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Choi JW, Yoo AJ. Outcomes of the Pilot Project for Community Care Among Older Adults in South Korea. J Aging Soc Policy 2023:1-18. [PMID: 38007618 DOI: 10.1080/08959420.2023.2284571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/27/2023] [Indexed: 11/27/2023]
Abstract
The Korean government implemented the pilot project for community care for older adults in June 2019. This study investigated the outcomes of the pilot project among Korean older adults by linking survey data from the pilot project with data of Korean National Health Insurance Service. The final sample included 17,801 pilot project participants and 68,145 in a matched comparison group. Pilot program participants experienced an increase of 4.8 days for length of home stay and a reduction of $956 (US) per participant relative to the matched comparison group. Pilot program participants with long-term care insurance who used home care services experienced an increase of 8.9 days for length of home stay and a reduction in $1,177 (US) in total costs, along with a reduction in the admission to long-term care facilities, compared to the matched comparison group. Patients discharged from hospitals indicated an increase of 35.2 days for length of home stay and a reduction of $6,947 (US) in total costs, but a 3.53 times increase in hospital readmissions relative to the matched comparison group. The pilot project for community care resulted in increased length of home stay and reduced total costs among older adults in Korea.
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Affiliation(s)
- Jae Woo Choi
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
| | - Ae Jung Yoo
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
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Abbasian M, Shaghaghi A. <p>An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR)</p>. Healthc Policy 2020; 13:1365-1374. [PMID: 32943954 PMCID: PMC7468414 DOI: 10.2147/rmhp.s258661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Population ageing has been steadily rising in Iran and in the over 60-year-old population, the ratio increased from 5.4% in 1986 to 8.6% in 2016 which represents an increase of 4.3 million over the past three decades. The inevitable impacts of a growing elderly population on the demand-side of the health care provision (HCP) equilibrium call for an urgent revision of the current arrangements of the Iran’s National health care system (INHS). The main aim of this study was to scrutinize the best available scientific evidence on the international integrated elderly health care governance (HCG) models to revamp health care practice and policy-making processes in Iran. Materials and Methods This multiphasic study consists of a scoping review of existent HCP modalities for the elderly population worldwide, and the disposition of an optimal HCP scheme for the elderly population and its application for the detection of the gaps in Iran. The final stage includes a Delphi-based consultation and consensus process which was reciprocated in three rounds and the key subjects were requested to give their judgment on the eventuated HCP layout designed to serve the ageing Iranian population. Results The yielded model (IEHCG-IR) included four dimensions consistent with the four levels of prevention along with social support services. The structure and feasibility of the preliminary framework were approved by 83.6% of the study participants. Conclusion The study findings could have important implications for future policy making in the INHS and the suggested healthcare framework for the elderly Iranian population could be a preliminary model for health system re-engineering.
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Affiliation(s)
- Mehdi Abbasian
- Elderly Health Section, Health Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Elderly Health Section, Health Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
- Correspondence: Abdolreza Shaghaghi Health Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Golgasht Ave, Tabriz5166614711, Iran Email
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de Moissac D, Savard J, Savard S, Giasson F, Kubina LA. Management strategies to improve French language service coordination and continuity for official language Francophone seniors in Canada. Healthc Manage Forum 2020; 33:271-276. [PMID: 32527149 DOI: 10.1177/0840470420931115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence suggests that language barriers present obstacles to healthcare access and quality for Francophone seniors in official language minority communities across Canada. Addressing language barriers and providing continuity is challenging, as French language services (FLSs) rely heavily on bilingual providers and the practice of active offer by all staff. This qualitative research used semi-structured group and individual interviews to explore mechanisms supporting FLS coordination and continuity in two Canadian provinces. Identification of the language variable in health records, virtual healthcare, and FLS directories are conducive to FLS continuity, but financial and resource limitations present major obstacles. Management strategies to facilitate continuity of FLS across health organizations are discussed.
