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.

Shared mental models of integrated care: aligning multiple stakeholder perspectives

Abstract: Purpose – Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter‐organizational and inter‐professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration.Design/methodology/approach – The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration‐task, system‐role, and integration‐belief.Findings – The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory‐based framework of psychological factors that may influence inter‐organizational and int...

Adoption of disease management model for diabetes in region of Maastricht

Abstract: Chronic diseases and associated conditions will always pose a challenge to healthcare systems. New healthcare models are being introduced in Western countries in response to a set of problems that are evident to some degree in all health services—for example, uncoordinated arrangements for delivering care, bias towards acute treatment, neglect of preventive care, and inappropriate treatment.1 These models take account of the pressure on quality and costs of chronic care and originate from the overlapping approaches of integrated care (United States) and shared care (western Europe). 2 3 In the Netherlands, shared care models have acted as a precursor of the recently introduced concept of disease management. Although several disease management initiatives are emerging, the model is not being adopted as fast as might be expected from the benefits that are claimed to result from it.4 In this article we describe the process of moving from a shared care model to a disease management model by considering recent developments in diabetes care in the region of Maastricht. We also describe the use of health technology assessment to evaluate the model. #### Summary points The concepts of integrated care and shared care can be regarded, in the Netherlands at least, as the precursor of disease management Implementation of a shared care model for diabetes in the region of Maastricht ensured that necessary conditions were met for a disease management model Widespread use of disease management models is hampered by lack of evidence Evidence from health technology assessment is necessary to justify large scale use of disease management models but will not be sufficient by itself Shared care for patients with stable diabetes mellitus type 2 who were receiving care from an endocrinologist in an outpatient clinic was implemented in the region of Maastricht in 1997. Two changes were made from usual care: …

Understanding Care Integration from the Ground Up: Five Organizing Constructs that Shape Integrated Practices

Abstract: Purpose: To provide empirical evidence on key organizing constructs shaping practical, real-world integration of behavior health and primary care to comprehensively address patients’ medical, emotional, and behavioral health needs. Methods: In a comparative case study using an immersion-crystallization approach, a multidisciplinary team analyzed data from observations of practice operations, interviews, and surveys of practice members, and implementation diaries. Practices were drawn from 2 studies of practices attempting to integrate behavioral health and primary care: Advancing Care Together, a demonstration project of 11 practices located in Colorado, and the Integration Workforce Study, a study of 8 practices across the United States. Results: We identified 5 key organizing constructs influencing integration of primary care and behavioral health: 1) Integration REACH (the extent to which the integration program was delivered to the identified target population), 2) establishment of continuum of care pathways addressing the location of care across the range of patient’s severity of illness, 3) approach to patient transitions: referrals or warm handoffs, 4) location of the integration workforce, and 5) participants’ mental model for integration. These constructs intertwine within an organization’s historic and social context to produce locally adapted approaches to integrating care. Contextual factors, particularly practice type, influenced whether specialty mental health and substance use services were colocated within an organization. Conclusion: Interaction among 5 organizing constructs and practice context produces diverse expressions of integrated care. These constructs provide a framework for understanding how primary care and behavioral health services can be integrated in routine practice. (J Am Board Fam Med 2015;28: S7–S20.)

The relationship between organizational culture and implementation of clinical practice guidelines: a narrative review.

Abstract: The context in which critical care providers work has been shown to be associated with adherence to recommendations of clinical practice guidelines (CPGs). Consideration of contextual factors such as organizational culture may therefore be important when implementing guidelines. Organizational culture has been defined simply as "how things are around here" and encompasses leadership, communication, teamwork, conflict resolution, and other domains. This narrative review highlights the results of recent quantitative and qualitative studies, including studies on adherence to nutrition guidelines in the critical care setting, which demonstrate that elements of organizational culture, such as leadership support, interprofessional collaboration, and shared beliefs about the utility of guidelines, influence adherence to guideline recommendations. Outside nutrition therapy, there is emerging evidence that strategies focusing on organizational change (eg, revision of professional roles, interdisciplinary teams, integrated care delivery, computer systems, and continuous quality improvement) can favorably influence professional performance and patient outcomes. Consequently, future interventions aimed at implementing nutrition guidelines should aim to measure and take into account organizational culture, in addition to considering the characteristics of the patient, provider, and guideline. Further high quality, multimethod studies are required to improve our understanding of how culture influences guideline implementation, and which organizational change strategies might be most effective in optimizing nutrition therapy.