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Stokes J, Struckmann V, Kristensen SR, Fuchs S, van Ginneken E, Tsiachristas A, Rutten van Mölken M, Sutton M. Towards incentivising integration: A typology of payments for integrated care. Health Policy 2018; 122:963-969. [PMID: 30033204 DOI: 10.1016/j.healthpol.2018.07.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/29/2018] [Accepted: 07/01/2018] [Indexed: 11/26/2022]
Abstract
Traditional provider payment mechanisms may not create appropriate incentives for integrating care. Alternative payment mechanisms, such as bundled payments, have been introduced without uniform definitions, and existing payment typologies are not suitable for describing them. We use a systematic review combined with example integrated care programmes identified from practice in the Horizon2020 SELFIE project to inform a new typology of payment mechanisms for integrated care. The typology describes payments in terms of the scope of payment (Target population, Time, Sectors), the participation of providers (Provider coverage, Financial pooling/sharing), and the single provider/patient involvement (Income, Multiple disease/needs focus, and Quality measurement). There is a gap between rhetoric on the need for new payment mechanisms and those implemented in practice. Current payments for integrated care are mostly sector- and disease-specific, with questionable impact on those with the most need for integrated care. The typology provides a basis to improve financial incentives supporting more effective and efficient integrated care systems.
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Affiliation(s)
- Jonathan Stokes
- Manchester Centre for Health Economics, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Verena Struckmann
- Berlin University of Technology, Department of Health Care Management, Straße des 17.Juni 135, Berlin 10623, Germany.
| | - Søren Rud Kristensen
- Manchester Centre for Health Economics, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom; Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, United Kingdom.
| | - Sabine Fuchs
- Department of Health Care Management, Berlin University of Technology, Straße des 17. Juni 135, Berlin 10623, Germany.
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Berlin University of Technology, Strasse des 17. Juni 135, Berlin 10623, Germany.
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom.
| | - Maureen Rutten van Mölken
- Erasmus School of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, The Netherlands.
| | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom.
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Singh J, Pokhrel S, Longworth L. Can Social Care Needs and Well-Being Be Explained by the EQ-5D? Analysis of the Health Survey for England. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:830-838. [PMID: 30005755 DOI: 10.1016/j.jval.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 10/25/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The recent shift to an integrated approach to health and social care aims to provide cohesive support to those who are in need of care, but raises a challenge for resource allocation decision making, in particular for comparison of diverse benefits from different types of care across the two sectors. OBJECTIVE To investigate the relationship of social care needs and well-being with a generic health status measure using multivariate regression. METHODS We empirically compared responses to health and well-being measures and social care needs from a cross-sectional data set of the general population (the Health Survey for England). Multivariate regression analyses were conducted to examine whether social care needs measured by the Barthel index can be explained by health status as captured by the EuroQol five-dimensional questionnaire (EQ-5D) and two well-being measures-the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and the General Health Questionnaire (GHQ-12). RESULTS Our study found that poor overall scores for EuroQol visual analogue scale, EQ-5D index, GHQ-12, and WEMWBS indicated a need for social care. Investigation of the dimensions found that the EQ-5D dimensions self-care and pain/discomfort were statistically significantly associated with the need for social care. Two dimensions of the WEMWBS ("been feeling useful" and "had energy to spare") were statistically significantly associated with the Barthel index, but none of the GHQ-12 dimensions were. CONCLUSIONS The results show that the need for social care, which is dependent on the ability to perform personal day-to-day activities, is more closely related to the EQ-5D dimensions than the well-being measures WEMWBS and GHQ-12.
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Affiliation(s)
- Jeshika Singh
- PHMR Ltd.-Health Economics, Pricing and Reimbursement, London, UK; Health Economics Research Group, Department of Clinical Sciences, Brunel University London, London, UK.
