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Gavaldà-Espelta E, Lleixà-Fortuño MDM, Aguilar Martín C, Pozo M, Ferré-Ferraté M, Tomàs-Navarro B, Curto-Romeu C, Lucas-Noll J, Baucells-Lluis J, Gonçalves AQ, Ferré-Grau C. Integrated Care Model Salut+Social Assessment by Professionals, Informal Caregivers and Chronic or Social Dependent Patients: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15467. [PMID: 36497541 PMCID: PMC9739042 DOI: 10.3390/ijerph192315467] [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: 10/07/2022] [Revised: 11/02/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
We explored the views of the professionals (from primary care and social services) and users (caregivers and patients) who participated in the clinical trial of the Salut+Social integrated care model to identify the implementation barriers and facilitators, to assess the impact on health and wellbeing and to obtain an assessment of the program. A qualitative descriptive study with a pragmatic, utilitarian approach was performed. Participants were recruited by purposive and convenience sampling. A focus group (FG) and in-depth interviews were conducted with professionals and users, respectively. Thematic content analysis was employed. A total of 11 professionals and 8 users participated in the FG and interviews, respectively. Seven themes were identified: (1) contextualizing the previous scenario; (2) achievements of the program from the professionals' perspective; (3) facilitators and barriers of the integrated care model; (4) proposals for improving the integrated care model; (5) users' assessment of the care received within the program framework; (6) users' perception of the impact on health and wellbeing; (7) users' demands for better care. Professionals reported improved coordination between services and highlighted the need for a protocol for emergencies and to strengthen community orientation. Users proposed more frequent home visits. This study shows the acceptability of the new model by professionals and the users' satisfaction with the care received.
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Affiliation(s)
- Ester Gavaldà-Espelta
- Direcció d’Atenció Primària Terres de l’Ebre, Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
- Departament d’Infermeria, Programa de Doctorat Infermeria i Salut, Universitat Rovira i Virgili, 43002 Tarragona, Spain
| | - Maria del Mar Lleixà-Fortuño
- Departament d’Infermeria, Programa de Doctorat Infermeria i Salut, Universitat Rovira i Virgili, 43002 Tarragona, Spain
- Departament d’Igualtat i Feminismes a les Terres de l’Ebre, Direcció de Serveis Territorials a les Terres de l’Ebre, Generalitat de Catalunya, 43500 Tortosa, Spain
| | - Carina Aguilar Martín
- Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Spain
| | - Macarena Pozo
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Spain
| | - Maria Ferré-Ferraté
- Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
| | - Begoña Tomàs-Navarro
- Equip d’Atenció Primària Amposta, Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, 43870 Amposta, Spain
| | - Claudia Curto-Romeu
- Equip d’Atenció Primària Amposta, Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, 43870 Amposta, Spain
| | - Jorgina Lucas-Noll
- Direcció d’Atenció Primària Terres de l’Ebre, Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
- Departament d’Infermeria, Programa de Doctorat Infermeria i Salut, Universitat Rovira i Virgili, 43002 Tarragona, Spain
| | - Jordi Baucells-Lluis
- Direcció de Sistemes d’Informació i Comunicació, Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Spain
- Unitat Docent de Medicina de Familia i Comunitària, Tortosa-Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
| | - Carmen Ferré-Grau
- Departament d’Infermeria, Programa de Doctorat Infermeria i Salut, Universitat Rovira i Virgili, 43002 Tarragona, Spain
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Löwe C, Mark P, Sommer S, Weltermann B. Collaboration between general practitioners and social workers: a scoping review. BMJ Open 2022; 12:e062144. [PMID: 36691249 PMCID: PMC9171253 DOI: 10.1136/bmjopen-2022-062144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/08/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Aim of the study is to present an overview of collaboration structures and processes between general practitioners and social workers, the target groups addressed as well the quality of available scientific literature. DESIGN A scoping review following the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). INCLUDED SOURCES AND ARTICLES According to a pre-published protocol, three databases (PubMed, Web of Science, DZI SoLit) were searched using the participant-concept-context framework. The searches were performed on 21 January 2021 and on 10 August 2021. Literature written in English and German since the year 2000 was included. Two independent researchers screened all abstracts for collaboration between general practitioners and social workers. Articles selected were analysed regarding structures, processes, outcomes, effectiveness and patient target groups. RESULTS A total of 72 articles from 17 countries were identified. Collaborative structures and their routine differ markedly between healthcare systems: 36 publications present collaboration structures and 33 articles allow an insight into the processual routines. For all quantitative studies, a level of evidence was assigned. Various measurements are used to determine the effectiveness of collaborations, for example, hospital admissions and professionals' job satisfaction. Case management as person-centred care for defined patient groups is a central aspect of all identified collaborations between general practitioners and social workers. CONCLUSION This scoping review showed evidence for benefits on behalf of patients, professionals and healthcare systems by collaborations between general practitioners and social workers, yet more rigorous research is needed to better understand the impact of these collaborations. TRIAL REGISTRATION NUMBER www.osf.io/w673q.