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Affiliation(s)
- Danielle de Moissac
- Faculty of Science, 33529Université de Saint-Boniface, Winnipeg, Manitoba, Canada
| | - Jacinthe Savard
- School of Rehabilitation Sciences, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Sébastien Savard
- School of Social Work, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Florette Giasson
- School of Social Work, 33529Université de Saint-Boniface, Winnipeg, Manitoba, Canada
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Tremblay D, Touati N, Poder T, Vasiliadis HM, Bilodeau K, Berbiche D, Denis JL, Pomey MP, Hébert J, Roch G, Prady C, Lévesque L. Collaborative governance in the Quebec Cancer Network: a realist evaluation of emerging mechanisms of institutionalization, multi-level governance, and value creation using a longitudinal multiple case study design. BMC Health Serv Res 2019; 19:752. [PMID: 31653231 PMCID: PMC6814997 DOI: 10.1186/s12913-019-4586-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes, and human and financial costs for PLCs and healthcare systems. National cancer control programs advocate organizing in a network to coordinate actions, solve fragmentation problems, and thus improve clinical outcomes and care experiences for every dollar invested. The variable outcomes of such networks and factors explaining them have been documented. Governance is the "missing link" for understanding outcomes. Governance refers to the coordination of collective action by a body in a position of authority in pursuit of a common goal. The Quebec Cancer Network (QCN) offers the opportunity to study in a natural environment how, why, by whom, for whom, and under what conditions collaborative governance contributes to practices that produce value-added outcomes for PLCs, healthcare providers, and the healthcare system. METHODS/DESIGN The study design consists of a longitudinal case study, with multiple nested cases (4 local networks nested in the QCN), mobilizing qualitative and quantitative data and mixed data from various sources and collected using different methods, using the realist evaluation approach. Qualitative data will be used for a thematic analysis of collaborative governance. Quantitative data from validated questionnaires will be analyzed to measure relational coordination and teamwork, care experience, clinical outcomes, and health-related health-related quality of life, as well as a cost analysis of service utilization. Associations between context, governance mechanisms, and outcomes will be sought. Robust data will be produced to support decision-makers to guide network governance towards optimized clinical outcomes and the reduction of the economic toxicity of cancer for PLCs and health systems.
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Affiliation(s)
- Dominique Tremblay
- Faculté de médecine et des sciences de la santé, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
- Centre de recherche Charles-Le Moyne - Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
| | - Nassera Touati
- Centre de recherche Charles-Le Moyne - Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
- École Nationale d’Administration Publique, 4750 Henri-Julien Avenue, Montréal, Québec, H2T 3E5 Canada
| | - Thomas Poder
- Département de gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9 Canada
- Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal, 7331, rue Hochelaga, Montréal, Québec, H1N 3V2 Canada
- École de gestion, Université de Sherbrooke, 2500, boulevard de l’Université, Sherbrooke, Québec, J1K 2R1 Canada
- Centre de recherche du Centre Hospitalier de l’Université de Sherbrooke (CR-CHUS), 3001, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4 Canada
| | - Helen-Maria Vasiliadis
- Faculté de médecine et des sciences de la santé, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
- Centre de recherche Charles-Le Moyne - Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
| | - Karine Bilodeau
- Faculté des sciences infirmières, Université de Montréal, 2375 chemin Côte-Ste-Catherine, Montréal, Québec, H3T 1A8 Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
| | - Jean-Louis Denis
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9 Canada
- École de santé publique, Université de Montréal, 7101, avenue du Parc, Montréal, Québec, H3N 1X9 Canada
- Centre de recherche en droit public, Université de Montréal, 3101, chemin de la Tour, Montréal, Québec, H3T 1J7 Canada
- Institut de recherche en santé publique de l’Université de Montréal (IRSPUM), Université de Montréal, 7101, avenue du Parc, Montréal, Montréal, Québec, H3N 1X9 Canada
| | - Marie-Pascale Pomey
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9 Canada
- École de santé publique, Université de Montréal, 7101, avenue du Parc, Montréal, Québec, H3N 1X9 Canada
- Institut de recherche en santé publique de l’Université de Montréal (IRSPUM), Université de Montréal, 7101, avenue du Parc, Montréal, Montréal, Québec, H3N 1X9 Canada
| | - Johanne Hébert
- Département des sciences infirmières, Campus de Lévis - Université du Québec à Rimouski (UQAR, 1595, boulevard Alphonse-Desjardins, Lévis, Québec, G6V 0A6 Canada
- Hôtel-Dieu de Lévis, Centre de recherche du CISSS de Chaudière-Appalaches, 143, rue Wolfe, Lévis, Québec, G6V 3Z1 Canada
- Centre de recherche du Centre hospitalier universitaire de Québec (CRCHUQ), 11 Côte du Palais, Québec, Québec, G1R 2J6 Canada
- Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs (ERMOS), Maison Michel-Sarrazin, 9, rue McMahon, Québec, Québec, G1R 3S3 Canada
