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.

Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: results of cluster randomised trial

Abstract: Objective To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with usual care Design 24 month, multicentre, pragmatic cluster randomised controlled trial Setting 40 general practices in the western part of the Netherlands Participants Patients with COPD according to GOLD (Global Initiative for COPD) criteria Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires Practices were included if they were willing to create a multidisciplinary COPD team Intervention General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice, including early recognition of exacerbations and self management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate integrated disease management into daily practice The control group continued usual care (based on international guidelines) Main outcome measures The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self management, physical activity, and level of integrated care (PACIC) were also assessed as secondary outcomes Results Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group No difference was seen between groups in the CCQ at 12 months (mean difference –001, 95% confidence interval –010 to 008; P=08) After 12 months, no differences were seen in secondary outcomes between groups, except for the PACIC domain “follow-up/coordination” (indicating improved integration of care) and proportion of physically active patients Exacerbation rates as well as number of days in hospital did not differ between groups After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain Conclusion In this pragmatic study, an integrated disease management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of integrated care and a self reported higher degree of daily activities The contradictory findings to earlier positive studies could be explained by differences between interventions (provider versus patient targeted), selective reporting of positive trials, or little room for improvement in the already well developed Dutch healthcare system Trial registration Netherlands Trial Register NTR2268

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care

Abstract: Purpose: This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. Methods: This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Results: Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs9 capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Conclusion: Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators.

A cost-effectiveness study of a patient-centred integrated care pathway.

Abstract: Title. A cost-effectiveness study of a patient-centred integrated care pathway. Aim. The aim of the study was to compare costs and consequences for an integrated care pathway intervention group with those of a usual care group for patients admitted with hip fracture. Background. Rehabilitation for patients with hip fracture consists of training in hospital and/or in a rehabilitation unit, and on their own at home with assistance from community care staff. It is important for hospitals to provide methods of care that can safeguard these older patients’ physical function and potential for independent living. Methods. A consecutive sample of 112 independently living participants, aged 65 years or older and admitted to hospital with a hip fracture, were included in the study. Data were collected over an 18-month period in 2003–2005. A costeffectiveness analysis was performed to compare an integrated care pathway intervention (treatment A) with usual care (treatment B). Results. There was a 40% reduction for each participant in the average total cost of treatment A of €9685 vs. €15,984 for treatment B. Moreover, clinical effectiveness was much improved. The cost-effectiveness ratio for treatment A was €14,840 vs. €31,908 for treatment B. In addition, 75% of the participants in treatment A were successfully rehabilitated vs. 55% in treatment B. Conclusions. The recovery trajectory for hip fracture surgery may be shortened if nurses pay more attention to the individual patient’s resources and motivation for rehabilitation. The application of an integrated care pathway with individualized care appears to enhance both rehabilitation outcomes and cost-effectiveness.

Integrated care pathways: eleven international trends

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.

Integrated care for asthma: a clinical, social, and economic evaluation

Abstract: Objective : To evaluate integrated care for asthma in clinical, social, and economic terms. Design : Pragmatic randomised trial. Setting : Hospital outpatient clinics and general practices throughout the north east of Scotland. Patients : 712 adults attending hospital outpatient clinics with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%. Main outcome measures : Use of bronchodilators and inhaled and oral steroids; number of general practice consultations and hospital admissions for asthma; sleep disturbance and other restrictions on normal activity; pyschological aspects of health including perceived asthma control; patient satisfaction; and financial costs. Results : After one year there were no significant overall differences between those patients receiving integrated asthma care and those receiving conventional outpatient care for any clinical or psycho-social outcome. For pulmonary function, forced expiratory volume was 76% of predicted for integrated care patients and 75% for conventional outpatients (95% confidence interval for difference -3.6% to 5.0%). Patients who had experienced integrated care were more likely to select it as their preferred course of future management (75% (251/ 333) v 62% (207/333) (6% to 20%); they saved pounds sterling 39.52 a year. This was largely because patients in conventional outpatient care consulted their general practioner as many times as those in integrated care, who were not also visiting hospital. Conclusion : Integrated care for moderately severe asthma patients is clinically as effective as conventional outpatient care, cost effective, and an attractive management option for patients, general practioners, and hospital consultants.