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Affiliation(s)
- Cornelia Löwe
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Patrick Mark
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Samira Sommer
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Birgitta Weltermann
- University Hospital / Institute of General Practice and Family Medicine, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
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Lanford D, Petiwala A, Landers G, Minyard K. Aligning healthcare, public health and social services: A scoping review of the role of purpose, governance, finance and data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:432-447. [PMID: 34018268 PMCID: PMC9291477 DOI: 10.1111/hsc.13374] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/28/2021] [Accepted: 03/10/2021] [Indexed: 06/01/2023]
Abstract
Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross-sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross-sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health-oriented cross-sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010-2020. We identified the main contributions and coded each based on its relevance to the cross-sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short-term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross-sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice.
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Affiliation(s)
- Daniel Lanford
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Aliza Petiwala
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Glenn Landers
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Karen Minyard
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
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Melby L, Kaspersen SL, Ådnanes M, Kalseth J. Oppfølgingsteam som sammenhengskapende mekanisme for personer med store og sammensatte behov. TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Petiwala A, Lanford D, Landers G, Minyard K. Community voice in cross-sector alignment: concepts and strategies from a scoping review of the health collaboration literature. BMC Public Health 2021; 21:712. [PMID: 33849498 PMCID: PMC8042631 DOI: 10.1186/s12889-021-10741-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background Health care access is an important driver of population health, and factors beyond health care also drive health outcomes. Recognizing the importance of the social determinants of health (SDOH), different actors in the health care, public health, and social service sectors are increasingly collaborating to improve health outcomes in communities. To support such collaboration, the Robert Wood Johnson Foundation developed a cross-sector alignment theory of change. According to the cross-sector alignment theory of change, community voice is critical for helping collaboratives address community health needs. Yet research on health collaboratives offers mixed guidance on how community voice should be understood and which community voice strategies are most effective. Methods This study addresses a gap in the literature with a systematic scoping review of research on health-oriented cross-sector collaboration and community voice. By scanning key academic journals, searching three academic databases, and obtaining documents from across our professional networks, we identified 36 documents that address community voice in health collaboratives. Results The review reveals several conceptions of community voice and a range of community voice strategies. We find that community voice strategies fall on a spectrum between two broad types of approaches: active and passive. These vary not only in the level of power shared between communities and collaborators, but also in the level of involvement required from the community, and this in turn has important implications for community collaboration strategies. We also find that while most strategies are discussed in the context of short-term collaboration, many also lend themselves to adoption in the context of sustainable collaboration and, ultimately, cross-sector alignment. Conclusion This review provides a characterization and conceptualization of community voice in health-oriented collaborations that provides a new theoretical basis for future research. Passive and active community voice strategies can be studied in more detail for their expected impact on health outcomes and disparities. Increased attention to active community voice and the resources it requires can help practitioners achieve improved health outcomes and researchers understand the pathways to health improvement through collaboration.