| | - Geneviève Roch
- Hôtel-Dieu de Lévis, Centre de recherche du CISSS de Chaudière-Appalaches, 143, rue Wolfe, Lévis, Québec, G6V 3Z1 Canada
- Centre de recherche du Centre hospitalier universitaire de Québec (CRCHUQ), 11 Côte du Palais, Québec, Québec, G1R 2J6 Canada
- Faculté des sciences infirmières, Université Laval, 1050, avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec, G1V 0A6 Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, 10, rue de l’Espinay, Québec, Québec, G1L 3L5 Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL‐UL), 2525, chemin de la Canardière, Québec, Québec G1J 0A4 Canada
| | - Catherine Prady
- Faculté de médecine et des sciences de la santé, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
- Centre de recherche Charles-Le Moyne - Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
- Centre intégré de santé et de services sociaux de la Montérégie-Centre, 3120 boulevard Taschereau, Greenfield Park, Québec, J4V 2H1 Canada
- Centre intégré de cancérologie de la Montérégie, 3120 Boulevard Taschereau, Greenfield Park, Québec, J4V 2G9 Canada
| | - Lise Lévesque
- Faculté de médecine et des sciences de la santé, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
- Centre de recherche Charles-Le Moyne - Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8 Canada
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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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Home Care Case Managers' Integrated Care of Older Adults With Multiple Chronic Conditions. Prof Case Manag 2018; 23:165-189. [DOI: 10.1097/ncm.0000000000000286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 2018; 18:350. [PMID: 29747651 PMCID: PMC5946491 DOI: 10.1186/s12913-018-3161-3] [Citation(s) in RCA: 301] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION Prospero registration number: 42016037725 .
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
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Leijten FR, Struckmann V, van Ginneken E, Czypionka T, Kraus M, Reiss M, Tsiachristas A, Boland M, de Bont A, Bal R, Busse R, Rutten-van Mölken M. The SELFIE framework for integrated care for multi-morbidity: Development and description. Health Policy 2018; 122:12-22. [DOI: 10.1016/j.healthpol.2017.06.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/17/2022]
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Struckmann V, Leijten FRM, van Ginneken E, Kraus M, Reiss M, Spranger A, Boland MRS, Czypionka T, Busse R, Rutten-van Mölken M. Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review. Health Policy 2017; 122:23-35. [PMID: 29031933 DOI: 10.1016/j.healthpol.2017.08.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In order to provide adequate care for the growing group of persons with multi-morbidity, innovative integrated care programmes are appearing. The aims of the current scoping review were to i) identify relevant models and elements of integrated care for multi-morbidity and ii) to subsequently identify which of these models and elements are applied in integrated care programmes for multi-morbidity. METHODS A scoping review was conducted in the following scientific databases: Cochrane, Embase, PubMed, PsycInfo, Scopus, Sociological Abstracts, Social Services Abstracts, and Web of Science. A search strategy encompassing a) models, elements and programmes, b) integrated care, and c) multi-morbidity was used to identify both models and elements (aim 1) and implemented programmes of integrated care for multi-morbidity (aim 2). Data extraction was done by two independent reviewers. Besides general information on publications (e.g. publication year, geographical region, study design, and target group), data was extracted on models and elements that publications refer to, as well as which models and elements are applied in recently implemented programmes in the EU and US. RESULTS In the review 11,641 articles were identified. After title and abstract screening, 272 articles remained. Full text screening resulted in the inclusion of 92 articles on models and elements, and 50 articles on programmes, of which 16 were unique programmes in the EU (n=11) and US (n=5). Wagner's Chronic Care Model (CCM) and the Guided Care Model (GCM) were most often referred to (CCM n=31; GCM n=6); the majority of the other models found were only referred to once (aim 1). Both the CCM and GCM focus on integrated care in general and do not explicitly focus on multi-morbidity. Identified elements of integrated care were clustered according to the WHO health system building blocks. Most elements pertained to 'service delivery'. Across all components, the five elements referred to most often are person-centred care, holistic or needs assessment, integration and coordination of care services and/or professionals, collaboration, and self-management (aim 1). Most (n=10) of the 16 identified implemented programmes for multi-morbidity referred to the CCM (aim 2). Of all identified programmes, the elements most often included were self-management, comprehensive assessment, interdisciplinary care or collaboration, person-centred care and electronic information system (aim 2). CONCLUSION Most models and elements found in the literature focus on integrated care in general and do not explicitly focus on multi-morbidity. In line with this, most programmes identified in the literature build on the CCM. A comprehensive framework that better accounts for the complexities resulting from multi-morbidity is needed.
