scispace - formally typeset
Search or ask a question
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.


Papers
More filters
Journal ArticleDOI
TL;DR: The analysis of best practices across experiences allowed us to identify factors which could enable decision makers to assess both the state of maturity of the health and social care environments and their readiness to scale up.

36 citations

Journal Article
TL;DR: For selected chronic diseases, introduction of an integrated chronic care management programme, based on internationally accepted best practice processes and interventions can make significant savings, reducing morbidity and improving the efficiency of health delivery in the Counties Manukau region.
Abstract: Aims To develop an effective and efficient process for the seamless delivery of care for targeted patients with specific chronic diseases. To reduce inexplicable variation and maximise use of available resources by implementing evidence-based care processes. To develop a programme that is acceptable and applicable to the Counties Manukau region. Methods A model for the management of people with chronic diseases was developed. Model components and potential interventions were piloted. For each disease project, a return on investment was calculated and external evaluation was undertaken. The initial model was subsequently modified and individual disease projects aligned to it. Results The final Chronic Care Management model, agreed in September 2001, described a single common process. Key components were the targeting of high risk patients, organisation of cost effective interventions into a system of care, and an integrated care server acting as a data warehouse with a rules engine, providing flags and reminders. Return on investment analysis suggested potential savings for each disease component from $277 to $980 per person per annum. Conclusions For selected chronic diseases, introduction of an integrated chronic care management programme, based on internationally accepted best practice processes and interventions can make significant savings, reducing morbidity and improving the efficiency of health delivery in the Counties Manukau region. Since the early 1990s there has been a steady and significant growth in the number of acute adult medical admissions to the Counties Manukau District Health Board (CMDHB) provider arm, South Auckland Health (Figure 1). The cumulative growth since 1997 has been 38%. In 1999, the Ministry of Health identified that much of the growth in acute hospitalisations was in preventable admissions and that a majority of these were “sensitive to prophylactic or therapeutic interventions deliverable in a primary health care setting”. It was suggested that up to 30% of hospital admissions could be prevented with more timely primary care intervention. 1 Prevention of 30% of acute medical admissions during the fiscal year 2000/01 would have meant approximately 4000 fewer admissions to South Auckland Health. Of the 10 conditions responsible for the most bed day utilisation, the most significant were respiratory infections, cardiovascular disease, chronic obstructive pulmonary disease (COPD), and heart failure. Eighty per cent of bed days were utilised by people suffering from these four conditions. Furthermore, diabetes was an often unrecorded,

36 citations

Journal ArticleDOI
TL;DR: The findings suggest that the model is feasible and well accepted by PCPs and patients, and the results indicate that the level of service utilization in COPA was less than what is reported at the national level, without any compromises in quality of care.
Abstract: Despite strong evidence for the efficacy of integrated systems, securing the participation of health professionals, particularly primary care physicians (PCPs), has proven difficult. Novel approaches are needed to resolve these problems. We developed a model - COPA - that is based on scientific evidence and an original design process in which health professionals, including PCPs, and managers participated actively. COPA targets very frail community-dwelling elders recruited through their PCP. It was designed to provide a better fit between the services provided and the needs of the elderly in order to reduce excess healthcare use, including unnecessary emergency room (ER) visits and hospitalizations, and prevent inappropriate long-term nursing home placements. The model's originality lies in: 1) having reinforced the role played by the PCP, which includes patient recruitment and care plan development; 2) having integrated health professionals into a multidisciplinary primary care team that includes case managers who collaborate closely with the PCP to perform a geriatric assessment (InterRAI MDS-HC) and implement care management programs; and 3) having integrated primary medical care and specialized care by introducing geriatricians into the community to see patients in their homes and organize direct hospitalizations while maintaining the PCP responsibility for medical decisions. Since COPA is currently the subject of both a quasi-experimental study and a qualitative study, we are also providing preliminary findings. These findings suggest that the model is feasible and well accepted by PCPs and patients. Moreover, our results indicate that the level of service utilization in COPA was less than what is reported at the national level, without any compromises in quality of care.

35 citations

Journal ArticleDOI
TL;DR: The CHRONIC Care Act boosts efforts to provide more integrated care for Medicare beneficiaries to better address needs that are not strictly medical, but it may also substantially affect risk selection in Medicare Advantage plans, which would be counterproductive.
Abstract: Integrating Medical and Nonmedical Services The CHRONIC Care Act boosts efforts to provide more integrated care for Medicare beneficiaries to better address needs that are not strictly medical, but it may also substantially affect risk selection in Medicare Advantage plans, which would be counterproductive.

