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.

Evaluation of a technology-enhanced integrated care model for frail older persons: protocol of the SPEC study, a stepped-wedge cluster randomized trial in nursing homes

Abstract: Limited evidence exists on the effectiveness of the chronic care model for people with multimorbidity. This study aims to evaluate the effectiveness of an information and communication technology- (ICT-)enhanced integrated care model, called Systems for Person-centered Elder Care (SPEC), for frail older adults at nursing homes. SPEC is a prospective stepped-wedge cluster randomized trial conducted at 10 nursing homes in South Korea. Residents aged 65 or older meeting the inclusion/exclusion criteria in all the homes are eligible to participate. The multifaceted SPEC intervention, a geriatric care model guided by the chronic care model, consists of five components: comprehensive geriatric assessment for need/risk profiling, individual need-based care planning, interdisciplinary case conferences, person-centered care coordination, and a cloud-based information and communications technology (ICT) tool supporting the intervention process. The primary outcome is quality of care for older residents using a composite measure of quality indicators from the interRAI LTCF assessment system. Outcome assessors and data analysts will be blinded to group assignment. Secondary outcomes include quality of life, healthcare utilization, and cost. Process evaluation will be also conducted. This study is expected to provide important new evidence on the effectiveness, cost-effectiveness, and implementation process of an ICT-supported chronic care model for older persons with multiple chronic illnesses. The SPEC intervention is also unique as the first registered trial implementing an integrated care model using technology to promote person-centered care for frail older nursing home residents in South Korea, where formal LTC was recently introduced. ISRCTN11972147

Intelligent Patient Management and Resource Planning for Complex, Heterogeneous, and Stochastic Healthcare Systems

Abstract: Effective resource requirement forecasting is necessary to reduce the escalating cost of care by ensuring optimum utilization and availability of scarce health resources. Patient hospital length of stay (LOS) and thus resource requirements depend on many factors including covariates representing patient characteristics such as age, gender, and diagnosis. We therefore propose the use of such covariates for better hospital capacity planning. Likewise, estimation of the patient's expected destination after discharge will help in allocating scarce community resources. Also, probable discharge destination may well affect a patient's LOS in hospital. For instance, it might be required to delay the discharge of a patient so as to make appropriate care provision in the community. A number of deterministic models such as ratio-based methods have failed to address inherent variability in complex health processes. To address such complexity, various stochastic models have therefore been proposed. However, such models fail to consider inherent heterogeneity in patient behavior. Therefore, we here use a phase-type survival tree for groups of patients that are homogeneous with respect to LOS distribution, on the basis of covariates such as time of admission, gender, and disease diagnosed; these homogeneous groups of patients can then model patient flow through a care system following stochastic pathways that are characterized by the covariates. Our phase-type model is then extended by further growing the survival tree based on covariates representing outcome measures such as treatment outcome or discharge destinations. These extended phase-type survival trees are very effective in modeling interrelationship between a patient's LOS and such outcome measures and allow us to describe patient movements through an integrated care system including hospital, social, and community components. In this paper, we first propose a generalization of the Coxian phase-type distribution to a Markov process with more than one absorbing state; we call this the multi-absorbing state phase-type distribution. We then describe how the model can be used with the extended phase-type survival tree for forecasting hospital, social, and community care resource requirements, estimating cost of care, predicting patient demography at a given time in the future, and admission scheduling. We can, thus, provide a stochastic approach to capacity planning across complex heterogeneous care systems. The approach is illustrated using a five year retrospective data of patients admitted to the stroke unit of the Belfast City Hospital.

Community health workers, recipients’ experiences and constraints to care in South Africa – a pathway to trust

Abstract: Community health workers (CHWs) affiliated with community-based organisations are central to the implementation of primary health care in district health services in South Africa. Here, we explore factors that affect the provision of and access to care in two provinces - Gauteng and Eastern Cape. Drawing on narratives of care recipients and the CHWs who support them, we illustrate the complex issues surrounding health maintenance and primary care outreach in poor communities, and describe how the intimate interactions between providers and recipients work to build trust. In the study we report here, householders in Gauteng Province had poor access to health care and other services, complicating the impoverished circumstances of their everyday lives. The limited resources available to CHWs hindered their ability to meet householders' needs and for householders to benefit from existing services. CHWs in the Eastern Cape were better able to address the needs of poor householders because of the organisational support available to them. Based on an ethos of integrated and holistic care, this enabled the CHWs to address the recipients' context-related needs, and health and medical needs, while building greater levels of trust with their clients.

Dis/integrated care: family caregivers and in‐hospital respite care

Abstract: Aim. The aim of this study was to explore family caregivers' experiences of in-hospital respite care for people with dementia and the factors that influenced their perceptions of the service. Background. The provision of respite care is based on the assumption that temporary relief from caregiving will relieve caregiver stress and may possibly extend the duration of home care. Research evidence suggests that this is a simplistic perspective which fails to account for families' concerns about the quality of institutional care and the impact of relocation on the person being cared for. Design. Nine family caregivers, using four different hospitals sites were interviewed during a period of 3 years from 1994 to 1997. The research texts were analysed using a critical discourse analysis approach drawing on the work of Foucault. Findings. Family caregiver texts were distinguished by difference rather than by homogeneity. Caregivers occupied a range of positions in terms of their ability to take advantage of the respite time intermittent care offered. My reading of these texts has highlighted the aspects of nurse–family relationships that ameliorated, or alternately exacerbated, the tensions felt by caregivers, as they were torn between the necessity to have a break and their anxieties about the impact of in-hospital respite care on the person with dementia. Conclusion. Nurses' practices in this study were a critical element in facilitating, or alternately constraining, family caregivers' ability to relinquish care and to take full advantage of the respite time. The research findings highlight the need for nurses and other formal caregivers to locate themselves in a secondary and supporting caregiving role, to acknowledge the family caregivers as the primary caregiver, and use family caregivers in-depth and intimate knowledge of the needs of their relative to inform care within the institutional setting.

Economic evidence on integrated care for stroke patients; a systematic review

Abstract: Introduction: Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of all integrated care arrangements for stroke patients compared to usual care. Integrated care was defined as a multidisciplinary tool to improve the quality and efficiency of evidence-based care and is used as a communication tool between professionals to manage and standardize the outcome-orientated care. Methods: A systematic literature review of cost analyses and economic evaluations was performed. Study characteristics, study quality and results were summarized. Results: Fifteen studies met the inclusion criteria; six on early-supported discharge services, four on home-based rehabilitation, two on stroke units and three on stroke services. The follow-up per patient was generally short; one year or less. The comparators and the scope of included costs varied between studies. Conclusions: Six out of six studies provided evidence that the costs of early-supported discharge are less than for conventional care, at similar health outcomes. Home-based rehabilitation is unlikely to lead to cost-savings, but achieves better health outcomes. Care in stroke units is more expensive than conventional care, but leads to improved health outcomes. The cost-effectiveness studies on integrated stroke services suggest that they can reduce costs. For future research we recommend to focus on the moderate and severely affected patients, include stroke severity as variable, adopt a societal costing perspective and include long-term costs and effects.