What are the priorities for the future development of integrated care? A scoping review

International research priorities for integrated care and cross-boundary working: an electronic Delphi study

BACKGROUND

Integrated care can be broadly defined as the delivery of high-quality and safe care for patients as they cross organizational boundaries or when care is delivered with multiple health care teams, professions, or organizations. Successful integration of care services is contingent on multiple and complex factors across macro, meso, and micro levels of health and social care systems in lower-, middle-, and higher-income countries. Previous priorities for the future development of integrated care have focused on designing and implementing models or approaches to integrated care rather than establishing the research needed to underpin them. This study aimed to address this evidence gap by developing a consensus on international research priorities related to integration of care and cross-boundary working.

METHODS

We conducted a sequential electronic Delphi (eDelphi) study from September 2023 to December 2023. The eDelphi process consisted of initial priority generation followed by two rounds of consensus development via an online survey. Sixty-six priorities were generated by 19 delegates at an international conference workshop titled, 'Priority setting for future research on integration of care and cross-boundary working'. Workshop delegates then identified other experts in integrated care and cross-boundary working from their networks. In each eDelphi round, participants then provided item-by-item responses using a seven-point Likert scale, with consensus defined a priori as ≥80% agreement (strongly agree or agree). Priorities that reached consensus were conceptually grouped into topics.

RESULTS

Twenty-five of 66 unique (37.9%) research priorities achieved consensus after two eDelphi rounds. In Round 1, 63/85 (74.1%) experts from 10 countries across 4 continents achieved consensus on 12/66 (18.2%) priorities. In Round 2, 51/63 (81.0%) experts achieved consensus on a further 13/54 (24.1%) priorities. From the 25 priorities, we derived six conceptual groupings that represent broad topics for future research on integrated care and cross-boundary working: (i) access to care, (ii) data sharing and technology, (iii) measurement of care quality, (iv) patient experience and satisfaction, (v) service design, integration and governance, and (vi) teamwork and leadership.

CONCLUSION

Integrating care services and improving cross-boundary working is important for improving the quality of care provided to patients, regardless of country. Therefore, the conceptual topics and individual priorities identified in this study can inform policymakers, practitioners, and researchers when designing or evaluating integrated care services across the world in pursuit of improved integrated care systems.

Informing low back pain care from the ground up: Survey of national musculoskeletal triage physiotherapists in Ireland

BACKGROUND

Healthcare is changing to meet the challenge of a rising musculoskeletal burden associated with the expanding, aging population. Clinicians, important stakeholders in healthcare provision, have crucial insights into service improvement, but clinician consultation is a shortcoming in healthcare development. In Ireland, specialist physiotherapist-led musculoskeletal (MSK) triage services operate at the primary-secondary care interface to expedite patient care.

OBJECTIVES

To inform future development of low back pain (LBP) care in Ireland through profiling the operationalisation of the national MSK triage service for LBP, including access, referral management, clinical investigations, onward referral options, access to multidisciplinary team (MDT) services and integration with primary healthcare services.

DESIGN

Cross-sectional observational study using a bespoke, anonymous electronic survey.

PARTICIPANTS

Thirty-eight clinical specialist physiotherapists working in national programme Irish MSK triage services.

RESULTS

Thirty-eight MSK Triage physiotherapists submitted responses (response rate 72%). There was considerable site-dependent variation in LBP service provision, with discrepancies in access to triage services, wait times, referral processing and prioritisation, access to clinical investigations and onward referral options. Most respondents (81%) reported wait times exceeding the three-month target; 75% reported that the level of clinical autonomy associated with their role limited service efficiency; 75% were dissatisfied with primary-secondary care service integration. Respondents identified insufficient availability of primary care multidisciplinary services.

CONCLUSION

Lack of standardisation of LBP services exists in Ireland. Services would benefit from improved standardisation, reduced wait times, national accreditation and a defined scope of advanced physiotherapy practice and the development of nationwide community multidisciplinary infrastructure with enhanced interservice communication.

Competency scale of quality and safety for greenhand nurses: instrument development and psychometric test

BACKGROUND

Guaranteeing nursing service safety and quality is a prioritized issue in the healthcare setting worldwide. However, there still lacks a valid scale to measure the quality and safety competencies of newly graduated nurses globally.

METHODS

This scale was developed in two phases. In Phase One, a literature review and three-round e-Delphi were conducted to generate the initial item pool; while in Phase Two, five experts tested the content validity of the scale. The construct validity was evaluated using confirmatory factor analysis (CFA), and the data were collected among 1,221 newly graduated nursing students between May, 2017 and August, 2017. Finally, the internal consistency reliability and test-retest reliability were tested.