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Affiliation(s)
- Aliza Petiwala
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA.
| | - Daniel Lanford
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
| | - Glenn Landers
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
| | - Karen Minyard
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
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Understanding Young People and Their Care Providers' Perceptions and Experiences of Integrated Care Within a Tertiary Paediatric Hospital Setting, Using Interpretive Phenomenological Analysis. Int J Integr Care 2020; 20:7. [PMID: 33177966 PMCID: PMC7597574 DOI: 10.5334/ijic.5545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Benefits of integrated care include improved health outcomes and more satisfaction with experiences of care for consumers. For children and young people with chronic and complex health conditions, their care may be fragmented due to the multitude of healthcare providers involved. This paper describes the experiences of integrated care in a paediatric tertiary hospital. Theory and methods: Using an Interpretive Phenomenological Analysis approach, semi-structured interviews were conducted with children and young people, their parents and healthcare providers to explore stakeholders’ integrated care experiences. Results: Nineteen interviews were completed (6 children and young people, 7 parents and 6 healthcare providers) and transcribed verbatim. Two recurrent themes were applicable across the three cohorts: ‘agency and empowerment’ and ‘impact of organisational systems, supports and structures’. Discussion and conclusion: Stakeholders’ experiences of integrated care highlighted the need to examine the discrepancies between healthcare strategies, policies and service delivery within a complex, and often inflexible organisational structure. Power imbalance and family agency (including directly with children and young people) needs to be addressed to support the implementation of integrated care.
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HUGHES GEMMA, SHAW SARAE, GREENHALGH TRISHA. Rethinking Integrated Care: A Systematic Hermeneutic Review of the Literature on Integrated Care Strategies and Concepts. Milbank Q 2020; 98:446-492. [PMID: 32436330 PMCID: PMC7296432 DOI: 10.1111/1468-0009.12459] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Policy Points Integrated care is best understood as an emergent set of practices intrinsically shaped by contextual factors, and not as a single intervention to achieve predetermined outcomes. Policies to integrate care that facilitate person-centered, relationship-based care can potentially contribute to (but not determine) improved patient experiences. There can be an association between improved patient experiences and system benefits, but these outcomes of integrated care are of different orders and do not necessarily align. Policymakers should critically evaluate integrated care programs to identify and manage conflicts and tensions between a program's aims and the context in which it is being introduced. CONTEXT Integrated care is a broad concept, used to describe a connected set of clinical, organizational, and policy changes aimed at improving service efficiency, patient experience, and outcomes. Despite examples of successful integrated care systems, evidence for consistent and reproducible benefits remains elusive. We sought to inform policy and practice by conducting a systematic hermeneutic review of literature covering integrated care strategies and concepts. METHODS We used an emergent search strategy to identify 71 sources that considered what integrated care means and/or tested models of integrated care. Our analysis entailed (1) comparison of strategies and concepts of integrated care, (2) tracing common story lines across multiple sources, (3) developing a taxonomy of literature, and (4) generating a novel interpretation of the heterogeneous strategies and concepts of integrated care. FINDINGS We identified four perspectives on integrated care: patients' perspectives, organizational strategies and policies, conceptual models, and theoretical and critical analysis. We subdivided the strategies into four framings of how integrated care manifests and is understood to effect change. Common across empirical and conceptual work was a concern with unity in the face of fragmentation as well as the development and application of similar methods to achieve this unity. However, integrated care programs did not necessarily lead to the changes intended in experiences and outcomes. We attribute this gap between expectations and results, in part, to significant misalignment between the aspiration for unity underpinning conceptual models on the one hand and the multiplicity of practical application of strategies to integrate care on the other. CONCLUSIONS Those looking for universal answers to narrow questions about whether integrated care "works" are likely to remain disappointed. Models of integrated care need to be valued for their heuristic rather than predictive powers, and integration understood as emerging from particular as well as common contexts.