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Affiliation(s)
- Verena Struckmann
- Berlin University of Technology, Department of Health Care Management, Germany.
| | - Fenna R M Leijten
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - Ewout van Ginneken
- WHO Observatory on Health Systems and Policies, Berlin University of Technology, Department of Health Care Management, Germany
| | | | | | - Anne Spranger
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Melinde R S Boland
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | | | - Reinhard Busse
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Maureen Rutten-van Mölken
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands
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Kirst M, Im J, Burns T, Baker GR, Goldhar J, O'Campo P, Wojtak A, Wodchis WP. What works in implementation of integrated care programs for older adults with complex needs? A realist review. Int J Qual Health Care 2017; 29:612-624. [PMID: 28992156 PMCID: PMC5890872 DOI: 10.1093/intqhc/mzx095] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 06/08/2017] [Accepted: 07/04/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE A realist review of the evaluative evidence was conducted on integrated care (IC) programs for older adults to identify key processes that lead to the success or failure of these programs in achieving outcomes such as reduced healthcare utilization, improved patient health, and improved patient and caregiver experience. DATA SOURCES International academic literature was searched in 12 indexed, electronic databases and gray literature through internet searches, to identify evaluative studies. STUDY SELECTION Inclusion criteria included evaluative literature on integrated, long-stay health and social care programs, published between January 1980 and July 2015, in English. DATA EXTRACTION Data were extracted on the study purpose, period, setting, design, population, sample size, outcomes, and study results, as well as explanations of mechanisms and contextual factors influencing outcomes. RESULTS OF DATA SYNTHESIS A total of 65 articles, representing 28 IC programs, were included in the review. Two context-mechanism-outcome configurations (CMOcs) were identified: (i) trusting multidisciplinary team relationships and (ii) provider commitment to and understanding of the model. Contextual factors such as strong leadership that sets clear goals and establishes an organizational culture in support of the program, along with joint governance structures, supported team collaboration and subsequent successful implementation. Furthermore, time to build an infrastructure to implement and flexibility in implementation, emerged as key processes instrumental to success of these programs. CONCLUSIONS This review included a wide range of international evidence, and identified key processes for successful implementation of IC programs that should be considered by program planners, leaders and evaluators.
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Affiliation(s)
- Maritt Kirst
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- Department of Psychology, Wilfrid Laurier University, 75 University Ave. West, Waterloo, ON, Canada N2L 3C5
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
| | - Jennifer Im
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
| | - Tim Burns
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
| | - G. Ross Baker
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
| | - Jodeme Goldhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- The Change Foundation, 200 Front Street West, Toronto, Canada M5V 3M1
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Canada M5B 1W8
| | - Anne Wojtak
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- Toronto Central Local Health Integration Network, 250 Dundas St. West, Toronto, Canada M5T 2Z5
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6
- Toronto Rehabilitation Institute, 550 University Ave., Toronto, Canada M5G 2A2
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, Canada M4N 3M5
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11
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Gougeon L, Johnson J, Morse H. Interprofessional collaboration in health care teams for the maintenance of community-dwelling seniors' health and well-being in Canada: A systematic review of trials. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.xjep.2017.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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de Bruin SR, Versnel N, Lemmens LC, Molema CC, Schellevis FG, Nijpels G, Baan CA. Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review. Health Policy 2012; 107:108-45. [DOI: 10.1016/j.healthpol.2012.06.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 06/19/2012] [Accepted: 06/21/2012] [Indexed: 12/21/2022]
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13
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Béland F, Hollander MJ. Integrated models of care delivery for the frail elderly: international perspectives. GACETA SANITARIA 2011; 25 Suppl 2:138-46. [DOI: 10.1016/j.gaceta.2011.09.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/31/2011] [Accepted: 09/04/2011] [Indexed: 11/26/2022]
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14
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Low LF, Yap M, Brodaty H. A systematic review of different models of home and community care services for older persons. BMC Health Serv Res 2011; 11:93. [PMID: 21549010 PMCID: PMC3112399 DOI: 10.1186/1472-6963-11-93] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 05/09/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Costs and consumer preference have led to a shift from the long-term institutional care of aged older people to home and community based care. The aim of this review is to evaluate the outcomes of case managed, integrated or consumer directed home and community care services for older persons, including those with dementia. METHODS A systematic review was conducted of non-medical home and community care services for frail older persons. MEDLINE, PsycINFO, CINAHL, AgeLine, Scopus and PubMed were searched from 1994 to May 2009. Two researchers independently reviewed search results. RESULTS Thirty five papers were included in this review. Evidence from randomized controlled trials showed that case management improves function and appropriate use of medications, increases use of community services and reduces nursing home admission. Evidence, mostly from non-randomized trials, showed that integrated care increases service use; randomized trials reported that integrated care does not improve clinical outcomes. The lowest quality evidence was for consumer directed care which appears to increase satisfaction with care and community service use but has little effect on clinical outcomes. Studies were heterogeneous in methodology and results were not consistent. CONCLUSIONS The outcomes of each model of care differ and correspond to the model's focus. Combining key elements of all three models may maximize outcomes.
