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Page B, Sugavanam T, Fitzpatrick R, Hogan H, Lalani M. Floundering or Flourishing? Early Insights from the Inception of Integrated Care Systems in England. Int J Integr Care 2024; 24:4. [PMID: 38974204 PMCID: PMC11225555 DOI: 10.5334/ijic.7738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 06/19/2024] [Indexed: 07/09/2024] Open
Abstract
Background In 2022, England embarked on an ambitious and innovative re-organisation to produce an integrated health and care system with a greater focus on improving population health. This study aimed to understand how nascent ICSs are developing and to identify the key challenges and enablers to integration. Methods Four ICSs participated in the study between November 2021 and May 2022. Semi-structured interviews with system leaders (n = 67) from health, social and voluntary care as well as representatives of local communities were held. A thematic framework approach supported by Leutz's five laws of integration framework was used to analyse the data. Results The benefits of ICSs include enhancing the delivery of good quality care, improving population health and providing more person-centred care in the community. However, differences between health and social care such as accountability, organisational/professional cultures, risks of duplicating efforts, tensions over funding allocation, issues of data integration and struggles in engaging local communities threaten to hamper integration. Conclusions Despite ICS's investing in the structural and relational components of integrated care, the unprecedented pressures on systems to reduce demand on primary and emergency care tackling elective backlogs may detract from a key goal of ICSs, improving population health and prevention.
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Affiliation(s)
- Bethan Page
- Cicely Saunders Institute, King’s College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | | | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirza Lalani
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Mouchaers I, Buma LE, Verbeek H, Zwakhalen S, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. A qualitative exploration of professionals' perspectives on the implementation of reablement intervention programs in community care. Sci Rep 2024; 14:11391. [PMID: 38762551 PMCID: PMC11102453 DOI: 10.1038/s41598-024-62047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/09/2024] [Indexed: 05/20/2024] Open
Abstract
Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults' active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals' experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual's goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement.
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Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands.
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium.
| | - Lise E Buma
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands.
- Cicero Zorggroep, Brunssum, The Netherlands.
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Sandra Zwakhalen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
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Dubas-Jakóbczyk K, Gonzalez AI, Domagała A, Astier-Peña MP, Vicente VC, Planet AG, Quadrado A, Serrano RM, Abellán IS, Ramos A, Ballester M, Seils L, Dan S, Flinterman L, Likic R, Batenburg R. Medical deserts in Spain-Insights from an international project. Int J Health Plann Manage 2024; 39:708-721. [PMID: 38358842 DOI: 10.1002/hpm.3782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Medical deserts are a growing phenomenon across many European countries. They are usually defined as (i) rural areas, (ii) underserved areas or (iii) by applying a measure of distance/time to a facility or a combination of the three characteristics. The objective was to define medical deserts in Spain as well as map their driving factors and approaches to mitigate them. METHODS A mixed methods approach was applied following the project "A Roadmap out of medical deserts into supportive health workforce initiatives and policies" work plan. It included the following elements: (i) a scoping literature review; (ii) a questionnaire survey; (iii) national stakeholders' workshop; (iv) a descriptive case study on medical deserts in Spain. RESULTS Medical deserts in Spain exist in the form of mostly rural areas with limited access to health care. The main challenge in their identification and monitoring is local data availability. Diversity of both factors contributing to medical deserts and solutions applied to eliminate or mitigate them can be identified in Spain. They can be related to demand for or supply of health care services. More national data, analyses and/or initiatives seem to be focused on the health care supply dimension. CONCLUSIONS Addressing medical deserts in Spain requires a comprehensive and multidimensional approach. Effective policies are needed to address both the medical staff education and planning system, working conditions, as well as more intersectoral approach to the population health management.
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Affiliation(s)
| | - Ana Isabel Gonzalez
- Avedis Donabedian Instituto Universitario-UAB, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Alicja Domagała
- Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Pilar Astier-Peña
- Centro de Salud de Universitas, Servicio Aragonés de Salud, Zaragoza, Spain
- Grupo H36_23D H36_23D Feminización y Ética de las Profesiones Sanitarias (FEPS), IIS_Aragón, Zaragoza, Spain
| | - Veronica Casado Vicente
- Centro de Salud Universitario Parquesol, Sanidad de Castilla y León, Valladolid, Spain
- Unidad Docente Universitaria de Medicina Familiar y Comunitaria, Facultad de Medicina, Valladolid, Spain
| | - Antonia-Gema Planet
- Unidad de Apoyo Técnico DA Noroeste y DA Centro, Dirección Técnica de Sistemas de Información, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de la Salud, Madrid, Spain
| | - Agueda Quadrado
- Centro de Salud de Navas Del Rey, Navas del Rey, Servicio Madrileño de la Salud, Tres Cantos, Madrid, Spain
| | - Rosa Mari Serrano
- Centre d'Atenció Primària Marià Fortuny, L'Entitat de Dret Públic Salut Sant Joan de Reus - Baix Camp, CatSalut, Servei Català de la Salut, Reus, Tarragona, Spain
| | | | - Alba Ramos
- Punto de Atención Continuada Tres Cantos, Servicio Madrileño de la Salud, Tres Cantos, Madrid, Spain
| | - Marta Ballester
- Avedis Donabedian Instituto Universitario-UAB, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Laura Seils
- Avedis Donabedian Instituto Universitario-UAB, Barcelona, Spain
| | - Sorin Dan
- School of Management, University of Vaasa, Vaasa, Finland
| | - Linda Flinterman
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Robert Likic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
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Abdelhalim A, Zargoush M, Archer N, Roham M. Decoding the persistence of delayed hospital discharge: An in-depth scoping review and insights from two decades. Health Expect 2024; 27:e14050. [PMID: 38628150 PMCID: PMC11021918 DOI: 10.1111/hex.14050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE This article addresses the persistent challenge of Delayed Hospital Discharge (DHD) and aims to provide a comprehensive overview, synthesis, and actionable, sustainable plan based on the synthesis of the systematic review articles spanning the past 24 years. Our research aims to comprehensively examine DHD, identifying its primary causes and emphasizing the significance of effective communication and management in healthcare settings. METHODS We conducted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) method for synthesizing findings from 23 review papers published over the last two decades, encompassing over 700 studies. In addition, we employed a practical and comprehensive framework to tackle DHD. Rooted in Linderman's model, our approach focused on continuous process improvement (CPI), which highlights senior management commitment, technical/administrative support, and social/transitional care. Our proposed CPI method comprised several stages: planning, implementation, data analysis, and adaptation, all contributing to continuous improvement in healthcare delivery. This method provided valuable insights and recommendations for addressing DHD challenges. FINDINGS Our DHD analysis revealed crucial insights across multiple dimensions. Firstly, examining causes and interventions uncovered issues such as limited discharge destinations, signaling unsustainable solutions, and inefficient care coordination. The second aspect explored the patient and caregiver experience, emphasizing challenges linked to staff uncertainty and negative physical environments, with notable attention to the underexplored area of caregiver experience. The third theme explored organizational and individual factors, including cognitive impairment and socioeconomic influences. The findings emphasized the importance of incorporating patients' data, recognizing its complexity and current avoidance. Finally, the role of transitional and social care and financial strategies was scrutinized, emphasizing the need for multicomponent, context-specific interventions to address DHD effectively. CONCLUSION This study addresses gaps in the literature, challenges prevailing solutions, and offers practical pathways for reducing DHD, contributing significantly to healthcare quality and patient outcomes. The synthesis introduces the vital CPI stage, enhancing Linderman's work and providing a pragmatic framework to eradicate delayed discharge. Future efforts will address practitioner consultations to enhance perspectives and further enrich the study. PATIENT OR PUBLIC CONTRIBUTION Our scoping review synthesizes and analyzes existing systematic review articles and emphasizes offering practical, actionable solutions. While our approach does not directly engage patients, it strategically focuses on extracting insights from the literature to create a CPI framework. This unique aspect is intentionally designed to yield tangible benefits for patients, service users, caregivers, and the public. Our actionable recommendations aim to improve hospital discharge processes for better healthcare outcomes and experiences. This detailed analysis goes beyond theoretical considerations and provides a practical guide to improve healthcare practices and policies.