RESULTS

The final version's Competency Scale of Quality and Safety (CSQS) was confirmed by the CFA involving 64 items in six dimensions, including patient-center care, safety, evidence-based practice, collaboration and teamwork, continuous quality improvement, and informatics. The results of data showed that the data supported the modified model of CSQS (Standardized Root Mean Square Residual = 0.03, p = 0.053, Adjusted Goodness of Normed Fit Index = 1.00, Root Mean Square Error of Approximation = 0.007, Fit Index = 0.95, Goodness of Fit Index = 0.97, χ2/df = 1.06), and the standardized factor loadings of items were from 0.59 to 0.74 (p < 0.05). The internal consistency reliability of the total scale was 0.98, and the test-retest reliability was 0.89.

CONCLUSIONS

CSQS was a valid and reliable instrument to measure the safety and quality abilities of greenhand nurses, and could be fully utilized by nursing students, greenhand nurses, nursing educators, as well as hospital nursing managers.

"It's My Life and It's Now or Never"-Transplant Recipients Empowered From a Service-Dominant Logic Perspective

Patient well-being after an organ transplant is a major outcome determinant and survival of the graft is crucial. Before surgery, patients are already informed about how they can influence their prognosis, for example by adhering to treatment advice and remaining active. Overall, effective selfmanagement of health-related issues is a major factor in successful long-term graft survival. As such, organ transplant recipients can be considered as co-producers of their own health status. However, although keeping the graft in good condition is an important factor in the patient's well-being, it is not enough. To have a meaningful life after a solid organ transplant, patients can use their improved health status to once again enjoy time with family and friends, to travel and to return to work -in short to get back on track. Our assertion in this article is twofold. First, healthcare providers should look beyond medical support in enhancing long-term well-being. Second, organ recipients should see themselves as creators of their own well-being. To justify our argument, we use the theoretical perspective of service-dominant logic that states that patients are the true creators of real value-in-use. Or as Bon Jovi sings, "It's my life and it's now or never."

Antecedents of physicians' intentions to engage in digital volunteering work: an extended technology acceptance model (TAM) approach

Purpose

The digitalization has changed the volunteer paradigm, making young volunteers use technology in their volunteering activities. The current study sets out to identify and model the antecedents that determine intention to engage in digital health volunteering among Algerian physicians to give insights promoting the development of digital volunteering in different countries of the world.

Design/methodology/approach

To this end, the authors used a survey design to extend the technology acceptance model (TAM) with two construct (self-efficacy and perceived risk of COVID-19 infection). A convenience sample of 163 physicians; working in the private and public sectors in six provinces of Algeria was selected. The data were analyzed through a multiple linear regression.

Findings

The findings show that the perceived usefulness, ease of use, attitudes toward digital volunteering, level of self-efficacy and perceived risk of COVID-19 infection have a significant positive effect on physicians' intentions to engage in digital volunteering work in the context of health crises.

Practical implications

This study reveals that engaging in digital volunteering can be promoted during health crises as an effective strategy to provide support and assist public health institutions and emergency management.

Originality/value

To the best of the authors' knowledge, this is the first study from Africa that explores digital volunteer work, and the first study that extends the TAM to investigate digital volunteer intention among physicians.

A realist process evaluation of an intervention to promote competencies in interprofessional collaboration among interdisciplinary integrated care teams for older people: Study protocol

Background: International policy is increasingly committed to placing interdisciplinary team-working at the centre of health and social care integration across the lifespan. The National Clinical Programme for Older People in Ireland has a critical role in the design and implementation of the National Older Person's Service Model, which aims to shift the delivery of care away from acute hospitals towards community-based care. Interdisciplinary Community Specialist Teams for older persons (CST-OPs) play an important role in this service model. To support the development of competencies for interprofessional collaboration and an interdisciplinary team-based approach to care integration, a culture shift will be required within care delivery. Design:This study builds upon a collaborative partnership project which co-designed a framework describing core competencies for interprofessional collaboration in CST-OPs. A realist-informed process evaluation of the framework will be undertaken as the competencies described in the framework are being fostered in newly developed CST-OPs under the national scale-up of the service model. Realist evaluation approaches reveal what worked, why it worked (or did not), for whom and under what circumstances. Three iterative and integrated work packages are proposed which combine multiple methods of data collection, analysis and synthesis. Prospective data collection will be undertaken within four CST-OPs, including qualitative exploration of the care experiences of older people and family carers. Discussion: The realist explanatory theory will provide an understanding of how interprofessional collaboration can be fostered and sustained in various contexts of care integration for older people. It will underpin curriculum development for team-based education and training of health and social care professionals, a key priority area in the national Irish health strategy. It will provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and to realise the goals of integrated care for older people.