| | - Subhash Pokhrel
- Health Economics Research Group, Department of Clinical Sciences, Brunel University London, London, UK
| | - Louise Longworth
- PHMR Ltd.-Health Economics, Pricing and Reimbursement, London, UK
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Turner A, Mulla A, Booth A, Aldridge S, Stevens S, Begum M, Malik A. The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [PMID: 29972636 DOI: 10.3310/hsdr06250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundThe Multispecialty Community Provider (MCP) model was introduced to the NHS as a primary care-led, community-based integrated care model to provide better quality, experience and value for local populations.ObjectivesThe three main objectives were to (1) articulate the underlying programme theories for the MCP model of care; (2) identify sources of theoretical, empirical and practice evidence to test the programme theories; and (3) explain how mechanisms used in different contexts contribute to outcomes and process variables.DesignThere were three main phases: (1) identification of programme theories from logic models of MCP vanguards, prioritising key theories for investigation; (2) appraisal, extraction and analysis of evidence against a best-fit framework; and (3) realist reviews of prioritised theory components and maps of remaining theory components.Main outcome measuresThe quadruple aim outcomes addressed population health, cost-effectiveness, patient experience and staff experience.Data sourcesSearches of electronic databases with forward- and backward-citation tracking, identifying research-based evidence and practice-derived evidence.Review methodsA realist synthesis was used to identify, test and refine the following programme theory components: (1) community-based, co-ordinated care is more accessible; (2) place-based contracting and payment systems incentivise shared accountability; and (3) fostering relational behaviours builds resilience within communities.ResultsDelivery of a MCP model requires professional and service user engagement, which is dependent on building trust and empowerment. These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. Together, these can facilitate accountability at the individual, community and system levels. The evidence base relating to these theory components was, for the most part, limited by initiatives that are relatively new or not formally evaluated. Support for the programme theory components varies, with moderate support for enhanced primary care and community involvement in care, and relatively weak support for new contracting models.Strengths and limitationsThe project benefited from a close relationship with national and local MCP leads, reflecting the value of the proximity of the research team to decision-makers. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change.ConclusionsMultispecialty Community Providers can be described as complex adaptive systems (CASs) and, as such, connectivity, feedback loops, system learning and adaptation of CASs play a critical role in their design. Implementation can be further reinforced by paying attention to contextual factors that influence behaviour change, in order to support more integrated working.Future workA set of evidence-derived ‘key ingredients’ has been compiled to inform the design and delivery of future iterations of population health-based models of care. Suggested priorities for future research include the impact of enhanced primary care on the workforce, the effects of longer-term contracts on sustainability and capacity, the conditions needed for successful continuous improvement and learning, the role of carers in patient empowerment and how community participation might contribute to community resilience.Study registrationThis study is registered as PROSPERO CRD42016039552.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alison Turner
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Abeda Mulla
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shiona Aldridge
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Sharon Stevens
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Mahmoda Begum
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Anam Malik
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 2018; 18:350. [PMID: 29747651 PMCID: PMC5946491 DOI: 10.1186/s12913-018-3161-3] [Citation(s) in RCA: 310] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION Prospero registration number: 42016037725 .
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
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Rodgers M, Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations. Int J Integr Care 2018; 18:9. [PMID: 29588643 PMCID: PMC5854169 DOI: 10.5334/ijic.2605] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2017] [Indexed: 11/20/2022] Open
Abstract
People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings. Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services. Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, WC2A 2AE, London, GB
| | - Gillian Parker
- Social Policy Research Unit, University of York, Heslington, YO10 5DD, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
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Affiliation(s)
- Kunsei Lee
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
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Exworthy M, Powell M, Glasby J. The governance of integrated health and social care in England since 2010: great expectations not met once again? Health Policy 2017; 121:1124-1130. [PMID: 28811098 DOI: 10.1016/j.healthpol.2017.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
Integrating health and social care has long been a goal of policy-makers and practitioners. Yet, this aim has remained elusive, partly due to conflicting definitions and a weak evidence base. As part of a special edition exploring the use of the TAPIC (transparency, accountability, participation, integrity and capability) framework in different national contexts and inter-agency settings, this article examines the governance of integrated care in England since 2010, focusing on the extent to which thesefive governance attributes are applicable to integrated care in England. The plethora of English policy initiatives on integrated care (such as the 'Better Care Fund', personal health budgets, and 'Sustainability and Transformation Plans') mostly shows signs of continuity over time although the barriers to integrated care often persist. The article concludes that the contribution of integrated care to improved outcomes remains unclear and yet it remains a popular policy goal. Whilst some elements of the TAPIC framework fit less well than others to the case of integrated care, the case of integrated care can be better understood and explained through this lens.
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Affiliation(s)
- Mark Exworthy
- Health Policy and Management, School of Social Policy, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Martin Powell
- Health and Social Policy, School of Social Policy, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Jon Glasby
- Health and Social Care, School of Social Policy, University of Birmingham, Birmingham, B15 2TT, UK.
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Early findings from the evaluation of the Integrated Care and Support Pioneers in England. JOURNAL OF INTEGRATED CARE 2017. [DOI: 10.1108/jica-12-2016-0047] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Integrating health and social care is a priority in England, although there is little evidence that previous initiatives have reduced hospital admissions or costs. In total, 25 Integrated Care Pioneers have been established to drive change “at scale and pace”. The early phases of the evaluation (April 2014-June 2016) aimed to identify their objectives, plans and activities, and to assess the extent to which they have overcome barriers to integration. In the longer term, the authors will assess whether integrated care leads to improved outcomes and quality of care and at what cost. The paper aims to discuss these issues.