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Affiliation(s)
- Alyaa Abdelhalim
- Information Systems, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
| | - Manaf Zargoush
- Health Policy & Management, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
| | - Norm Archer
- Information Systems, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
| | - Mehrdad Roham
- Information Systems, DeGroote School of BusinessMcMaster UniversityHamiltonOntarioCanada
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Yordanov D, Oxholm AS, Prætorius T, Kristensen SR. Financial incentives for integrated care: A scoping review and lessons for evidence-based design. Health Policy 2024; 141:104995. [PMID: 38290390 DOI: 10.1016/j.healthpol.2024.104995] [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: 02/21/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND In response to the increasing prevalence of people with chronic conditions, healthcare systems restructure to integrate care across providers. However, many systems fail to achieve the desired outcomes. One likely explanation is lack of financial incentives for integrating care. OBJECTIVES We aim to identify financial incentives used to promote integrated care across different types of providers for patients with common chronic conditions and assess the evidence on (cost-)effectiveness and the facilitators/barriers to their implementation. METHODS This scoping review identifies studies published before December 2021, and includes 33 studies from the United States and the Netherlands. RESULTS We identify four types of financial incentives: shared savings, bundled payments, pay for performance, and pay for coordination. Substantial heterogeneity in the (cost-)effectiveness of these incentives exists. Key implementation barriers are a lack of infrastructure (e.g., electronic medical records, communication channels, and clinical guidelines). To facilitate integration, financial incentives should be easy to communicate and implement, and require additional financial support, IT support, training, and guidelines. CONCLUSIONS All four types of financial incentives may promote integrated care but not in all contexts. Shared savings appears to be the most promising incentive type for promoting (cost-)effective care integration with the largest number of favourable studies allowing causal interpretations. The limited evidence pool makes it hard to draw firm conclusions that are transferable across contexts.
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Affiliation(s)
- Dimitar Yordanov
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Anne Sophie Oxholm
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Thim Prætorius
- Research Unit for Integrated Care and Prevention, Steno Diabetes Centre Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
| | - Søren Rud Kristensen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
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de Matos RC, do Nascimento G, Fernandes AC, Matos C. Implementation and impact of integrated health and social care services: an umbrella review. J Public Health Policy 2024; 45:14-29. [PMID: 38287089 DOI: 10.1057/s41271-023-00465-y] [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] [Accepted: 12/28/2023] [Indexed: 01/31/2024]
Abstract
Governments in many European countries have been working towards integrating health and social care services to eliminate the fragmentation that leads to poor care coordination for patients. We conducted a systematic review to identify and synthesize knowledge about the integration of health and social care services in Europe. We identified 490 records, in 14 systematic reviews that reported on 1148 primary studies and assessed outcomes of integration of health care and social care. We categorized records according to three purposes: health outcomes, service quality and integration procedures outcomes. Health outcomes include improved clinical outcomes, enhanced quality of life, and positive effects on quality of care. Service quality improvements encompass better access to services, reduced waiting times, and increased patient satisfaction. Integration procedure outcomes involve cost reduction, enhanced collaboration, and improved staff perceptions; however, some findings rely on limited evidence. This umbrella review provides a quality-appraised overview of existing systematic reviews.
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Affiliation(s)
- Ricardo Correia de Matos
- Department of Psychiatry and Mental Health, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal.
- Ordem dos Enfermeiros, Secção Regional do Centro (SRCOE), Coimbra, Portugal.
- ISCTE - University Institute of Lisbon, Lisbon, Portugal.
| | | | | | - Cristiano Matos
- Instituto Politécnico de Coimbra, Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal
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Chong F, Jianping Z, Zhenjie L, Wenxing L, Li Y. Does competition support integrated care to improve quality? Heliyon 2024; 10:e24836. [PMID: 38333801 PMCID: PMC10850910 DOI: 10.1016/j.heliyon.2024.e24836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction This work investigates the compatibility of integrated care and competition in China and analyses the impact of integrated care on regional care quality (DeptQ) within a competitive framework. Method The study was built on multivariate correspondence analysis and a two-way fixed-effects model. The data were collected from Xiamen's Big Data Application Open Platform and represent nine specialised departments that regularly performed inter-institutional referrals between 2016 and 2019. Results First, care quality for referred patients (ReferQ) and the relative scale of referred patients (ReferScale) and competition have an antagonistic but not completely mutually exclusive relationship. Second, ReferQ and competition both have a significant effect on DeptQ, but only when competition is weak can ReferQ and competition act synergistically on DeptQ. When competition is fierce, competition will weaken the impact of ReferQ on DeptQ. Conclusion Changes in the intensity of integrated care and competition ultimately affect care quality.
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Affiliation(s)
- Feng Chong
- School of Mathematics and Statistics, Xiamen University of Technology, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
| | - Zhu Jianping
- School of Management, Xiamen University, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Fujian, Xiamen, China
| | - Liang Zhenjie
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- College of Economics and Management, Minjiang University, Fujian, Fuzhou, China
| | - Lin Wenxing
- Xiamen Health and Medical Big Data Center, Fujian, Xiamen, China
| | - Yumin Li
- School of Economics and Management, Nanjing University of Science and Technology, Jiangsu, Nanjing, China
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Bouton C, Journeaux M, Jourdain M, Angibaud M, Huon JF, Rat C. Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review. BMC PRIMARY CARE 2023; 24:253. [PMID: 38031014 PMCID: PMC10685527 DOI: 10.1186/s12875-023-02189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In a period of change in the organization of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of our study was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes. METHODS We conducted a systematic literature review using the PubMed, Embase, PsycINFO and CINAHL databases from 01/01/1995 to 01/03/2021, according to the PRISMA guidelines. Studies reporting the effects of IPC in primary care on patient health outcomes were included. The quality of the studies was assessed using the revised Downs and Black checklist. RESULTS Sixty-five articles concerning 61 interventions were analysed. A total of 43 studies were prospective and randomized. Studies were classified into 3 main categories as follows: 1) studies with patients at cardiovascular risk (28 studies)-including diabetes (18 studies) and arterial hypertension (5 studies); 2) studies including elderly and/or polypathological patients (18 studies); and 3) patients with symptoms of mental or physical disorders (15 studies). The number of included patients varied greatly (from 50 to 312,377). The proportion of studies that reported a positive effect of IPC on patient-centred outcomes was as follows: 23 out of the 28 studies including patients at cardiovascular risk, 8 out of the 18 studies of elderly or polypathological patients, and 11 out of the 12 studies of patients with mental or physical disorders. CONCLUSIONS Evidence suggests that IPC is effective in the management of patients at cardiovascular risk. In elderly or polypathological patients and in patients with mental or physical disorders, the number of studies remains very limited, and the results are heterogeneous. Researchers should be encouraged to perform studies based on comparative designs: it would increase evidence on the positive effect and benefits of IPC on patient variables.
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Affiliation(s)
- Céline Bouton
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France.
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France.
| | - Manon Journeaux
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
| | - Maud Jourdain
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
| | - Morgane Angibaud
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
| | - Jean-François Huon
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
- Faculty of Pharmacy, University of Nantes, Nantes, France
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
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Carron T, Domeisen Benedetti F, Fringer A, Fierz K, Peytremann-Bridevaux I. Integrated care models in Swiss primary care: An embedded multiple case study. J Eval Clin Pract 2023; 29:1025-1038. [PMID: 37427549 DOI: 10.1111/jep.13891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
RATIONALE, AIMSAND OBJECTIVES Healthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient-centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each model and the challenges they face. METHOD We used an embedded multiple case study design to describe in-depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administered and semistructured interviews with key actors were conducted. A within-case analysis followed by a cross-case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted. RESULTS Eight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groups and regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient education and use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging. CONCLUSION The integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice.
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Affiliation(s)
- Tania Carron
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Franzisca Domeisen Benedetti
- School of Health Professions, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - André Fringer
- School of Health Professions, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Katharina Fierz
- School of Health Professions, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
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García-Mochón L, Špacírová Z, Espín J. Costing methodologies in European economic evaluation guidelines: commonalities and divergences. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:979-991. [PMID: 34825296 DOI: 10.1007/s10198-021-01414-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
From both the methodological point of view and standardization of methodology, little attention has been paid to the estimation of direct costs in evaluation of healthcare technologies. The objective is to revise the recommendations on direct costs provided in European economic evaluation guidelines and to identify the commonalities and divergences among them. To achieve this, a comprehensive search through several online databases was performed resulting in 41 documents from 26 European countries, be they economic evaluation guidelines or costing guidelines. The results show a large disparity in methodologies used in estimation of direct costs to be included in economic evaluations of health technologies recommended by European countries. A lack of standardization of cost estimation methodologies influences arbitrariness in selecting costs of resources included in economic evaluations of medicinal products or any other technologies and, therefore, in decision making process necessary to introduce new technology. In addition, this heterogeneity poses a major challenge for identifying factors that could affect the variability of unit costs across countries.
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Affiliation(s)
- Leticia García-Mochón
- Andalusian School of Public Health/Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain/CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Zuzana Špacírová
- Andalusian School of Public Health/Escuela Andaluza de Salud Pública (EASP), Granada, Spain.
- Instituto de Investigación Biosanitaria ibs, Granada, Spain.