35 citations

Journal ArticleDOI
27 Jan 2010-JAMA
TL;DR: Prospective care, a strategic approach that combines personalized health planning with integrated care services to focus on individualized health promotion, disease prevention, monitoring, and early intervention, is proposed.
Abstract: TO RESOLVE THE NATION’S HEALTH CARE DILEMMA AND tackle exploding costs, the current sporadic and reactive focus on treating episodes of disease must be transformed into one that is coordinated to improve health and minimize the consequences of chronic diseases. Because care is more effective when services are coordinated, there are mounting efforts to spur greater integration of delivery systems. What is missing is an approach that aligns the patient’s individual needs with health services tailored to meet those needs. Coordination of services will be insufficient unless they are driven by plans designed to anticipate the health needs of the patient over time. A proposal to do this is “prospective care,” a strategic approach that combines personalized health planning with integrated care services to focus on individualized health promotion, disease prevention, monitoring, and early intervention. Personalized health planning has the potential to effectively engage individuals with any aligned delivery system and serve as a foundation for payment models for valued outcomes. To deliver prospective care, 3 interrelated elements are essential: (1) a care model that uses personalized and predictive health planning, patient engagement, and processes to track health status, anticipate events, and personalize care when disease occurs; (2) care delivery systems to support the patient’s strategic health plan and medical needs in a coordinated, integrated fashion; and (3) a reimbursement system that supports prospective approaches and provides incentives for effective interventions. A problem with the current approach to care is that it is reactive, as exemplified by the medical work-up that starts with the “chief complaint and history of the present illness” and attempts to find the root cause of the disease and treat it. This model is well designed to treat disease events but not to promote health, prevent disease, or effectively treat chronic disease. Currently, many patients take little responsibility for their health, resulting in adherence barriers to effective prevention and treatment of long-term conditions. Existing reimbursement rewards interventions for disease events rather than prevention and continuity of care. Moreover, the current approach does not align with scientific concepts of disease development that indicate that an individual inherits a range of susceptibilities to chronic diseases and that, depending on exposures, health may improve or deteriorate into recognizable illnesses. Based on these concepts and emerging research enabling clinical prediction, the idea of prospective care, a strategic approach to personalized medicine, was developed. Personalized medicine refers to all factors that distinguish an individual’s health characteristics and risks, including family history, clinical data, behavioral factors, and genomics when applicable. Prospective care uses personalized health planning as its underlying approach to effectively link the patient and the delivery system. Personalized health planning is based on the understanding that an individual’s genetic inheritance creates baseline risk for diseases that are modified by environmental factors, resulting in development of or resistance to disease. Given the time dependency of the disease process, an individual’s health risks and status can be quantified and tracked over time, with strategies developed to engage patients and caregivers to minimize diseases and treat them appropriately when they occur. The personalized health plan consists of a health risk assessment, a process to track risk factors, and a wellnesstherapeutic plan that involves patients and maximizes their commitment. Thus, the plan serves as a point of coordination between the patient and the delivery system over time, ensuring maximum engagement on the part of both toward the goals of enhancing the patient’s well-being and minimizing disease. Inherited and acquired risks continue to be identified for many common diseases. The fields of genomics, proteomics, metabolomics, and bioinformatics will improve individual risk prediction accuracy, but they are not required to get started. A key element in the proposed medical workup is the identification of the patient’s specific susceptibilities to chronic diseases and the risk factors that allow tracking of disease development. Physicians are trained to anticipate disease risks based on numerous clinical factors including family history, physical findings, and results of laboratory tests. It will be important to adopt a more formal approach using the latest evidence-based standards and health

35 citations


Network Information
Related Topics (5)
Health care
342.1K papers, 7.2M citations
88% related
Psychological intervention
82.6K papers, 2.6M citations
86% related
Mental health
183.7K papers, 4.3M citations
82% related
Qualitative research
39.9K papers, 2.3M citations
82% related
Psychosocial
66.7K papers, 2M citations
82% related
Performance
Metrics
No. of papers in the topic in previous years
YearPapers
202384
2022166
2021672
2020663
2019630
2018663