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Affiliation(s)
- GEMMA HUGHES
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - SARA E. SHAW
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - TRISHA GREENHALGH
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
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Lette M, Boorsma M, Lemmens L, Stoop A, Nijpels G, Baan C, de Bruin S. Unknown makes unloved-A case study on improving integrated health and social care in the Netherlands using a participatory approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:670-680. [PMID: 31773803 PMCID: PMC7028071 DOI: 10.1111/hsc.12901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/04/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co-created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors.
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Affiliation(s)
- Manon Lette
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Marijke Boorsma
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
| | - Lidwien Lemmens
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Annerieke Stoop
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
| | - Caroline Baan
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Simone de Bruin
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
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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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Riste LK, Coventry PA, Reilly ST, Bower P, Sanders C. Enacting person-centredness in integrated care: A qualitative study of practice and perspectives within multidisciplinary groups in the care of older people. Health Expect 2018; 21:1066-1074. [PMID: 30004166 PMCID: PMC6250865 DOI: 10.1111/hex.12803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/26/2022] Open
Abstract
Background Person‐centredness is important in delivering care for long‐term conditions. New models of care aim to co‐ordinate care through integration of health and social care which require new ways of working, often remotely from the patient. Objective To describe how person‐centred care is enacted within multidisciplinary groups (MDGs) created as part of a new service, integrating health and social care for older people. Methods We followed the implementation of eight neighbourhood MDGs, observing and interviewing staff from three MDGs at different phases of programme implementation using semi‐structured topic guides. Results Thirty‐four MDG meetings were observed and 32 staff interviewed. Three core themes were identified which impacted on enactment of person‐centred care: the structural context of MDGs enabling person‐centred care; interaction of staff and knowledge sharing during the MDG meetings; and direct staff involvement of the person outside the MDG discussion. Conclusions This study provides new insights into attempts to enact person‐centred care within a new model of service delivery. Teams did what they could to enact person‐centred care in the absence of the “real” patient within MDG meetings. They were successful in delivering and co‐ordinating some aspects of care (eg prompting medication reviews, referring to social worker, health improvement and arranging further multidisciplinary team meetings for complex cases). This “absence of patients” and time pressures within the MDGs led to reliance on the “virtual” record, enhanced by additional “soft” knowledge provided by staff, rather than ensuring the patient's voice was included.
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Affiliation(s)
- Lisa K Riste
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | | | - Siobhan T Reilly
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
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Round T, Ashworth M, Crilly T, Ferlie E, Wolfe C. An integrated care programme in London: qualitative evaluation. JOURNAL OF INTEGRATED CARE 2018; 26:296-308. [PMID: 30464724 PMCID: PMC6195169 DOI: 10.1108/jica-02-2018-0020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment. DESIGN/METHODOLOGY/APPROACH Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes. FINDINGS The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of "successes", "challenges" and "lessons learnt". RESEARCH LIMITATIONS/IMPLICATIONS Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit. PRACTICAL IMPLICATIONS Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation. ORIGINALITY/VALUE Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.
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Affiliation(s)
- Thomas Round
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Ewan Ferlie
- King's Business School, King's College London, London, UK
| | - Charles Wolfe
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Sykes S, Baillie L, Thomas B, Scotter J, Martin F. Enhancing Care Transitions for Older People through Interprofessional Simulation: A Mixed Method Evaluation. Int J Integr Care 2017; 17:3. [PMID: 29588636 PMCID: PMC5853909 DOI: 10.5334/ijic.3055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/11/2017] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The educational needs of the health and social care workforce for delivering effective integrated care are important. This paper reports on the development, pilot and evaluation of an interprofessional simulation course, which aimed to support integrated care models for care transitions for older people from hospital to home. THEORY AND METHODS The course development was informed by a literature review and a scoping exercise with the health and social care workforce. The course ran six times and was attended by health and social care professionals from hospital and community (n = 49). The evaluation aimed to elicit staff perceptions of their learning about care transfers of older people and to explore application of learning into practice and perceived outcomes. The study used a sequential mixed method design with questionnaires completed pre (n = 44) and post (n = 47) course and interviews (n = 9) 2-5 months later. RESULTS Participants evaluated interprofessional simulation as a successful strategy. Post-course, participants identified learning points and at the interviews, similar themes with examples of application in practice were: Understanding individual needs and empathy; Communicating with patients and families; Interprofessional working; Working across settings to achieve effective care transitions. CONCLUSIONS AND DISCUSSION An interprofessional simulation course successfully brought together health and social care professionals across settings to develop integrated care skills and improve care transitions for older people with complex needs from hospital to home.