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain/CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Jaime Espín
- Andalusian School of Public Health/Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain/CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Sun Y, Zhang X, Han Y, Yu B, Liu H. Evolutionary game model of health care and social care collaborative services for the elderly population in China. BMC Geriatr 2022; 22:616. [PMID: 35879656 PMCID: PMC9317207 DOI: 10.1186/s12877-022-03300-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The synergy of health care and elderly social care organizations has become the focus of the research on integrated health care and social care. This study aims to propose a collaborative strategy among health care and elderly social care service providers. METHODS An evolutionary game model is applied for performance analysis and optimization of the cooperation between health care and elderly social care organizations. The behavioural strategies and the impact of key parameters on promoting the cooperation of the players are presented in detail. RESULTS Simulation experiments and sensitivity analysis results indicate that (1) the behavioural evolution of health care organizations and elderly social care organizations forms three types of integrated health care and social care services, namely, the bilateral cooperation type, health care organization-led type and elderly social care organization-led type. (2) Increasing the additional benefits for cooperation and reducing the additional costs for cooperation can promote the willingness to synergize to provide integrated health care and elderly social care services. At the early stage of evolution, increasing the costs that elderly social care organizations pay to purchase health care services or pay for negotiation in the bilateral cooperation type can provide incentives for health care organizations to cooperate while reducing the cooperation preferences of elderly social care organizations. However, the long-term impact of the costs on the behavioural strategies for cooperation of the two players cannot be determined. CONCLUSION The behavioural decisions on cooperation between health care and elderly social care organizations influence each other; commitment to integration and effective collaboration can be achieved by increasing the additional benefits and reducing the marginal costs. The findings suggest that the political-economic context and government policies have a greater influence on promoting cooperation, thus yielding positive or negative results for integrated care practice.
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Affiliation(s)
- Yin Sun
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Xudong Zhang
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan Province, China.
| | - Yuehong Han
- School of Marxism, Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Bo Yu
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan Province, China.,School of Humanities and Management, Yunnan University of Chinese Medicine, Kunming, Yunnan Province, China
| | - Haidan Liu
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan Province, China
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12
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Reindersma T, Fabbricotti I, Ahaus K, Sülz S. Integrated Payment, Fragmented Realities? A Discourse Analysis of Integrated Payment in the Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148831. [PMID: 35886684 PMCID: PMC9318584 DOI: 10.3390/ijerph19148831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022]
Abstract
The current models used for paying for health and social care are considered a major barrier to integrated care. Despite the implementation of integrated payment schemes proving difficult, such initiatives are still widely pursued. In the Netherlands, this development has led to a payment architecture combining traditional and integrated payment models. To gain insight into the justification for and future viability of integrated payment, this paper’s purpose is to explain the current duality by identifying discourses on integrated payment models, determining which discourses predominate, and how they have changed over time and differ among key stakeholders in healthcare. The discourse analysis revealed four discourses, each with its own underlying assumptions and values regarding integrated payment. First, the Quality-of-Care discourse sees integrated payment as instrumental in improving care. Second, the Affordability discourse emphasizes how integrated payment can contribute to the financial sustainability of the healthcare system. Third, the Bureaucratization discourse highlights the administrative burden associated with integrated payment models. Fourth, the Strategic discourse stresses micropolitical and professional issues that come into play when implementing such models. The future viability of integrated payment depends on how issues reflected in the Bureaucratization and Strategic discourses are addressed without losing sight of quality-of-care and affordability, two aspects attracting significant public interest in The Netherlands.
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13
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Alonso JM, Andrews R. Does vertical integration of health and social care organizations work? Evidence from Scotland. Soc Sci Med 2022; 307:115188. [DOI: 10.1016/j.socscimed.2022.115188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
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14
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Hanson K, Brikci N, Erlangga D, Alebachew A, De Allegri M, Balabanova D, Blecher M, Cashin C, Esperato A, Hipgrave D, Kalisa I, Kurowski C, Meng Q, Morgan D, Mtei G, Nolte E, Onoka C, Powell-Jackson T, Roland M, Sadanandan R, Stenberg K, Vega Morales J, Wang H, Wurie H. The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health 2022; 10:e715-e772. [PMID: 35390342 PMCID: PMC9005653 DOI: 10.1016/s2214-109x(22)00005-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nouria Brikci
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Darius Erlangga
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abebe Alebachew
- Breakthrough International Consultancy, Addis Ababa, Ethiopia
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Ina Kalisa
- World Health Organization, Kigali, Rwanda
| | | | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - David Morgan
- Health Division, The Organisation for Economic Co-operation and Development, Paris, France
| | | | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chima Onoka
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | | | | | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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15
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Mozhaeva I. Inequalities in Utilization of Institutional Care Among Older People in Estonia. Health Policy 2022; 126:704-714. [DOI: 10.1016/j.healthpol.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/07/2021] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
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16
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Financial Integration Scenario for Community Integrated Care: Focusing on the Case of Korea. Int J Integr Care 2022; 22:18. [PMID: 35693296 PMCID: PMC9165675 DOI: 10.5334/ijic.6465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
This study analyzes the potential effects of a reform based on community integrated care in Korea, which is experiencing a high rate of population aging, and a specific method for financial integration. We first analyze the size and trend of funds used for the care for the elderly out of Korea’s health insurance, long-term care insurance, and national budget. We then analyze the amount of financial resources required and the cost-saving effect when the related financial resources are converted into local community care funds. This approach sheds light on the possibility of harmonizing healthcare policy for the elderly and integrated care under the existing insurance system and suggests a direction for reform in policies pertaining to healthcare for the elderly. Given that the same services are provided, we find that combining the finances from the insurance and the national budget would result in a fund of KRW 2.6 trillion to KRW 4.7 trillion. This approach also confirms that health care costs for the elderly can be reduced by 1-5% in the long term, which we estimate to be between KRW 1 trillion to KRW 4 trillion by 2050. We find that by tapping into the national budget to manage the pre-medical stage care, we can utilize an efficient operation mechanism unlike insurance. We also confirm that information exchange and harmonious operation between the national budget and state-run insurance as well as feedback and incentives through performance management are necessary for these results to become a reality.
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17
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Maguire AM, Keyser J, Brown K, Kivlahan D, Romaniuk M, Gardner IR, Dwyer M. Veteran families with complex needs: a qualitative study of the veterans' support system. BMC Health Serv Res 2022; 22:74. [PMID: 35031051 PMCID: PMC8760758 DOI: 10.1186/s12913-021-07368-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Families with complex needs face significant challenges accessing and navigating health and social services. For veteran families, these challenges are exacerbated by interactions between military and civilian systems of care, and the density of the veterans’ non-profit sector. This qualitative study was designed to gather rich, detailed information on complex needs in veteran families; and explore service providers’ and families’ experiences of accessing and navigating the veterans’ support system. Methods The study comprised participant background questionnaires (n = 34), focus groups with frontline service providers (n = 18), and one-on-one interviews with veteran families (n = 16) in Australia. The semi-structured focus groups and interviews were designed to gather rich, detailed information on four study topics: (i) health and wellbeing needs in veteran families; (ii) service-access barriers and facilitators; (iii) unmet needs and gaps in service provision; and (iv) practical solutions for improving service delivery. The study recruited participants who could best address the focus on veteran families with complex needs. The questionnaire data was used to describe relevant characteristics of the participant sample. The focus groups and interviews were audio-recorded, transcribed, and a reflexive thematic analysis was conducted to identify patterns of shared meaning in the qualitative data. Results Both service providers and families found the veterans’ support system difficult to access and navigate. System fragmentation was perceived to impede care coordination, and delay access to holistic care for veteran families with complex needs. The medico-legal aspects of compensation and rehabilitation processes were perceived to harm veteran identity, and undermine health and wellbeing outcomes. Recovery-oriented practice was viewed as a way to promote veteran independence and self-management. Participants expressed a strong preference for family-centred care that was informed by an understanding of military lifestyle and culture. Conclusion The health and wellbeing needs of veteran families intensify during the transition from full-time military service to civilian environments, and service- or reintegration-related difficulties may emerge (or persist) for a significant period of time thereafter. Veteran families with complex needs are unduly burdened by care coordination demands. There is a pressing need for high-quality implementation studies that evaluate initiatives for integrating fragmented systems of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07368-2.
