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Tian Y, Wang S, Zhang Y, Meng L, Li X. Effectiveness of information and communication technology-based integrated care for older adults: a systematic review and meta-analysis. Front Public Health 2024; 11:1276574. [PMID: 38249380 PMCID: PMC10797014 DOI: 10.3389/fpubh.2023.1276574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Background Information and communication technology (ICT) is a key factor in advancing the implementation of integrated care for older adults in the context of an aging society and the normalization of epidemics. This systematic review aims to comprehensively evaluate the effectiveness of ICT-based integrated care for older adults to provide input for the construction of intelligent integrated care models suitable for the context of an aging population in China. Methods A systematic review and meta-analysis were conducted using PubMed, Web of Science Core Collection, Scopus, MEDLINE, EBSCO, EMBASE, CINAHL with full text, ProQuest, and Cochrane Library databases, along with the Google Scholar search engine, for papers published between January 1, 2000, and July 25, 2022, to include randomized controlled trials and quasi-experimental studies of ICT-based integrated care for older adults. Two reviewers independently performed literature screening, quality assessment (JBI standardized critical appraisal tool), and data extraction. The results were pooled using a random effects model, and narrative synthesis was used for studies with insufficient outcome data. Results We included 32 studies (21 interventions) with a total of 30,200 participants (14,289 in the control group and 15,911 in the intervention group). However, the quality of the literature could be improved. The meta-analysis results showed that ICT-based integrated care significantly improved the overall perceived health status of older adults (n=3 studies, MD 1.29 (CI 0.11 to 2.46), no heterogeneity) and reduced the number of emergency department visits (n=11 studies, OR 0.46 (CI 0.25 to 0.86), high heterogeneity) but had no significant effect on improving quality of life, mobility, depression, hospital admissions and readmissions, or mortality in older adults, with a high degree of study heterogeneity. Narrative analysis showed that the overall quality of care, primary care service use, and functional status of older adults in the intervention group improved, but the cost-effectiveness was unclear. Conclusions ICT-based integrated care is effective in improving health outcomes for older adults, but the quality and homogeneity of the evidence base need to be improved. Researchers should develop intelligent integrated care programs in the context of local health and care welfare provision systems for older adults, along with the preferences and priorities of the older adults.
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Affiliation(s)
- Yutong Tian
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lixue Meng
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaohua Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Wang X, Zheng C, Wang Y, Birch S, Huang Y, Valentijn P. Patients' and Care Professionals' Evaluation of the Effect of a Hospital Group on Integrated Care in Chinese Urban Health Systems: A Propensity Score Matching and Difference-in-differences Regression Approach. Int J Health Policy Manag 2023; 12:7897. [PMID: 38618775 PMCID: PMC10843371 DOI: 10.34172/ijhpm.2023.7897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/28/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND A hospital group is an organizational integration strategy that has recently been widely implemented in Chinese urban health systems to promote integrated care. This study aims to evaluate the effect of hospital group on integrated care from the perspectives of both patients and care professionals. METHODS Two cross-sectional surveys were conducted in Shenzhen city of China, in June 2018 and July 2021. All thirty Community Health Stations (CHSs) in the hospital group were included in the intervention group, with 30 CHSs in the same district selected as the control group by simple random sampling. All care professionals within both the intervention and the control groups were invited to participate in the surveys. Twelve CHSs were selected from 30 CHSs in the intervention and the control groups by simple random sampling, and 20 patients with type 2 diabetes mellitus (T2DM) were selected from each of these selected CHSs to participate in the survey by systematic sampling. The Rainbow Model of Integrated Care-Measurement Tool (Chinese version) was used to assess integrated care. Propensity score matching and difference-in-differences regression (PSM-DID) were used to evaluate the effect of the hospital group on integrated care. RESULTS After matching, 528 patients and 1896 care professionals were included in the DID analysis. Results from care professionals indicated that the hospital group significantly increased technical competence of the health system by 0.771 points, and cultural competence by 1.423 points. Results from patients indicated that the hospital group significantly decreased organizational integration of the health system by 0.649 points. CONCLUSION The results suggests that the effect of the hospital group on integrated care over and above routine strategies for integrated care is limited. Therefore, it is necessary to pay attention to implementing professional, clinical and other integration strategies beyond establishing hospital groups, in urban Chinese health systems.