Exploration of understanding of integrated care from a public health perspective: A scoping review

Background

Many health care systems attempt to develop an integrated care approach that is a whole population health-oriented system. However, knowledge of strategies to support this effort are scarce and fragmented. The aim of the current paper is to investigate existing concepts of integrated care and their elements from a public health perspective and to propose an elaborated approach that could be applied to explore the public health orientation of integrated care.

Design and methods

We applied a scoping review approach. A literature search was conducted in Embase, Medline, CINAHL, Scopus and Web of Science for the period 2000-2020 yielding 16 studies for inclusion.

Results

Across the papers, 14 frameworks were identified. Nine of these referred to the Chronic Care Model (CCM). Service delivery, person-centeredness, IT systems design and utilization and decision support were identified as the core elements of most of the included frameworks. The descriptions of these elements were mainly clinical-oriented focusing particularly on clinical care processes and treatment of diseases instead of wider determinants of population health.

Conclusions

A synthesized model is proposed that emphasizes the importance of mapping the unique needs and characteristics of the population it aims to serve, leans on the social determinants approach with a commitment to individual and community empowerment, health literacy and suggests reorienting services to meet the expressed needs of the population.

Protocol for a mixed methods feasibility and implementation study of a community-based integrated care model for home-dwelling older adults: The INSPIRE project

BACKGROUND

Evaluations of integrated care models for home-dwelling frail older adults have shown inconclusive results on health and service outcomes. However, limited research has focused on the implementation of integrated care models. Applying implementation science methods may facilitate uptake of integrated care models, thus generating positive outcomes e.g., reduced hospital admissions. This paper describes the protocol to assess the feasibility of an integrated care model (featuring a four-step comprehensive geriatric assessment: screening, a multi-dimensional assessment, a coordinated individualized care plan and follow-up) designed for a new community-based center for home-dwelling older adults in Switzerland. The study includes the following objectives: 1) to assess implementation by a) monitoring respondents to the outreach strategies and describing the Center's visitors; b) assessing implementation outcomes related to the care model (i.e., adoption, acceptability, feasibility, fidelity) and implementation processes related to collaboration; and 2) assessing implementation costs.

METHODS

For objective 1a, we will use a descriptive design to assess respondents to the outreach strategies and describe the Center's visitors. We will use a parallel convergent mixed methods design for objective 1b. Implementation outcomes data will be collected from meetings with the Center's staff, interviews with older adults and their informal caregivers, and reviewing older adults' health records at the Center. Implementation processes related to collaboration will be assessed through a questionnaire to external collaborators (e.g., GPs) towards the end of the study. For objective 2, implementation costs will be calculated using time-driven activity-based costing methods. Data collection is anticipated to occur over approximately six months.

DISCUSSION

This study of a contextually adapted integrated care model will inform adaptations to the outreach strategies, care model and implementation strategies in one community center, prior to evaluating the care model effectiveness and potentially scaling out the intervention.

TRIAL REGISTRATION

Feasibility study registration ID with clinicaltrials.gov: NCT05302310; registration ID with BMC: ISRCTN12324618.

'Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies' (ValueCare) for older people in Europe: study protocol for a pre-post controlled trial

Background

Older people receive care from multiple providers which often results in a lack of coordination. The Information and Communication Technology (ICT) enabled value-based methodology for integrated care (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older people with multimorbidity, and/or frailty, and/or mild to moderate cognitive impairment in seven sites (Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain). We will evaluate the implementation and the outcomes of the ValueCare approach. This paper presents the study protocol of the ValueCare project; a protocol for a pre-post controlled study in seven large-scale sites in Europe over the period between 2021 and 2023.

Methods

A pre-post controlled study design including three time points (baseline, post-intervention after 12 months, and follow-up after 18 months) and two groups (intervention and control group) will be utilised. In each site, (net) 240 older people (120 in the intervention group and 120 in the control group), 50–70 informal caregivers (e.g. relatives, friends), and 30–40 health and social care practitioners will be invited to participate and provide informed consent. Self-reported outcomes will be measured in multiple domains; for older people: health, wellbeing, quality of life, lifestyle behaviour, and health and social care use; for informal caregivers and health and social care practitioners: wellbeing, perceived burden and (job) satisfaction. In addition, implementation outcomes will be measured in terms of acceptability, appropriateness, feasibility, fidelity, and costs. To evaluate differences in outcomes between the intervention and control group (multilevel) logistic and linear regression analyses will be used. Qualitative analysis will be performed on the focus group data.

Discussion

This study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people, their informal caregivers, and health and social care practitioners in seven different European settings.

Trial registration

ISRCTN registry number is 25089186. Date of trial registration is 16/11/2021.