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Affiliation(s)
- Angela M Maguire
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Julieann Keyser
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | - Kelly Brown
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Daniel Kivlahan
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Madeline Romaniuk
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.,Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Ian R Gardner
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | - Miriam Dwyer
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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18
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Defining Pooled' Place-Based' Budgets for Health and Social Care: A Scoping Review. Int J Integr Care 2022; 22:16. [PMID: 36186513 PMCID: PMC9479665 DOI: 10.5334/ijic.6507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Current descriptions of pooled budgets in the literature pose challenges to good quality evaluation of their contribution to integrated care. Addressing this gap is increasingly important given the shift from early models of integrated care targeting segments of the population, to more recent approaches that aim to target 'places', broader geographically defined populations. This review draws on the current international evidence to describe practical examples of pooled health and social care budgets, highlighting specific place-based approaches. Methods We initially conducted a scoping review, a systematic database search ('Medline', 'Embase', 'Econ Lit' and 'Google Scholar') complemented by further snowballing for academic and 'grey literature' publications (1995 - 2020). Results were analysed thematically according to budget characteristics and macro-environment, with additional specific case studies. Results Thirty-six primary studies were included, describing ten broad models of pooled budgets across seven countries. Most budgets targeted specific sub-populations rather than an entire geographically defined population. Specific budget structures varied and were generally under-described. The closest place-based models were for small populations and implemented in a national health system, or insurance-based with natural geographical boundaries. Conclusion Despite their increasing relevance in the current political debate, pooled place-based budgets are still at an early stage of implementation and research. Adequate description is required for future meta-analysis of effectiveness on outcomes.
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19
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Integrated Health and Social Care in the United States: A Decade of Policy Progress. Int J Integr Care 2021; 21:9. [PMID: 34785994 PMCID: PMC8570194 DOI: 10.5334/ijic.5687] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction: Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. Policy practice: This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. Discussion and Conclusion: National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors.
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20
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Ahmad N, Scholz M, AlDhaen E, Ullah Z, Scholz P. Improving Firm's Economic and Environmental Performance Through the Sustainable and Innovative Environment: Evidence From an Emerging Economy. Front Psychol 2021; 12:651394. [PMID: 34803789 PMCID: PMC8599963 DOI: 10.3389/fpsyg.2021.651394] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Businesses in the present era are dealing with a complex and unprecedented brew of social, environmental, and technological trends. This requires sophisticated, sustainability-based management. Yet organizations are often reluctant to place sustainability core to their business strategies with the mistaken belief that the costs associated with environmental investments outweigh the benefits. The Global Climate Risk Index has placed Pakistan on 5th position in the list of nations, most susceptible to climate change in its recent report. Pakistan lost the lives of 9,989 people, incurred economic losses of $ 3.8 billion, and faced 152 shocking climates between 1999 and 2018. Based on this information, it is established that Pakistan's susceptibility to climate change is growing unprecedentedly and industrial pollution is one of the biggest contributors in this respect. The country needs to take emergency measures to address this issue. With this background, the present study aims to investigate the impact of environmental sustainability on environmental and economic performance (EP) with the mediating effect of environmental innovation (EI) in the manufacturing sector of Pakistan. The results show that environmental sustainability is a significant predictor of environmental performance and EP and EI mediates this relationship. The findings of the present study provide better insights to policymakers to address the environmental degradation, resulting from industrial pollution.
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Affiliation(s)
- Naveed Ahmad
- Faculty of Management Studies, University of Central Punjab, Lahore, Pakistan
- Department of Management Sciences, Virtual University of Pakistan, Lahore, Pakistan
| | - Miklas Scholz
- Division of Water Resources Engineering, Department of Building and Environmental Technology, Faculty of Engineering, Lund University, Lund, Sweden
- Department of Civil Engineering Science, School of Civil Engineering and the Built Environment, University of Johannesburg, Johannesburg, South Africa
- Department of Town Planning, Engineering Networks, and Systems, South Ural State University, Chelyabinsk, Russia
- Institute of Environmental Engineering, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Esra AlDhaen
- Marketing Department, College of Business and Finance, Ahlia University, Manama, Bahrain
| | - Zia Ullah
- Leads Business School, Lahore Leads University, Lahore, Pakistan
| | - Philippa Scholz
- Department of Human Geography, Lund University, Lund, Sweden
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21
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Muusse C, Kroon H, Mulder CL, Pols J. Frying eggs or making a treatment plan? Frictions between different modes of caring in a community mental health team. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1581-1597. [PMID: 34250614 PMCID: PMC8456910 DOI: 10.1111/1467-9566.13346] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
In this article, we conduct an empirical ethics approach to unravel the different perspectives on good care that are present in a community mental health team (CMHT) in Utrecht. With the deinstitutionalisation of mental health care, the importance of a close collaboration between the social and medical domains of care on the level of the local community is put in the foreground. Next to organisational thresholds or incentives, this collaboration is shaped by different notions of what good mental health care should entail. Using the concept of modes of ordering care (Moser 2005), we describe five modes of ordering mental health care that are present in the practice of the CMHT: the medical specialist, the juridical, the community, the relational and the bureaucratic perspective. These different modes of ordering care lead to frictions and misunderstandings, but are mutually enhancing at other times. Unravelling these different modes of ordering care can facilitate collaboration between professionals of different care domains and support a mutual understanding of what needs to be done. More so, the analysis foregrounds that ordering care from a relational approach is important in daily practice, but is in need of stronger legitimation.
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Affiliation(s)
- Christien Muusse
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
- Department Ethics, Law & HumanitiesAmsterdam UMCAmsterdamThe Netherlands
| | - Hans Kroon
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
- Tranzo, School of Social and Behavioural SciencesTilburg UniversityTilburgThe Netherlands
| | - Cornelis L. Mulder
- Department of PsychiatryErasmus MCRotterdamThe Netherlands
- Parnassia Psychiatric InstituteThe HagueThe Netherlands
| | - Jeannette Pols
- Department Ethics, Law & HumanitiesAmsterdam UMCAmsterdamThe Netherlands
- Department of AnthropologyUniversity of AmsterdamAmsterdamThe Netherlands
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22
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Henderson L, Bain H, Allan E, Kennedy C. Integrated health and social care in the community: A critical integrative review of the experiences and well-being needs of service users and their families. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1145-1168. [PMID: 33058359 DOI: 10.1111/hsc.13179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
A need for people-centred health and social support systems is acknowledged as a global priority. Most nations face challenges in providing safe, effective, timely, affordable, coordinated care around the needs and preferences of people who access integrated health and social care (IHSC) services. Much of the current research in the field focuses on describing and evaluating specific models for delivering IHSC. Fewer studies focus on person-centred experiences, needs and preferences of people who use these services. However, current international guidance for integrated care sets a precedence of person-centred integrated care that meets the health and well-being needs of people who access IHSC services. This integrative literature review synthesises empirical literature from six databases (CINAHL; MEDLINE; AMED; TRIP; Web of Science and Science Direct; 2007-2019). This review aims to better understand the experiences and health and well-being needs of people who use IHSC services in a community setting. Twenty studies met the inclusion criteria and results were thematically analysed. Three overarching themes were identified, including relationships, promoting health and well-being and difficulty understanding systems. Findings of this review indicate that relationships hold significance in IHSC. People who access IHSC services felt that they were not always involved in planning their care and that there was a lack of clarity in navigating integrated systems; subsequently, this impacted upon their experiences of those services. However, service user and informal carer voices appear to be underrepresented in current literature and studies that included their views were found to be of low quality overall. Collectively, these findings support the need for further research that explores the person-centred experiences and needs of people who access IHSC.
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Affiliation(s)
- Louise Henderson
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Heather Bain
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Elaine Allan
- School Nursing AHSCP & NHSG Strategic Lead CEL 13 School Nursing, NHS Grampian, Aberdeen, UK
- School Nursing, School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Catriona Kennedy
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
- The University of Limerick, Limerick, Ireland
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Bussu S, Marshall M. Organisational development to support integrated care in East London: the perspective of clinicians and social workers on the ground. J Health Organ Manag 2021; 34:603-619. [PMID: 32681632 DOI: 10.1108/jhom-10-2019-0294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Organisational Development (OD), with its focus on partnership working and distributed leadership, is increasingly advocated as an effective approach to driving change. Our evaluation of the impact of OD on delivery of integrated care in three London boroughs sheds light on how OD is being understood and implemented within health services, and what impact it is having on delivery of care. DESIGN/METHODOLOGY/APPROACH The findings presented here are based on a qualitative and participatory evaluation. The authors looked at how health and social care professionals communicated and coordinated delivery of care and evaluated the impact of current OD activities on the ground to evidence whether and to which degree they are enabling frontline staff to change their working routines towards greater coordination. FINDINGS Our findings highlight the limited reach and scope of a top-down approach to OD based on ad hoc coaching and staff engagement events, often delivered by external consultancies, and mostly focused at the senior management level. This approach fell short of enabling the creation of sustainable, integrated and collaborative organisations. Instead, some of the professionals that participated in our study tried to develop spaces that facilitated ongoing dialogue and mutual support among professionals on the ground. PRACTICAL IMPLICATIONS Initiatives of bottom-up OD such as those described in this paper have greater potential to change working routines as they enable staff to move towards more collaborative and coordinated work. ORIGINALITY/VALUE These findings contribute to the literature on OD in public services and highlight the benefits of a context-sensitive, pragmatic, and long-term approach to OD to help create sustainable collaborative organisations.