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Affiliation(s)
- Xin Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Caiyun Zheng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yao Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, Australia
| | - Yixiang Huang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Pim Valentijn
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, The Netherlands
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Valentijn PP, Eggers C, Bloem BR, Grimes D, Goldman J, McGinley J, Gardner J, Piemonte MEP, Dahodwala N, Brennan L, Iansek R, Kovacs N, Parashos S, Hilel A, Rajan R. Validation of the Rainbow Model of Integrated Care Measurement Tool in Parkinson's Disease. Mov Disord 2023. [PMID: 37148424 DOI: 10.1002/mds.29413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Integrated care is essential for improving the management and health outcomes for people with Parkinson's disease (PD); reliable and objective measures of care integration are few. OBJECTIVE The aim of this study was to test the psychometric properties of the Rainbow Model of Integrated Care Measurement Tool (RMIC-MT, provider version) for healthcare professionals involved in PD care. METHODS A cross-sectional survey was administered online to an international network representing 95 neurology centers across 41 countries and 588 healthcare providers. Exploratory factor analysis with principal axis extraction method was used to assess construct validity. Confirmatory factor analysis was used to evaluate model fit of the RMIC-MT provider version. Cronbach's alpha was used to assess the internal consistency reliability. RESULTS Overall, 371 care providers (62% response rate) participated in this study. No item had psychometric sensitivity problems. Nine factors (professional coordination, cultural competence, triple aims outcome, system coordination, clinical coordination, technical competence, community-centeredness, person-centeredness, and organizational coordination) with 42 items were determined by exploratory factor analysis. Cronbach's alpha ranged from 0.76 (clinical coordination) to 0.94 (system coordination) and showed significant correlation among all items in the scale (>0.4), indicating good internal consistency reliability. The confirmatory factor analysis model passed most goodness-of-fit tests, thereby confirming the factor structure of nine categories with a total of 40 items. CONCLUSIONS The results provide evidence for the construct validity and other psychometric properties of the provider version of the RMIC-MT to measure integrated care in PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pim P Valentijn
- Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, the Netherlands
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Center for Mind, Brain and Behavior, Universities Marburg and Giessen, Marburg, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bastiaan R Bloem
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - David Grimes
- Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jennifer Goldman
- Parkinson's and Movement Disorders Shirley Ryan Ability Lab and Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer McGinley
- Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
| | - Joan Gardner
- Struthers Parkinson's Center, HealthPartners, Minneapolis, Minnesota, USA
| | | | - Nabila Dahodwala
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura Brennan
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Comprehensive Parkinson Care Program, Parkinson Foundation Centre of Excellence, Kington Centre Monash Health Cheltenham, Cheltenham, Australia
| | - Norbert Kovacs
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
| | - Sotirios Parashos
- Struthers Parkinson's Center, HealthPartners, Minneapolis, Minnesota, USA
| | - Ariela Hilel
- Movement Disorders Center Unit, Neurology Division, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Care Integration in Primary Dementia Care Networks: A Longitudinal Mixed-Methods Study. Int J Integr Care 2021; 21:29. [PMID: 34963758 PMCID: PMC8663750 DOI: 10.5334/ijic.5675] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 11/13/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: Currently, care integration for community-dwelling persons with dementia is poor and knowledge on how to effectively facilitate development of integrated dementia care is lacking. The DementiaNet program aims to overcome this with a focus on interprofessional collaboration. The objective of this study is to investigate how care integration in interprofessional primary dementia care networks matures and to identify factors associated with (un)successfully maturation. Theory and methods: A longitudinal mixed-methods study, including 17 primary care networks participating in the DementiaNet study, was performed. Semi-structured interviews based on the Rainbow Model of Integrated Care were conducted at start, at 12- and 24 months. Network maturity scores (range 1–4) were derived from the interviews and qualitative data was used to explain the observed patterns. Results: Networks consisted on average of 9 professionals (range 4–22) covering medical, care and social disciplines. Network maturity yearly increased with 0.29 (95%-CI: 0.20–0.38). Important factors for improvement included getting to know each other’s expertise, having a capable network leader(s), stable network composition and participation of a general practitioner. Conclusions: The DementiaNet approach enables a transition towards more mature networks. Identified success factors provide better understanding of how network maturity can be achieved and gives guidance to future care integration strategies.
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