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Affiliation(s)
- Susie Sykes
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, GB
| | - Lesley Baillie
- School of Health, Wellbeing and Social Care, Open University, Walton Hall, Milton Keynes, MK7 6AA, GB
| | - Beth Thomas
- Simulation and Interactive Learning (SaIL) Centre, Guy’s and St Thomas’ NHS Foundation Trust, GB
| | - Judy Scotter
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, GB
| | - Fiona Martin
- Clever Together, 2 Primrose Street, London, EC2A 2EX, GB
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Denis F, Millot I, Abello N, Carpentier M, Peteuil A, Soudry-Faure A. Study protocol: a cluster randomized controlled trial to assess the effectiveness of a therapeutic educational program in oral health for persons with schizophrenia. Int J Ment Health Syst 2016; 10:65. [PMID: 27757142 PMCID: PMC5053217 DOI: 10.1186/s13033-016-0096-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schizophrenia is a severe mental disorder that affects 1 % of the world's population, including 600,000 people in France. Persons with schizophrenia (PWS) have excess mortality (their life expectancy is reduced by 20 %) and excess morbidity. In addition, such persons may have a large number of missing or decayed teeth. Dental caries and periodontal measurement indexes are often twice as high as the level found in the general population. Poor oral health can also affect quality of life and oral health is inseparable from general health. The management of oral health problems needs a multidisciplinary approach. According to the World Health Organization, the aim of therapeutic education (TE) is to help patients take care of themselves and to improve empowerment and recovery. In this educational approach, it is important to take into account the patient's personal experience. Though rarely investigated, the personal experience of PWS in oral health quality of life (OHRQoL) must be used to build a therapeutic educational programme in oral health (TEPOH) in a multidisciplinary approach, and the effectiveness of this program must be evaluated. METHODS/DESIGN We report the protocol of a randomized controlled cluster study. This study will be conducted in twelve hospitals in France. We hypothesized that a decrease of 20 % in the proportion of patients with CPI ≥ 3 would establish the effectiveness of TEPOH. Therefore, 12 hospitals will be randomly allocated to either TEPOH or no TEPOH. Altogether, they will have to recruit 230 PWS, who will be randomly allocated with a ratio of 1:1 to one of two conditions: control without intervention versus the group benefitting from TEPOH. DISCUSSION If successful, the study will generate methodologically sound results that provide knowledge on the effectiveness of a TEP in oral health for PWS. The results can be used to promote OHRQoL in a global health approach and develop appropriate strategies to encourage and facilitate financial support for healthcare, the multidisciplinary treatment of dental disorders, and the development of training in oral and mental health for caregivers. Trial registration Clinical Trials Gov NCT02512367. Date registered 19 July, 2015.