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Affiliation(s)
- Sonia Bussu
- Department of History, Politics, and Philosophy, Manchester Metropolitan University, Manchester, UK
| | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
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24
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Alderwick H, Hutchings A, Briggs A, Mays N. The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews. BMC Public Health 2021; 21:753. [PMID: 33874927 PMCID: PMC8054696 DOI: 10.1186/s12889-021-10630-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Policymakers in many countries promote collaboration between health care organizations and other sectors as a route to improving population health. Local collaborations have been developed for decades. Yet little is known about the impact of cross-sector collaboration on health and health equity. METHODS We carried out a systematic review of reviews to synthesize evidence on the health impacts of collaboration between local health care and non-health care organizations, and to understand the factors affecting how these partnerships functioned. We searched four databases and included 36 studies (reviews) in our review. We extracted data from these studies and used Nvivo 12 to help categorize the data. We assessed risk of bias in the studies using standardized tools. We used a narrative approach to synthesizing and reporting the data. RESULTS The 36 studies we reviewed included evidence on varying forms of collaboration in diverse contexts. Some studies included data on collaborations with broad population health goals, such as preventing disease and reducing health inequalities. Others focused on collaborations with a narrower focus, such as better integration between health care and social services. Overall, there is little convincing evidence to suggest that collaboration between local health care and non-health care organizations improves health outcomes. Evidence of impact on health services is mixed. And evidence of impact on resource use and spending are limited and mixed. Despite this, many studies report on factors associated with better or worse collaboration. We grouped these into five domains: motivation and purpose, relationships and cultures, resources and capabilities, governance and leadership, and external factors. But data linking factors in these domains to collaboration outcomes is sparse. CONCLUSIONS In theory, collaboration between local health care and non-health care organizations might contribute to better population health. But we know little about which kinds of collaborations work, for whom, and in what contexts. The benefits of collaboration may be hard to deliver, hard to measure, and overestimated by policymakers. Ultimately, local collaborations should be understood within their macro-level political and economic context, and as one component within a wider system of factors and interventions interacting to shape population health.
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Affiliation(s)
- Hugh Alderwick
- Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Andrew Hutchings
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Adam Briggs
- Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
- University of Warwick, Coventry, CV4 7AL UK
| | - Nicholas Mays
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Karimi M, Tsiachristas A, Looman W, Stokes J, Galen MV, Rutten-van Mölken M. Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients. Health Policy 2021; 125:751-759. [PMID: 33947604 DOI: 10.1016/j.healthpol.2021.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
Bundled payments aim to stimulate the integration of healthcare services and ultimately reduce healthcare expenditure growth through improved quality of care. The Netherlands introduced bundled payments for chronic diseases in 2010 by reimbursing providers annually for a bundle of primary care services related to COPD, Diabetes, or Vascular Risk Management. We aimed to assess the long-term effects of these bundled payments on healthcare expenditure. We used health insurance claims data from 2008 to 2015 to compare the healthcare expenditure between everyone who was included in bundled payments and a control group. We performed a difference-in-difference analysis in combination with propensity score matching and found that bundled payments consistently increased health care expenditure over seven years. The average half-year increase was €233 (95%CI: 204-262) for DM2, €609 (95%CI: 533-686) for COPD, and €231 (95%CI: 208-254) for VRM, representing 13%, 52%, and 20% of 2008 half-year cost. The increase was higher for those with multimorbidity compared to those without multimorbidity. This suggests that the expectations of the bundled payments are yet to be fulfilled.
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Affiliation(s)
- Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Apostolos Tsiachristas
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Willemijn Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Jonathan Stokes
- Health Organisation, Policy and Economics, Primary Care and Health Services Research Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Mirte van Galen
- Vektis C.V., Sparrenheuvel 18, Building B, 3708 JE Zeist, the Netherlands
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands, PO Box 1738, 3000 DR Rotterdam.
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Wilson P, Billings J, MacInnes J, Mikelyte R, Welch E, Checkland K. Investigating the nature and quality of locally commissioned evaluations of the NHS Vanguard programme: an evidence synthesis. Health Res Policy Syst 2021; 19:63. [PMID: 33845858 PMCID: PMC8042862 DOI: 10.1186/s12961-021-00711-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 03/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND With innovation in service delivery increasingly viewed as crucial to the long-term sustainability of health systems, NHS England launched an ambitious new model of care (Vanguard) programme in 2015. Supported by a £350 million transformation fund, 50 Vanguard sites were to act as pilots for innovation in service delivery, to move quickly to change the way that services were delivered, breaking down barriers between sectors and improving the coordination and delivery of care. METHODS As part of a national evaluation of the Vanguard programme, we conducted an evidence synthesis to assess the nature and quality of locally commissioned evaluations. With access to a secure, online hub used by the Vanguard and other integrated care initiatives, two researchers retrieved any documents from a locally commissioned evaluation for inclusion. All identified documents were downloaded and logged, and details of the evaluators, questions, methodological approaches and limitations in design and/or reporting were extracted. As included evaluations varied in nature and type, a narrative synthesis was undertaken. RESULTS We identified a total of 115 separate reports relating to the locally commissioned evaluations. Five prominent issues relating to evaluation conduct were identified across included reports: use of logic models, number and type of evaluation questions posed, data sharing and information governance, methodological challenges and evaluation reporting in general. A combination of resource, data and time constraints means that evaluations often attempted to but did not fully address the wide range of questions posed by individual Vanguards. CONCLUSIONS Significant investment was made in independent local evaluations of the Vanguard programme by NHS England. This synthesis represents the only comprehensive attempt to capture methodological learning and may serve as a key resource for researchers and policy-makers seeking to understand investigating large-scale system change, both within the NHS and internationally. PROSPERO (Registration number: CRD42017069282).
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Affiliation(s)
- Paul Wilson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Jenny Billings
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Julie MacInnes
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Rasa Mikelyte
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Elizabeth Welch
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Kath Checkland
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Davidson L, Scott J, Forster N. Patient experiences of integrated care within the United Kingdom: A systematic review. INTERNATIONAL JOURNAL OF CARE COORDINATION 2021. [DOI: 10.1177/20534345211004503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction Integrated care and patient experience are central to the coordination and delivery of high quality health and social care in the UK, but their joint application is poorly understood. This systematic review aimed to gain an understanding of patient experience within current integrated care services in the UK, and specifically, whether they reflect person-centred coordinated care (PCCC). Methods Following PRISMA, electronic databases (ProQuest, EBSCO and Cochrane Library) were searched from 2012 to 2019 for primary, peer-reviewed literature. Papers were included where patients’ or carers’ experiences of integrated care were reported. Papers were excluded where they focused on acute integrated care interventions, measured experience via satisfaction scores only, or findings lacked sufficient depth to answer the research question. Quality was assessed using Mixed Methods Appraisal Tool, and findings synthesised using a framework approach, incorporating the Rainbow Model of Integrated Care and Measuring Integrated Care Patient Framework. Results Sixteen studies were included. Person-centred and shared responsibility experiences were most often discussed. Experiences were not always described as positive and some patients experienced a lack of PCCC. Clinical, professional/organisational and functional integration processes were associated with experiencing domains of PCCC. Discussion People with complex needs experience a lack of coordination across teams and wider community resources, and limited associations were made between integration processes and patient experience. Further research which gives context to individual experience, provides greater detail of integration processes and utilises validated patient experience measures of PCCC is required to understand the association between integration processes and domains of PCCC.
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Häkkinen U, Sund R. What works? The association of organisational structure, reforms and interventions on efficiency in treating hip fractures. Soc Sci Med 2021; 274:113611. [PMID: 33685757 DOI: 10.1016/j.socscimed.2020.113611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/06/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Many studies indicate huge regional and hospital-level differences in health care performance. In order to increase health system efficiency, it is important to know the reasons behind the differences and analyse the effects of those factors that can be affected by health policy. The aim of this study is to evaluate and compare various organisational factors and health policy interventions in the performance of the care of hip fracture patients in Finland. We analysed the relationship between organisational factors (hospital volume, regional concentration of treatments) and performance. The focus is also on the effects of two macro-level organisational changes (integration of production of all health and social services in one provider) and two micro-level interventions (integrated patient pathway interventions, aiming to discharge patients as soon as possible). Our results indicate that macro-level integration of the production or financing of health and social services, bigger hospital volumes, and the concentration of the acute phase of care in fewer hospitals within hospital districts were not consistently related to efficiency in the care of hip fracture patients. Instead, efficiency can be increased using micro-level interventions aiming to coordinate patient pathways at the patient group level.