Design/methodology/approach
Mixed methods involving documentary analysis, qualitative interviews and an online key informant survey.
Findings
Over time, there was a narrowing of the integration agenda in most Pioneers. The predominant approach was to establish community-based multi-disciplinary teams focussed on (older) people with multiple long-term conditions with extensive needs. Moving from design to delivery proved difficult, as many barriers are outside the control of local actors. There was limited evidence of service change.
Research limitations/implications
Because the findings relate to the early stage of the 5+ years of the Pioneer programme (2014-2019), it is not yet possible to detect changes in services or in user experiences and outcomes.
Practical implications
The persistence of many barriers to integration highlights the need for greater national support to remove them.
Originality/value
The evaluation demonstrates that implementing integrated health and social care is not a short-term process and cannot be achieved without national support in tackling persistent barriers.
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Feather J, Carter N, Valaitis R, Kirkpatrick H. A narrative evaluation of a community-based nurse navigation role in an urban at-risk community. J Adv Nurs 2017; 73:2997-3006. [DOI: 10.1111/jan.13355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Janice Feather
- Lawrence S. Bloomberg School of Nursing; University of Toronto; Hamilton ON Canada
| | - Nancy Carter
- School of Nursing; McMaster University; Hamilton ON Canada
| | - Ruta Valaitis
- School of Nursing; McMaster University; Hamilton ON Canada
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Goddard M, Mason AR. Integrated Care: A Pill for All Ills? Int J Health Policy Manag 2017; 6:1-3. [PMID: 28005536 PMCID: PMC5193502 DOI: 10.15171/ijhpm.2016.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/09/2016] [Indexed: 11/09/2022] Open
Abstract
There is an increasing policy emphasis on the integration of care, both within the healthcare sector and also between the health and social care sectors, with the simple aim of ensuring that individuals get the right care, in the right place, at the right time. However, implementing this simple aim is rather more complex. In this editorial, we seek to make sense of this complexity and ask: what does integrated care mean in practice? What are the mechanisms by which it is expected to achieve its aim? And what is the nature of the evidence base around the outcomes delivered?
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Affiliation(s)
- Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Anne R Mason
- Centre for Health Economics, University of York, York, UK
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Eyre L, Farrelly M, Marshall M. What can a participatory approach to evaluation contribute to the field of integrated care? BMJ Qual Saf 2016; 26:588-594. [PMID: 27932546 DOI: 10.1136/bmjqs-2016-005777] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/26/2016] [Accepted: 11/13/2016] [Indexed: 11/03/2022]
Abstract
Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge. Participatory approaches are characterised by a desire to use social science methods to solve practical problems and a commitment on the part of researchers to substantive and sustained collaboration with relevant stakeholders. We describe how we applied an emerging practical model of participatory research, the researcher-in-residence model, to evaluate a large-scale integrated care programme in the UK. We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms. While there is still much to learn about the benefits and challenges of applying participatory approaches in the health sector, we demonstrate how using such approaches have the potential to help practitioners integrate care more effectively in their daily practice and help progress the academic study of integrated care.
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Affiliation(s)
- Laura Eyre
- Reserach Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Farrelly
- School of Histories, Languages and Cultures, University of Hull, Hull, UK
| | - Martin Marshall
- Reserach Department of Primary Care and Population Health, University College London, London, UK
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Sentell TL, Seto TB, Young MM, Vawer M, Quensell ML, Braun KL, Taira DA. Pathways to potentially preventable hospitalizations for diabetes and heart failure: a qualitative analysis of patient perspectives. BMC Health Serv Res 2016; 16:300. [PMID: 27456233 PMCID: PMC4960879 DOI: 10.1186/s12913-016-1511-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 07/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Potentially preventable hospitalizations (PPH) for heart failure (HF) and diabetes mellitus (DM) cost the United States over $14 billion annually. Studies about PPH typically lack patient perspectives, especially across diverse racial/ethnic groups with known PPH health disparities. METHODS English-speaking individuals with a HF or DM-related PPH (n = 90) at the largest hospital in Hawai'i completed an in-person interview, including open-ended questions on precipitating factors to their PPH. Using the framework approach, two independent coders identified patient-reported factors and pathways to their PPH. RESULTS Seventy-two percent of respondents were under 65 years, 30 % were female, 90 % had health insurance, and 66 % had previously been hospitalized for the same problem. Patients' stories identified immediate, precipitating, and underlying reasons for the admission. Underlying background factors were critical to understanding why patients had the acute problems necessitating their hospitalizations. Six, non-exclusive, underlying factors included: extreme social vulnerability (e.g., homeless, poverty, no social support, reported by 54 % of respondents); health system interaction issues (e.g., poor communication with providers, 44 %); limited health-related knowledge (42 %); behavioral health issues (e.g., substance abuse, mental illness, 36 %); denial of illness (27 %); and practical problems (e.g., too busy, 6 %). From these findings, we developed a model to understand an individual's pathways to a PPH through immediate, precipitating, and underlying factors, which could help identify potential intervention foci. We demonstrate the model's utility using five examples. CONCLUSIONS In a young, predominately insured population, factors well outside the traditional purview of the hospital, or even clinical medicine, critically influenced many PPH. Patient perspectives were vital to understanding this issue. Innovative partnerships and policies should address these issues, including linkages to social services and behavioral health.