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Affiliation(s)
- Lee-Fay Low
- Dementia Collaborative Research Centre, School of Psychiatry, Faculty of Medicine, AGSM Building, University of NSW, Sydney NSW 2052 Australia
| | - Melvyn Yap
- Dementia Collaborative Research Centre, School of Psychiatry, Faculty of Medicine, AGSM Building, University of NSW, Sydney NSW 2052 Australia
| | - Henry Brodaty
- Dementia Collaborative Research Centre, School of Psychiatry, Faculty of Medicine, AGSM Building, University of NSW, Sydney NSW 2052 Australia
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15
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16
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Abstract
Canadians with dementia have access to Medicare, a universal, single payer healthcare program. Implementation of Medicare is through the provinces and territories, giving variation in the level of care available. At present, there is no national strategy for dementia, although a recent report from the Alzheimer Society of Canada is expected to catalyze one. Most dementia care is provided by primary care practitioners, with three specialties (geriatric psychiatry, geriatric medicine and neurology) providing consultant expertise. Primary care reforms are aimed at developing a more coordinated approach to the complex needs of people with dementia, and have especially emphasized education of providers. Any national strategy is expected to underscore prevention and research, the latter building on Canada's strong contribution to this international undertaking.
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17
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[Do the activities of day programs for the elderly correspond to their various needs?]. Can J Aging 2009; 28:27-49. [PMID: 19860965 DOI: 10.1017/s0714980809090035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study was carried out to explore the fit between health and functional characteristics of Day Program participants and the types of program activities they were offered in Day Programs. The subjects were 132 participants from 5 Day Programs in Montreal. Four different participant profile groups were identified using cluster analysis. A classification of program activities was created by a panel of experts. Participation in these activities was studied for each profile group, and compared to recommended activities for such client groups outlined through examination of the literature and consultation with our panel of experts. Results showed only partial correspondence between program activities and participants' needs. This correspondence seemed higher for individuals with physical health problems or mobility impairments and weaker for those presenting depressive symptoms or cognitive impairments. These results suggest a need to review activity program components and determine ways to match better these with client needs to optimise the benefits of Day Program participation.
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18
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Zunzunegui Pastor MV, Lázaro P, Mercado D. Integración y fronteras entre la atención sanitaria y social. Informe SESPAS 2008. GACETA SANITARIA 2008; 22 Suppl 1:156-62. [DOI: 10.1016/s0213-9111(08)76087-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Savard J, Leduc N, Lebel P, Béland F, Bergman H. [Utilization of day care services by frail seniors]. Can J Aging 2008; 26:255-74. [PMID: 18238730 DOI: 10.3138/cja.26.3.255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study consists of a secondary analysis of data collected during the SIPA demonstration project. Its purpose is to identify the proportion of Adult Day Care (ADC) users as well as the determinants of use in this group of persons 65 years old and over receiving home care services in Montreal. Results show that 18.8% of the sample have at least one ADC presence during a 6 months study period. The following factors increase the probability of ADC use: being younger; not having a university degree; being born outside of Canada or for persons born in Canada, living with a caregiver; receiving help from the CLSC for daily life activities more than once a week; being in the catchment population of an ADC which fees are lower; and for men only, having had a stroke or presenting functional incapacity.
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Affiliation(s)
- Jacinthe Savard
- Groupe de recherche SOLIDAGE, Faculté de Médecine, Université de Montréal et Université McGill.
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