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Affiliation(s)
- Unto Häkkinen
- Centre for Health and Social Economics (CHESS), Finnish Institute for Health and Welfare, Finland.
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Wikström K, Lamidi ML, Rautiainen P, Tirkkonen H, Kivinen P, Laatikainen T. The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland. BMC Health Serv Res 2021; 21:65. [PMID: 33441132 PMCID: PMC7805148 DOI: 10.1186/s12913-021-06059-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The need to improve the care of people with complex care requirements has been driving the reforms integrating care processes. This study examines the effect of the integration of health services on health care usage and the processes and outcomes of care among type 2 diabetes patients. METHODS Data include all type 2 diabetes patients who lived in North Karelia, Finland, between 2014 and 2018. Health care contacts and glycated haemoglobin (HbA1c) measurements were obtained from the electronic health records. Logistic, Poisson and linear models with generalised estimating equations and the Friedman test were used to study the differences between years. RESULTS The health care usage was highest in 2017, the first year of a new organisation, and smallest in the following year. Before the new organisation, the health care usage was lowest in 2014, being slightly higher compared with 2018. Between the last two years, the mean number of contacts per person declined from 3.25 to 2.88 (-0.37, p < 0.001). The decreasing pattern seen in total health care usage was most obvious among contacts with primary health care nurses. The number of contacts increased only among specialised care nurses between the last two years. The number of HbA1c measurements was also in its lowest in 2018 but in its highest in 2015. Between the years 2014 and 2018, the difference in the mean number of contacts was - 0.05 (p = 0.011) for those not measured, -0.02 (p = 0.225) for those measured and within the target level of HbA1c, and 0.12 (p = 0.001) for those measured and not at the target level of HbA1c. CONCLUSIONS Health care integration first increased the health care usage but then brought it to a slightly lower level than before. The changes were most obvious in primary health care nurses' appointments, and no decline was observed in secondary-level care. Even though the numbers of HbA1c measurements and the proportion measured declined, measurements increased among those with poor glycaemic control. The observed changes might reflect the better targeting and more concordant services in different service units.
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Affiliation(s)
- Katja Wikström
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland. .,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland
| | - Päivi Rautiainen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Hilkka Tirkkonen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Petri Kivinen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
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Yeh SC, Tsay SF, Wang WC, Lo YY, Shi HY. Determinants of Successful Nursing Home Accreditation. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059998. [PMID: 34812691 PMCID: PMC8640283 DOI: 10.1177/00469580211059998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study examined the factors associated with better accreditation outcomes among nursing homes. METHOD A total of 538 nursing homes in Taiwan were included in this study. Measures included accreditation scores, external factors (household income, Herfindahl-Hirschman Index, old-age dependency ratio, population density, and number of older adult households), organizational factors (hospital-based status, chain-affiliated status, occupancy rate, the number of registered nurses or nurse aides per bed, and bed size), and internal factors (accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care). RESULTS Bed size, hospital-based status, accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care were found to predict accreditation. CONCLUSION Among all variables in this study, the quality indicators contributed to the most variation, followed by organizational factors. External environmental factors played a minor role in predicting accreditation. A focus on quality of care would benefit not only the residents of a nursing home but also facilitate its accreditation.
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Affiliation(s)
- Shu-Chuan Yeh
- Institute of Health Care Management & Department of Business Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shwu-Feng Tsay
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen Chun Wang
- Director-General, Department of Nursing and Health Care, Ministry of Health and Welfare, Taiwan
| | - Ying-Ying Lo
- Adjunct Associate Professor, Department of Health Services Administration, College of Public Health, China Medical University, Taiwan
| | - Hon-Yi Shi
- Department of Business Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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Shao Q, Yuan J, Ma J, Ding H, Huang W. Exploring the determinants of synergetic development of social organizations participating in home-based elderly care service: An SEM method. PLoS One 2020; 15:e0244880. [PMID: 33382827 PMCID: PMC7775099 DOI: 10.1371/journal.pone.0244880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
The current aging service industry has problems in meeting the ever-increasing demand for the home-based elderly care service (HECS). Social organizations participating in HECS seems to be a promising way to address these problems but also raises new challenges, like uncoordinated cooperation among stakeholders, which could lead to low management efficiency and low service quality. However, Synergetic development can be promising to enhance the participation of social organizations and to improve social welfare. This study introduces a conceptual model to explore relationships between five determinants and synergetic development of social organizations participating in HECS. A structural equation model (SEM) based on questionnaire survey is used as a test methodology. The results indicated that stakeholder engagement plays a critical role in synergetic development in HECS, resource allocation can only be improved by institutional climate, and supervision capacity cannot facilitate information sharing. This study provides effective strategies and directions for the improvement of home-based elderly care services.
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Affiliation(s)
- Qiuhu Shao
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Jingfeng Yuan
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Junwei Ma
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Hongxing Ding
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Wei Huang
- School of Civil Engineering, Sanjiang University, Nanjing, Jiangsu Province, P. R. China
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Olugbenga Ayeleke R, Tenbensel T, Silwal PR, Walton L. Like using a refrigerator to heat food: capacity and capability funding in primary care and the legacy of the Primary Health Organisation Performance Programme. J Prim Health Care 2020; 12:345-351. [PMID: 33349322 DOI: 10.1071/hc20012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/11/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2016, the New Zealand Ministry of Health introduced the System Level Measures (SLM) framework as a new approach to health system improvement that emphasised quality improvement and integration. A funding stream that was a legacy of past primary care performance management was repurposed as 'capacity and capability' funding to support the implementation of the SLM framework. AIM This study explored how the capacity and capability funding has been used and the issues and challenges that have arisen from the funding implementation. METHODS Semi-structured interviews with 50 key informants from 18 of New Zealand's 20 health districts were conducted. Interview transcripts were coded using thematic analysis. RESULTS The capacity and capability funding was used in three different ways. Approximately one-third of districts used it to actively support quality improvement and integration initiatives. Another one-third tweaked existing performance incentive schemes and in the remaining one-third, the funding was passed directly on to general practices without strings attached. Three key issues were identified related to implementation of the capacity and capability funding: lack of clear guidance regarding the use of the funding; funding perceived as a barrier to integration; and funding seen as insufficient for intended purposes. DISCUSSION The capacity and capability funding was intended to support collaborative integration and quality improvement between health sector organisations at the district level. However, there is a mismatch between the purpose of the capacity and capability funding and its use in practice, which is primarily a product of incremental and inconsistent policy development regarding primary care improvement.
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Affiliation(s)
- Reuben Olugbenga Ayeleke
- School of Population Health, The University of Auckland, Auckland, New Zealand; and Corresponding author.
| | - Timothy Tenbensel
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Pushkar Raj Silwal
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Lisa Walton
- School of Population Health, The University of Auckland, Auckland, New Zealand
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Lalani M, Bussu S, Marshall M. Understanding integrated care at the frontline using organisational learning theory: A participatory evaluation of multi-professional teams in East London. Soc Sci Med 2020; 262:113254. [DOI: 10.1016/j.socscimed.2020.113254] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/29/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
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Kasteridis P, Mason A, Street A. Evaluating integrated care for people with complex needs. J Health Serv Res Policy 2020; 26:46-53. [PMID: 32611255 DOI: 10.1177/1355819620931872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES As part of the Vanguard programme, two integrated care models were introduced in South Somerset for people with complex care needs: the Complex Care Team and Enhanced Primary Care. We assessed their impact on a range of utilization measures and mortality. METHODS We used monthly individual-level linked primary and secondary care data from April 2014 to March 2018 to assess outcomes before and after the introduction of the care models. The analysis sample included 564 Complex Care Team and 841 Enhanced Primary Care cases that met specific criteria. We employed propensity score methods to identify out-of-area control patients and difference-in-differences analysis to isolate the care models' impact. RESULTS We found no evidence of significantly reduced utilization in any of the Complex Care Team or Enhanced Primary Care cohorts. The death rate was significantly lower only for those in the first Enhanced Primary Care cohort. CONCLUSIONS The integrated care models did not significantly reduce utilization nor consistently reduce mortality. Future research should test longer-term outcomes associated with the new models of care and quantify their contribution in the context of broader initiatives.
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Affiliation(s)
| | - Anne Mason
- Senior Research Fellow, Centre for Health Economics, University of York, UK
| | - Andrew Street
- Professor, Department of Health Policy, London School of Economics and Political Science, UK
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Doheny M, Agerholm J, Orsini N, Schön P, Burström B. Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis. BMJ Open 2020; 10:e036182. [PMID: 32499268 PMCID: PMC7279653 DOI: 10.1136/bmjopen-2019-036182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits. DESIGN Interrupted time series analysis from 2000 to 2015. SETTING Stockholm County. PARTICIPANTS All inhabitants 65+ years in Stockholm County on 31 December of each study year. INTERVENTION IC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County. OUTCOME Rates of hospital-based ED visits. RESULTS IC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65-79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years. CONCLUSION The implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.