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Affiliation(s)
- Tetine L. Sentell
- Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Biomed, Honolulu, HI 96821 USA
| | - Todd B. Seto
- Queens Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 USA
| | | | - May Vawer
- 1301 Punchbowl Street, Honolulu, HI 96813 USA
| | - Michelle L. Quensell
- Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Biomed, Honolulu, HI 96821 USA
| | - Kathryn L. Braun
- Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Biomed, Honolulu, HI 96821 USA
| | - Deborah A. Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, 677 Ala Moana Boulevard, Suite 1025, Honolulu, HI 96813 USA
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Trappes-Lomax T. Self-care for people coping with long-term health conditions in the community: the views of patients and GPs. JOURNAL OF INTEGRATED CARE 2016. [DOI: 10.1108/jica-05-2015-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Long-term health problems put great pressures on health and social care services. Supporting ‘self-care’ has measurable benefits in helping patients cope better, but is difficult to do in practice. This review aims to help improve services by exploring existing evidence about the views of patients and GPs.
Design/methodology/approach
The search terms were identified following detailed discussion with service users. Five databases (PUBMED, CINAHL, TRIP, SCIE and PSYCINFO) were interrogated against pre-set questions and criteria. The data were managed in EndNote v6 and analysed in a series of Word tables.
Findings
37 community-based studies were identified, covering diverse chronic illnesses. Analysis of ‘barriers and enablers’ showed a very complex picture, with health systems often actively inhibiting the responsiveness and flexibility which support self-care. Directly seeking service user and practitioner views could shape more effective services
Research limitations/implications
Further research is needed into: the purpose and outcomes of user involvement, the relationship between integrated care and self-care, how patient motivation and resilience can be encouraged in primary care and the effect of current incentive schemes on self-care support
Due to organisational changes, eligible studies were reviewed by one researcher only and these were mainly qualitative studies lacking generalisability. However, the results spanned a range of settings and health conditions. They are also clearly supported by later primary research findings
Practical implications
Several evidence-based, achievable opportunities to improve self-care support in primary care settings are identified
Originality/value
This service-user study, offers detailed analysis of what helps or hinders self-care in everyday life
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Rodgers M, Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated care to address the physical health needs of people with severe mental illness: a rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BackgroundPeople with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests that this discrepancy is driven by a combination of clinical risk factors, socioeconomic factors and health system factors.Objective(s)To explore current service provision and map the recent evidence on models of integrated care addressing the physical health needs of people with severe mental illness (SMI) primarily within the mental health service setting. The research was designed as a rapid review of published evidence from 2013–15, including an update of a comprehensive 2013 review, together with further grey literature and insights from an expert advisory group.SynthesisWe conducted a narrative synthesis, using a guiding framework based on nine previously identified factors considered to be facilitators of good integrated care for people with mental health problems, supplemented by additional issues emerging from the evidence. Descriptive data were used to identify existing models, perceived facilitators and barriers to their implementation, and any areas for further research.Findings and discussionThe synthesis incorporated 45 publications describing 36 separate approaches to integrated care, along with further information from the advisory group. Most service models were multicomponent programmes incorporating two or more of the nine factors: (1) information sharing systems; (2) shared protocols; (3) joint funding/commissioning; (4) colocated services; (5) multidisciplinary teams; (6) liaison services; (7) navigators; (8) research; and (9) reduction of stigma. Few of the identified examples were described in detail and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge from the evidence. Efforts to improve the physical health care of people with SMI should empower people (staff and service users) and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication between professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.Limitations and future workThe literature identified in the rapid review was limited in volume and often lacked the depth of description necessary to acquire new insights. All members of our advisory group were based in England, so this report has limited information on the NHS contexts specific to Scotland, Wales and Northern Ireland. A conventional systematic review of this topic would not appear to be appropriate in the immediate future, although a more interpretivist approach to exploring this literature might be feasible. Wherever possible, future evaluations should involve service users and be clear about which outcomes, facilitators and barriers are likely to be context-specific and which might be generalisable.FundingThe research reported here was commissioned and funded by the Health Services and Delivery Research programme as part of a series of evidence syntheses under project number 13/05/11. For more information visitwww.nets.nihr.ac.uk/projects/hsdr/130511.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Andrew Street
