic. Over the lifetime, 7318 publications have been published within this topic receiving 106960 citations. The topic is also known as: Integrated Delivery of Health Care & Delivery of Health Care, Integrated.

Transitions of Care in Heart Failure A Scientific Statement From the American Heart Association

Abstract: In patients with heart failure (HF), use of 30-day rehospitalization as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach. Transition programs are being used to achieve goals. Transition of care in the context of HF management refers to individual interventions and programs with multiple activities that are designed to improve shifts or transitions from one setting to the next, most often from hospital to home. As transitional care programs become the new normal for patients with chronic HF, it is important to understand the current state of the science of transitional care, as discussed in the available research literature. Of transitional care reports, there was much heterogeneity in research designs, methods, study aims, and program targets, or they were not well described. Often, programs used bundled interventions, making it difficult to discuss the efficiency and effectiveness of specific interventions. Thus, further HF transition care research is needed to ensure best practices related to economically and clinically effective and feasible transition interventions that can be broadly applicable. This statement provides an overview of the complexity of HF management and includes patient, hospital, and healthcare provider barriers to understanding end points that best reflect clinical benefits and to achieving optimal clinical outcomes. The statement describes transitional care interventions and outcomes and discusses implications and recommendations for research and clinical practice to enhance patient-centered outcomes.

Defining the future of primary care: what can we learn from patients?.

Abstract: From the earliest definitions of the term primary care to the most recent, all have stressed that primary care is predicated on a sustained relationship between patients and the clinicians who care for them. Primary care differentiates itself from other areas of medicine by attending to the whole person, in the context of the patient's personal and medical history and life circumstances, rather than focusing on a particular disease, organ, or system. Finally, the primary care physician plays a distinctive role in integrating the care that patients receive from within and outside of the primary care setting. Data obtained from patients over the past 15 years demonstrate that most Americans have a physician whom they consider to be their primary physician. This was the case well before the rules of managed care plans required patients to align themselves with a particular primary care physician and to allow that physician to coordinate all of their medical care. However, information from patients indicates that despite primary care relationships that endure over several years, the ideals of whole-person, integrated care are largely unmet in patients' primary care experiences. Moreover, considerable evidence indicates that the quality of primary care relationships has eroded over the past several years. This article highlights the relative strengths and weaknesses of primary care, as experienced and reported by patients, and posits three areas that must be addressed for primary care to live up to the ideals of sustained partnerships providing whole-person, integrated care. These three areas involve the use of teams in medicine, the establishment of meaningful primary care partnerships, and integration of care in a delivery system that patients experience as increasingly fragmented.

The clinician's perspective on electronic health records and how they can affect patient care.

Abstract: Many attempts to get clinicians to use electronic health records have failed, often because of difficulties with data entry.1–4 Technology should complement and improve clinical care, not impose extra burdens on already overloaded medical staff. The clinical “usability” of electronic records systems is particularly relevant with the recent appointment of service providers to implement the national Integrated Care Record Service for the NHS as usability also affects patient care. I examine important lessons learned from previous attempts to get clinicians to use computers in health care; discuss how clinicians actually work; make recommendations on designing or selecting clinical computer systems; and explore how the use of electronic health records might affect patient care. ### Use of narratives in clinical reasoning Patient documentation systems that try to reproduce previously accepted models of clinical reasoning (pattern recognition, algorithms, or hypothetico-deductive models) have achieved limited acceptance. According to Greenhalgh, the medical encounter consists of stories within stories.5 Kay and Purves maintain that narratives are at the heart of clinical decision making and refers to this concept as “narrative reasoning.”6 They argue that “every patient tells a story (narrative) and clinicians intuitively use narrative devices in relation to the delivery of patient care.” The patient is seen as “a page from the book of nature, a text to be read,” and the doctor becomes the author of “stories within the medical record.” Kay and Purves make a strong case for retaining information in a conceptual framework and maintain that this is best accomplished by means of narratives rather than “reducing the semantic richness and degrading the story to limited codes and weakly connected phrases.” Van Ginneken also states that many computerised medical record systems are rejected by clinicians because they are not based on a story metaphor.7 Frisse and colleagues state that “using conversations as …

Frailty: an emerging concept for general practice.

Abstract: Ageing of the population in western societies and the rising costs of health and social care are refocusing health policy on health promotion and disability prevention among older people. However, efforts to identify at-risk groups of older people and to alter the trajectory of avoidable problems associated with ageing by early intervention or multidisciplinary case management have been largely unsuccessful. This paper argues that this failure arises from the dominance in primary care of a managerial perspective on health care for older people, and proposes instead the adoption of a clinical paradigm based on the concept of frailty. Frailty, in its simplest definition, is vulnerability to adverse outcomes. It is a dynamic concept that is different from disability and easy to overlook, but also easy to identify using heuristics (rules of thumb) and to measure using simple scales. Conceptually, frailty fits well with the biopsychosocial model of general practice, offers practitioners useful tools for patient care, and provides commissioners of health care with a clinical focus for targeting resources at an ageing population.