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Affiliation(s)
- Megan Doheny
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Nicola Orsini
- Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Karolinska, Stockholm, Sweden
| | - Bo Burström
- Global Public Health, Karolinska Institute, Stockholm, Sweden
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Kelly L, Harlock J, Peters M, Fitzpatrick R, Crocker H. Measures for the integration of health and social care services for long-term health conditions: a systematic review of reviews. BMC Health Serv Res 2020; 20:358. [PMID: 32336288 PMCID: PMC7183623 DOI: 10.1186/s12913-020-05206-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/12/2020] [Indexed: 01/09/2023] Open
Abstract
Background As people are living longer with higher incidences of long-term health conditions, there is a move towards greater integration of care, including integration of health and social care services. Integrated care needs to be comprehensively and systematically evaluated if it is to be implemented widely. We performed a systematic review of reviews to identify measures which have been used to assess integrated care across health and social care services for people living with long-term health conditions. Methods Four electronic databases (PUBMED; MEDLINE; EMBASE; Cochrane library of systematic reviews) were searched in August 2018 for relevant reviews evaluating the integration of health and social care between 1998 and 2018. Articles were assessed according to apriori eligibility criteria. A data extraction form was utilised to collate the identified measures into five categories. Results Of the 18 articles included, system outcomes and process measures were most frequently identified (15 articles each). Patient or carer reported outcomes were identified in 13 articles while health outcomes were reported in 12 articles. Structural measures were reported in nine articles. Challenges to measuring integration included the identification of a wide range of potential impacts of integration, difficulties in comparing findings due to differences in study design and heterogeneity of types of outcomes, and a need for appropriate, robust measurement tools. Conclusions Our review revealed no shortage of measures for assessing the structures, processes and outcomes of integrated care. The very large number of available measures and infrequent use of any common set make comparisons between schemes more difficult. The promotion of core measurement sets and stakeholder consultation would advance measurement in this area.
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Affiliation(s)
- Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.,Harris Manchester College, Oxford, OX1 3TD, UK
| | - Jenny Harlock
- Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Helen Crocker
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
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Would integrating women's professional care of pelvic organ prolapse improve the symptoms and quality of life: an integrative literature review. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-07-2019-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeIntegrated healthcare is a central tenant of the NHS Long Term Plan (NHS, 2019). NICE in 2019 published guidelines; advising the integration of multidisciplinary professionals which may lead to an improvement in conservative treatment methods of pelvic organ prolapse. Therefore, current literature on the conservative treatments for pelvic organ prolapse needs to be reviewed to ascertain if an integrated approach would improve the symptoms and quality of life for women.Design/methodology/approachA systematic review of the literature between 2013 and 2018 was implemented. Papers included were written in English, peer-reviewed and consisted of treatments of pelvic organ prolapse in women. Papers containing surgical interventions, postpartum participants, reviews, evaluations, guidelines, follow-up studies, focusing on cost effectiveness, sexual function were excluded.FindingsSeven studies in total were included, and two overarching themes were identified: quality of life after treatment and the effect of conservative treatment on pelvic organ prolapse symptoms. The literature suggested that integrating care had a more positive outcome on pelvic organ symptoms and quality of life.Research limitations/implicationsTo develop a robust enhanced model of care for conservative treatment of pelvic organ prolapse through more mixed method or qualitative research, that incorporates integrative treatment methods with collaboration from multidisciplinary professionals.Practical implicationsThe practical implications of integrating the conservative management of pelvic organ prolapse is the communication between the multidisciplinary team must be exceptional to ensure everyone understands and agrees the treatment that is being provided to patient. Also, effective teamwork is important to ensure the patient receives the best care with input from the correct disciplines. The multi-professional team will need to have regular meetings to discuss and implement care plans for patients that might prove difficult to schedule due to differing commitments and priorities. This must be overcome to insure a successful and effective integrated approach to pelvic organ prolapse is delivered.Social implicationsThe social implications of integrating the professional approach to women's care of pelvic organ prolapse involves reducing the severity of the symptoms therefore, increasing the quality of life. This may result in the reduction of surgical intervention due to the patient being satisfied with the conservative management. Through integrating the management of the prolapse the patient will receive an accessible individualised care plan pathway that focuses on treating or reducing the impact of the symptoms that are bothersome to the patient whilst managing patient expectations. Patients will also, be reassured by the number of multi-disciplinary professionals involved in their care.Originality/valueGlobal integration of conservative treatments and multidisciplinary-professionals specialising in pelvic organ prolapse and pelvic floor dysfunction is needed.
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Kumpunen S, Edwards N, Georghiou T, Hughes G. Why do evaluations of integrated care not produce the results we expect? INTERNATIONAL JOURNAL OF CARE COORDINATION 2020. [DOI: 10.1177/2053434520909089] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A number of evaluations of models of integrated care have not produced the expected result of reduced hospital admissions, and in some cases have even found people receiving integrated care services using hospitals more than matched controls. We tested three hypotheses for these surprising results with a group of 50 integrated care experts in a seminar: (1) problems with the model; (2) problems of implementation; and (3) problems of evaluation. Our group of experts did not rule out any of these hypotheses and came up with some advice as to manage these issues. For example, model designers should rigorously test the underlying logic; commissioners should seek out advice from experts and patients/professionals; and evaluators should choose outcomes wisely, use mixed methods approaches, and provide regular feedback loops to implementation sites. Evaluating integrated care is a skilled task that requires multiple approaches in terms of the design and implementation of the models. National research funders or other appropriate bodies might consider developing an advisory service to provide support to local systems planning evaluations.
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Briggs ADM, Göpfert A, Thorlby R, Allwood D, Alderwick H. Integrated health and care systems in England: can they help prevent disease? INTEGRATED HEALTHCARE JOURNAL 2020. [DOI: 10.1136/ihj-2019-000013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesOver the past 12 months, there has been increasing policy rhetoric regarding the role of the National Health Service (NHS) in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change.MethodsWe reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health.ResultsThe evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health.ConclusionsFor ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants.
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Koushkaki SR, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:60-70. [PMID: 32015729 PMCID: PMC6996071 DOI: 10.1176/appi.focus.18102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from Current Psychiatry Reports (2020) 21: 35).
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McGuire F, Vijayasingham L, Vassall A, Small R, Webb D, Guthrie T, Remme M. Financing intersectoral action for health: a systematic review of co-financing models. Global Health 2019; 15:86. [PMID: 31849335 PMCID: PMC6918645 DOI: 10.1186/s12992-019-0513-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility. AIM This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. METHODS We conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded. RESULTS Of 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes. CONCLUSION Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals.
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Affiliation(s)
- Finn McGuire
- University of York (Centre for Health Economics), York, UK
| | - Lavanya Vijayasingham
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia.
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, (Centre for Health Economics in London (CHIL)), London, UK
| | - Roy Small
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
| | - Douglas Webb
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
| | - Teresa Guthrie
- United Nations Development Programme (HIV, Health and Development Group), New York, USA
- Independent consultant, Cape Town, South Africa
| | - Michelle Remme
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
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Harlock J, Caiels J, Marczak J, Peters M, Fitzpatrick R, Wistow G, Forder J, Jones K. Challenges in integrating health and social care: the Better Care Fund in England. J Health Serv Res Policy 2019; 25:86-93. [DOI: 10.1177/1355819619869745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The Better Care Fund is the first and only national policy in England that has legally mandated the use of pooled budgets to support local health and social care systems to provide better integrated care. Methods We report qualitative findings from the first national multi-method evaluation of the Better Care Fund, focusing on its implementation, perceptions of progress and expected impacts among key stakeholders. Interviews were carried out with 40 staff responsible for Better Care Fund implementation in 16 local health and social care sites between 2017 and 2018. Results Study participants reported their experiences of implementation, and we present these in relation to three themes: organizational issues, relational issues and wider contextual issues. Participants stressed the practical and political challenges of managing pooled budgets and the complexity of working across geographical boundaries. In a context of unprecedented austerity, shared vision and strong leadership were even more vital to achieve collaborative outcomes. Conclusion Pooling budgets through the Better Care Fund can lever closer collaboration between sectors and services. Shared vision and leadership are essential to develop and foster this closer collaboration. Although some successes were reported, the study highlights that there are major cultural, operational and territorial barriers to overcome.