- Centre for Health Economics, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
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Bunn F, Burn AM, Goodman C, Robinson L, Rait G, Norton S, Bennett H, Poole M, Schoeman J, Brayne C. Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem). HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04080] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Anne-Marie Burn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Louise Robinson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Holly Bennett
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marie Poole
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Eyre L, George B, Marshall M. Protocol for a process-oriented qualitative evaluation of the Waltham Forest and East London Collaborative (WELC) integrated care pioneer programme using the Researcher-in-Residence model. BMJ Open 2015; 5:e009567. [PMID: 26546147 PMCID: PMC4636614 DOI: 10.1136/bmjopen-2015-009567] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/23/2015] [Accepted: 10/12/2015] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The integration of health and social care in England is widely accepted as the answer to fragmentation, financial concerns and system inefficiencies, in the context of growing and ageing populations with increasingly complex needs. Despite an expanding body of literature, there is little evidence yet to suggest that integrated care can achieve the benefits that its advocates claim for it. Researchers have often adopted rationalist and technocratic approaches to evaluation, treating integration as an intervention rather than a process. Results have usually been of limited use to practitioners responsible for health and social care integration. There is, therefore, a need to broaden the evidence base, exploring not only what works but also how integrated care can most successfully be implemented and delivered. For this reason, we are carrying out a formative evaluation of the Waltham Forest and East London Collaborative (WELC) integrated care pioneer programme. Our expectation is that this will add value to the literature by focusing on the processes by which the vision and objectives of integrated care are translated through phases of development, implementation and delivery from a central to a local perspective, and from a strategic to an operational perspective. METHODS AND ANALYSIS The qualitative and process-oriented evaluation uses an innovative participative approach-the Researcher-in-Residence model. The evaluation is underpinned by a critical ontology, an interpretive epistemology and a critical discourse analysis methodology. Data will be generated using interviews, observations and documentary gathering. ETHICS AND DISSEMINATION Emerging findings will be interpreted and disseminated collaboratively with stakeholders, to enable the research to influence and optimise the effective implementation of integrated care across WELC. Presentations and publications will ensure that learning is shared as widely as possible. The study has received ethical approval from University College London's Research Ethics Committee and has all appropriate NHS governance clearances.
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Affiliation(s)
- Laura Eyre
- Department of Primary Care and Population Health, University College London, Sir Ludwig Guttman Health Centre, London, UK
| | | | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
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Billings J, de Weger E. Contracting for integrated health and social care: a critical review of four models. JOURNAL OF INTEGRATED CARE 2015. [DOI: 10.1108/jica-03-2015-0015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Service transformation of health and social care is currently requiring commissioners to assess the suitability of their contracting mechanisms to ensure goodness of fit with the integration agenda. The purpose of this paper is to provide a description and critical account of four models of contracting, namely Accountable Care Organisations, the Alliance Model, the Lead Provider/Prime Contractor Model, and Outcomes-based Commissioning and Contracting.
Design/methodology/approach
– The approach taken to the literature review was narrative and the results were organised under an analytical framework consisting of six themes: definition and purpose; characteristics; application; benefits/success factors; use of incentives; and critique.
Findings
– The review highlighted that while the models have relevance, there are a number of uncertainties regarding their direct applicability and utility for the health and social care agenda, and limited evidence of effectiveness.
Research limitations/implications
– Due to the relative newness of the models and their emerging application, much of the commentary was limited to a narrow range of contributors and a broader discussion is needed. It is clear that further research is required to determine the most effective approach for integrated care contracting. It is suggested that instead of looking at individual models and assessing their transferable worth, there may be a place for examining principles that underpin the models to reshape current contracting processes.
Practical implications
– What appears to be happening in practice is an organic development. With the growing number of examples emerging in health and social care, these may act as “trailblazers” and support further development.
Originality/value
– There is emerging debate surrounding the best way to contract for health and social care services, but no literature review to date that takes these current models and examines their value in such critical detail. Given the pursuit for “answers” by commissioners, this review will raise awareness and provide knowledge for decision making.
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