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Affiliation(s)
- Frederic Denis
- La Chartreuse Psychiatric Centre, 1, boulevard Chanoine Kir, BP 23314, 21033 Dijon Cedex, France
| | - Isabelle Millot
- Instance Régionale d’éducation et de promotion de la santé, 21000 Dijon Cedex, France
| | - Nicolas Abello
- Direction de la Recherche Clinique, University Hospital of Dijon, 21079 Dijon Cedex, France
| | - Maud Carpentier
- Direction de la Recherche Clinique, University Hospital of Dijon, 21079 Dijon Cedex, France
| | - Audrey Peteuil
- Instance Régionale d’éducation et de promotion de la santé, 21000 Dijon Cedex, France
| | - Agnès Soudry-Faure
- USMR-Réseau d’aide Méthodologiste, University Hospital of Dijon, 21079 Dijon Cedex, France
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Abstract
Background: Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability. Purpose: This study develops and validates a conceptual framework of organizational capabilities for integrating care, identifies which of these capabilities may be most important, and explores the mechanisms by which they influence integrated care efforts. Methods: The Context and Capabilities for Integrating Care (CCIC) Framework was developed through a literature review, and revised and validated through interviews with leaders and care providers engaged in integrated care networks in Ontario, Canada. Interviews involved open-ended questions and graphic elicitation. Quantitative content analysis was used to summarize the data. Results: The CCIC Framework consists of eighteen organizational factors in three categories: Basic Structures, People and Values, and Key Processes. The three most important capabilities shaping the capacity of organizations to implement integrated care interventions include Leadership Approach, Clinician Engagement and Leadership, and Readiness for Change. The majority of hypothesized relationships among organizational capabilities involved Readiness for Change and Partnering, emphasizing the complexity, interrelatedness and importance of these two factors to integrated care efforts. Conclusions: Organizational leaders can use the framework to determine readiness to integrate care, develop targeted change management strategies, and select appropriate partners with overlapping or complementary profiles on key capabilities. Researchers may use the results to test and refine the proposed framework, with a focus on the hypothesized relationships among organizational capabilities and between organizational capabilities and performance outcomes.
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Janse B, Huijsman R, de Kuyper RDM, Fabbricotti IN. Delivering Integrated Care to the Frail Elderly: The Impact on Professionals' Objective Burden and Job Satisfaction. Int J Integr Care 2016; 16:7. [PMID: 28413364 PMCID: PMC5374987 DOI: 10.5334/ijic.2014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 08/03/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The impact of integrated working on professionals' objective burden and job satisfaction was examined. An evidence-based intervention targeting frail elderly patients was implemented in the Walcheren region of the Netherlands in 2010. The intervention involved the primary care practice as a single entry point, and included proactive frailty screening, a comprehensive assessment of patient needs, case management, multidisciplinary teams, care plans and protocols, task delegation and task specialisation, a shared information system, a geriatric care network and integrated funding. METHODS A quasi-experimental design with a control group was used. Data regarding objective burden involved the professionals' time investments over a 12-month period that were collected from patient medical records (n = 377) time registrations, transcripts of meetings and patient questionnaires. Data regarding job satisfaction were collected using questionnaires that were distributed to primary care and home-care professionals (n = 180) after the intervention's implementation. Within- and between-groups comparisons and regression analyses were performed. RESULTS Non-patient related time was significantly higher in the experimental group than in the control group, whereas patient-related time did not differ. Job satisfaction remained unaffected by the intervention. CONCLUSION AND DISCUSSION Integrated working is likely to increase objective burden as it requires professionals to perform additional activities that are largely unrelated to actual patient care. Implications for research and practice are discussed. [Current Controlled Trials ISRCTN05748494].
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Affiliation(s)
- Benjamin Janse
- Rotterdam University of Applied Sciences, School of Health Care, P.O. Box 25035, 3001 HA Rotterdam, the Netherlands
| | - Robbert Huijsman
- Rotterdam University of Applied Sciences, School of Health Care, P.O. Box 25035, 3001 HA Rotterdam, the Netherlands
| | | | - Isabelle Natalina Fabbricotti
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
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Rashid A. Yonder: Fatigue, role models, MDT meetings, and GP signatures. Br J Gen Pract 2015; 65:598. [PMID: 26500308 PMCID: PMC4617255 DOI: 10.3399/bjgp15x687493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- NIHR Academic Clinical Fellow in General Practice, University of Cambridge, Cambridge. E-mail: @Dr_A_Rashid
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