Topic
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.
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TL;DR: Investments in PBHCI can improve access to outpatient medical care for persons with severe mental illness and may also curb hospitalizations and associated costs in more established programs.
Abstract: Objective:This evaluation was designed to assess the impact of providing integrated primary and mental health care on utilization and costs for outpatient medical, inpatient hospital, and emergency department treatment among persons with serious mental illness.Methods:Two safety-net, community mental health centers that received a Substance Abuse and Mental Health Services Administration Primary and Behavioral Health Care Integration (PBHCI) grant were the focus of this study. Clinic 1 had a ten-year history of providing integrated services whereas clinic 2 began integrated services with the PBHCI grant. Difference-in-differences (DID) analyses were used to compare individuals enrolled in the PBHCI programs (N=373, clinic 1; N=389, clinic 2) with propensity score–matched comparison groups of equal size at each site by using data obtained from medical records.Results:Relative to the comparison groups, a higher proportion of PBHCI clients used outpatient medical services at both sites following program enro...
37 citations
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TL;DR: When designing integrated care models for CMC, it is essential to understand and address the challenges experienced by their health care providers, which requires adequate training of providers, additional resources and time for coordination of care, improved systems of communication among services, with timely access to key information for parents and providers.
Abstract: Children with medical complexity (CMC) have a wide range of long term health problems and disabilities that have an adverse impact on their quality of life. They have high levels of family identified health care needs and health care utilisation. There is no Australian literature on the experiences of health care providers working in the Australian tertiary, secondary and primary health care system, whilst managing CMC. This information is essential to inform the design of integrated health care systems for these children. We address this knowledge gap by exploring the perceptions and experiences of health care providers on the provision of health care for CMC aged 0 to 18 years. A qualitative research study was undertaken. Stakeholder forums, group and individual in depth interviews were undertaken using a semi-structured interview guide. The stakeholder forums were audio recorded and transcribed verbatim. Field notes of the stakeholder forums, group and individual interviews were taken. Inductive thematic analysis was undertaken to identify key themes. One hundred and three providers took part in the stakeholder forums and interviews across 3 local health districts, a tertiary paediatric hospital network, and primary health care organisations. Providers expressed concern regarding family capacity to negotiate the system, which was impacted by the medical complexity of the children and psychosocial complexity of their families. Lack of health care provider capacity in terms of their skills, time and availability to manage CMC was also a key problem. These issues occurred within a health system that had impaired capacity in terms of fragmentation of care and limited communication among health care providers. When designing integrated care models for CMC, it is essential to understand and address the challenges experienced by their health care providers. This requires adequate training of providers, additional resources and time for coordination of care, improved systems of communication among services, with timely access to key information for parents and providers.
37 citations
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TL;DR: In this article, the authors proposed to integrate antenatal care with other health services, including PNC, to improve the quality of services provided during ANC contact, and strengthen continuity and quality of care through to the postnatal period.
Abstract: Since 2005, antenatal care (ANC) coverage has risen considerably worldwide [1]. The World Health Organization (WHO) estimates suggest that during 2005–2012 approximately 80.5% of pregnant women globally, including 71.8% of women in low–income countries, had at least one ANC visit during pregnancy [1]. ANC provides an opportunity for women to access effective interventions that reduce risks associated with pregnancy and improve their health and well–being, as well as that of their progeny. However, while there was considerable progress towards the Millennium Development Goals 4 (to reduce child mortality) and 5 (to improve maternal health), maternal and neonatal mortality from preventable pregnancy– and birth–related complications remain high, particularly in low– and middle–income countries (LMICs) [2]. In 2013, around 289 000 women died during and following pregnancy and childbirth–the vast majority in low–resource settings [3]. Between one–third and one–half of these pregnancy–related deaths are due to preventable complications, such as eclampsia and haemorrhage, directly related to inadequate care [4]. Additionally, nearly three million newborns died during their first month of life, in large part due to insufficient provision of postnatal care (PNC) [2,5–8]. Lack of PNC not only affects neonatal mortality, but also has long–term negative impacts on the development of children who survive, as opportunities for promoting healthy home behaviours are missed. The unacceptably high maternal and neonatal mortality rates in LMICs suggest new approaches are needed to expand access to ANC, improve the quality of services provided during ANC contact, and strengthen continuity and quality of care through to the postnatal period.
In most LMICs pregnancy often marks a woman’s first encounter with formal health services, and ANC can serve as an effective platform for a broad range of health interventions [9], including for the provision of services for conditions that increase the risk of complications during pregnancy (eg, malaria, sexually transmitted infections (STIs), HIV/AIDS, tuberculosis (TB), tetanus, and malnutrition). Integrating ANC with malaria, STIs, HIV/AIDS and TB services can also expand the reach of these programmes to a broader population [10]. In settings where the prevalence of such conditions is high, integrating ANC with cost–effective services like prevention of mother to child transmission (PMTCT) of HIV [11], intermittent preventative treatment in pregnancy for malaria, and provision of insecticide treated nets [9] would likely improve maternal and child health outcomes. The WHO has identified integration of ANC with other health services, including PNC, as a key strategy for reducing missed opportunities for patient contact and for effectively and comprehensively addressing the health and social needs of pregnant women and their children, thereby improving maternal and child health [5,8,9].
Integration in health systems is variously defined [12–15], referring to establishing joint systems for organisation, financing, management, planning and evaluation of health programmes at different levels of the health system (from health facilities to ministry of health level) to improve the efficiency and effectiveness of health systems [16]. Integrated care has also been defined by WHO as “bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion” in order to “improve services in relation to access, quality, user satisfaction and efficiency” [17,18]. The rationale for integrating health services is to improve user access to health services across the care continuum to meet users’ health needs over time [19,20] and to create positive synergies among investments in health programmes [21].
However, ‘injudicious integration’ may also have harmful consequences for already constrained health systems [22]. For example, provision of multiple services during a single point of contact requires that health care providers be sufficiently trained in all aspects of the services concerned to ensure high quality care. But, in resource constrained systems training can take away health staff from frontline services [23]. Furthermore, provision of multiple services could stretch the already limited capacity, thus leading to long waiting times and hindering access for women who have to travel far to reach health facilities. In an attempt to reduce workload providers may reduce the time spent on consultations, thus compromising service quality.
To date few studies have systematically examined how integration of ANC with other services could influence health outcomes, service access, efficiency, or patient satisfaction [19,24–26]. Evidence to guide policy on the best ways to integrate ANC with PNC and other health services for pregnant women and integration impact is limited. This review examines the evidence on how integration of ANC services with PNC or other health services in LMICs affects health outcomes for women and children, health care provision (including processes, outputs, service quality) and costs. The review analyses ways in which the quality of ANC can be improved through integration with PNC and other health services. Specifically, the review focuses on the impact of integrated provision of ANC services, which can take different forms, such as co–location of ANC and PNC or other health services with a single point of access, through a well–connected referral system [27,28], or by merger of services within or across a domain of care [29].
37 citations
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TL;DR: The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations by adopting a mixed methods evaluation methodology.
Abstract: Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. Study design: We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context.
37 citations
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TL;DR: A care process model for youths at risk for suicide and self-harm is presented, with guidance for clinicians based on the scientific evidence.
37 citations