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Affiliation(s)
- Jenny Harlock
- Senior Research Fellow, Division of Health Sciences, Warwick Medical School, University of Warwick, UK
| | - James Caiels
- Research Fellow, Personal Social Services Research Unit, University of Kent, UK
| | - Joanna Marczak
- Researcher, Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | - Michele Peters
- Associate Professor, Nuffield Department of Population Health, University of Oxford, UK
| | - Raymond Fitzpatrick
- Professor of Public Health and Primary Care, Nuffield Department of Population Health, University of Oxford, UK
| | - Gerald Wistow
- Professorial Research Fellow, Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | - Karen Jones
- Professor of the Economics of Social Policy, School of Social Policy, Sociology and Social Research, University of Kent, UK
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Naqvi D, Malik A, Al-Zubaidy M, Naqvi F, Tahir A, Tarfiee A, Vara S, Meyer E. The general practice perspective on barriers to integration between primary and social care: a London, United Kingdom-based qualitative interview study. BMJ Open 2019; 9:e029702. [PMID: 31434776 PMCID: PMC6707672 DOI: 10.1136/bmjopen-2019-029702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/10/2019] [Accepted: 08/02/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE There is an ongoing challenge of effective integration between primary and social care in the United Kingdom; current systems have led to fragmentation of services preventing holistic patient-centred care for vulnerable populations. To improve clinical outcomes and achieve financial efficiencies, the barriers to integration need to be identified and addressed. This study aims to explore the unique perspectives of frontline staff (general practitioners and practice managers) towards these barriers to integration. DESIGN Qualitative study using semistructured interviews and thematic analysis to obtain results. SETTING General practices within London. PARTICIPANTS 18 general practitioners (GPs) and 7 practice managers (PMs) based in London with experience of working with social care. RESULTS The study identified three overarching themes where frontline staff believed problems exist: accessing social services, interprofessional relationships and infrastructure. Issues with contacting staff from other sectors creates delays in referrals for patient care and perpetuates existing logistical challenges. Likewise, professionals noted a hostile working culture between sectors that has resulted in silo working mentalities. In addition to staff being overworked as well as often inefficient multidisciplinary team meetings, poor relationships across sectors cause a diffusion of responsibility, impacting the speed with which patient requests are responded to. Furthermore, participants identified that a lack of interoperability between information systems, lack of pooled budgets and misaligned incentives between managerial staff compound the infrastructural divide between both sectors. CONCLUSION In this study, primary care staff identify intangible barriers to integration such as poor interprofessional relationships, in addition to more well-described structural issues such as insufficient funding and difficulty accessing social care. Participants believe that educating the next generation of medical professionals may lead to the development of collaborative, instead of siloed, working cultures and that change is needed at both an interpersonal and institutional level to successfully integrate care.
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Affiliation(s)
| | | | | | | | | | | | | | - Edgar Meyer
- Imperial College Business School, London, UK
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Stokes J, Lau YS, Kristensen SR, Sutton M. Does pooling health & social care budgets reduce hospital use and lower costs? Soc Sci Med 2019; 232:382-388. [DOI: 10.1016/j.socscimed.2019.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/02/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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Longo F, Siciliani L, Moscelli G, Gravelle H. Does hospital competition improve efficiency? The effect of the patient choice reform in England. HEALTH ECONOMICS 2019; 28:618-640. [PMID: 30815943 DOI: 10.1002/hec.3868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/27/2018] [Accepted: 11/19/2018] [Indexed: 05/27/2023]
Abstract
We use the 2006 relaxation of constraints on patient choice of hospital in the English NHS to investigate the effect of hospital competition on dimensions of efficiency including indicators of resource management (admissions per bed, bed occupancy rate, proportion of day cases, and cancelled elective operations) and costs (reference cost index for overall and elective activity, cleaning services costs, laundry and linen costs). We employ a quasi differences-in-differences approach and estimate seemingly unrelated regressions and unconditional quantile regressions with data on hospital trusts from 2002/2003 to 2010/2011. Our findings suggest that increased competition had mixed effects on efficiency. An additional equivalent rival increased admissions per bed by 1.1%, admissions per doctor by 0.9% and the proportion of day cases by 0.38 percentage points, but it also increased the number of cancelled elective operations by 2.5%.
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Affiliation(s)
| | - Luigi Siciliani
- Centre for Health Economics, University of York, York, UK
- Department of Economic and Related Studies, University of York, York, UK
| | | | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
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Forder J, Gousia K, Saloniki EC. The impact of long-term care on primary care doctor consultations for people over 75 years. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:375-387. [PMID: 30187252 PMCID: PMC6438947 DOI: 10.1007/s10198-018-0999-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
Many countries are adopting policies to create greater coordination and integration between acute and long-term care services. This policy is predicated on the assumption that these service areas have interdependent outcomes for patients. In this paper, we study the interdependencies between the long-term (home care) services and consultations with a primary care doctor, as used by people over 75 years. Starting with a model of individual's demand for doctor consultations, given supply, we formalize the hypothesis that exogenous increases to home care supply will reduce the number of consultations where these services are technical substitutes. Furthermore, greater coordination of public service planning and use of pooled budgets could lead to better outcomes because planners can account for these externalities. We test our main hypothesis using data from the British Household Panel Study for 1991-2009. To address potential concerns about endogeneity, we use a set of instrumental variables for home care motivated by institutional features of the social care system. We find that there is a statistically significant substitution effect between home care and doctor visits, which is robust across a range of specifications. This result has implications for policies that consider increased coordination between health care and social care systems.
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Affiliation(s)
- Julien Forder
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, CT2 7NX, UK
| | - Katerina Gousia
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, CT2 7NX, UK.
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, CT2 7NX, UK.
| | - Eirini-Christina Saloniki
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, CT2 7NX, UK
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, CT2 7NX, UK
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Rahmanian Koushkaki S, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. Curr Psychiatry Rep 2019; 21:35. [PMID: 30927093 PMCID: PMC6440941 DOI: 10.1007/s11920-019-1017-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. RECENT FINDINGS There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.
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Affiliation(s)
- Enrico G Castillo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA.
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA.
| | - Roya Ijadi-Maghsoodi
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Division of Population Behavioral Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Sonya Shadravan
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Elizabeth Moore
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Michael O Mensah
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Mary Docherty
- Harkness Fellow in Healthcare Policy and Practice, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Maria Gabriela Aguilera Nunez
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nicolás Barcelo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nichole Goodsmith
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Laura E Halpin
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Isabella Morton
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Joseph Mango
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Alanna E Montero
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Sara Rahmanian Koushkaki
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Department of Anthropology, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Bowen Chung
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- Los Angeles Biomedical Research Institute, Los Angeles, CA, USA
- Healthy African American Families II, Los Angeles, CA, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | - Sonya Gabrielian
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Jared M Greenberg
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ippolytos Kalofonos
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA
- UCLA International Institute, Los Angeles, CA, USA
| | - Sheryl H Kataoka
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Jeanne Miranda
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Harold A Pincus
- Rand Corporation, Santa Monica, CA, USA
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, NewYork-Presbyterian Hospital, Irving Institute for Clinical and Translational Research, New York, NY, USA
| | - Bonnie T Zima
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Kenneth B Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06290] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Bower P, Reeves D, Sutton M, Lovell K, Blakemore A, Hann M, Howells K, Meacock R, Munford L, Panagioti M, Parkinson B, Riste L, Sidaway M, Lau YS, Warwick-Giles L, Ainsworth J, Blakeman T, Boaden R, Buchan I, Campbell S, Coventry P, Reilly S, Sanders C, Skevington S, Waheed W, Checkland K. Improving care for older people with long-term conditions and social care needs in Salford: the CLASSIC mixed-methods study, including RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness.ObjectivesTo explore the process of implementation of the SICP and the impact on patient outcomes and costs.DesignQualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies.SettingSalford in the north-west of England.ParticipantsOlder people aged ≥ 65 years, carers, and health and social care professionals.InterventionsA large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’).Main outcome measuresPatient self-management, care experience and quality of life, and health-care utilisation and costs.Data sourcesProfessional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation.ResultsThe SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776).LimitationsThe Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were < 40%.ConclusionsThe SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes.Future workFurther research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use.Trial registrationCurrent Controlled Trials ISRCTN12286422.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 31. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Bower
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - David Reeves
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Kelly Howells
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Luke Munford
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Beth Parkinson
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Lisa Riste
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | - Yiu-Shing Lau
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Lynsey Warwick-Giles
- Policy Research Unit in Commissioning and the Healthcare System, Centre for Primary Care, University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Ruth Boaden
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care for Greater Manchester, Alliance Business School Manchester, University of Manchester, Manchester, UK
| | - Iain Buchan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Stephen Campbell
- National Institute for Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | | | - Caroline Sanders
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Suzanne Skevington
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Waquas Waheed
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Katherine Checkland
- Policy Research Unit in Commissioning and the Healthcare System, Centre for Primary Care, University of Manchester, Manchester, UK
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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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