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Nixon P, Broccatelli C, Moss P, Baggio S, Young A, Newcomb D. Healthcare social network research and the ECHO model™: Exploring a community of practice to support cultural brokers and transfer cultural knowledge. BMC Health Serv Res 2024; 24:558. [PMID: 38693520 PMCID: PMC11062014 DOI: 10.1186/s12913-024-11024-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Project ECHO® networks at Children's Health Queensland Hospital and Health Service (CHQHHS) are communities of practice designed to mitigate services and systems fragmentation by building collaborative partnerships addressing priority child and youth health needs. Aboriginal and Torres Strait Islander people experience the negative impacts of fragmentation in addition to historical challenges of absent or culturally inappropriate health services. Access to culturally safe and responsive services can be improved by engaging Aboriginal and Torres Strait Islander Health Workers and similar roles in an online community of practice, supporting the integration of cultural and clinical knowledge and self-determination of Aboriginal and Torres Strait Islander consumers in decisions affecting their health. Analysing professional support networks and knowledge sharing patterns helps identify enablers and barriers to partnerships. Using social network research, the multilevel network inclusive of ECHO network members and their colleagues was studied to identify interdisciplinary and cross-sector advice exchange patterns, explore the position of cultural brokers and identify common relational tendencies. METHODS Social network theories and methods informed the collection of network data and analysis of advice-seeking relationships among ECHO network members and their nominees. Registered members from two ECHO networks were invited to complete the Qualtrics survey. Networks analysed comprised 398 professionals from mainstream health, Aboriginal and Torres Strait Islander Community Controlled Health Organisation, education, disability and child safety service settings. RESULTS Brokers were well represented, both those who hold knowledge brokerage positions as well as cultural brokers who incorporate clinical and cultural knowledge enabling holistic care for Aboriginal and Torres Strait Islander patients (38 individuals, 17% of network). Professionals who occupy brokerage positions outside the ECHO network tend to be more connected with co-members within the network. CONCLUSIONS This study is the first application of contemporary social network theories and methods to investigate an ECHO network. The findings highlight the connectivity afforded by brokers, enabling the coordination and collaboration necessary for effective care integration. Inclusion of cultural brokers in an ECHO network provides sustained peer group support while also cultivating relationships that facilitate the integration of cultural and clinical knowledge.
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Affiliation(s)
- Phil Nixon
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Chiara Broccatelli
- Department of Social and Cultural Anthropology, Universitat Autònoma de Barcelona, Barcelona, 08193, Spain
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia
| | - Perrin Moss
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, 4072, Australia
| | - Sarah Baggio
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
| | - Angela Young
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
| | - Dana Newcomb
- Integrated Care, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
- General Practice Clinical Unit, The University of Queensland, Herston, QLD, 4029, Australia
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Clay-Williams R, Hibbert P, Loy G, Braithwaite J. Innovative Models of Care for Hospitals of the Future. Int J Health Policy Manag 2024; 13:7861. [PMID: 38618834 PMCID: PMC11016280 DOI: 10.34172/ijhpm.2024.7861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/23/2024] [Indexed: 04/16/2024] Open
Abstract
New ways of providing acute care outside of traditional hospital building complexes, such as virtual care or hospital in the home, are becoming more common. Despite this, many hospitals are still conceived as "bricks and mortar" centralised constructions, and few health service infrastructure organisations meet intensively with consumers or clinicians prior to conceptualising hospital design. Our study sought to understand the needs and expectation of community members and healthcare providers, and co-design innovative models of acute care to inform development of a new metropolitan hospital in Australia. Our study used a three-step approach, consisting of academic and grey literature reviews; a demographic analysis of the hospital catchment population; and a series of 20 workshops and 6 supplementary interviews with community members and local healthcare providers. We found that care should be tailored to the healthcare needs and expectations of each consumer, with consumers cared for in the community where possible and safe. We propose an innovative model of care for hospitals of the future, consisting of fully integrated acute care underpinned by appropriate digital architecture to deliver care that is community focussed. It is vital that new hospitals build in sufficient adaptability to leverage future innovation and meet the needs of growing and changing communities.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Wang X, Zheng C, Wang Y, Birch S, Huang Y, Valentijn P. Patients' and Care Professionals' Evaluation of the Effect of a Hospital Group on Integrated Care in Chinese Urban Health Systems: A Propensity Score Matching and Difference-in-differences Regression Approach. Int J Health Policy Manag 2023; 12:7897. [PMID: 38618775 PMCID: PMC10843371 DOI: 10.34172/ijhpm.2023.7897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/28/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND A hospital group is an organizational integration strategy that has recently been widely implemented in Chinese urban health systems to promote integrated care. This study aims to evaluate the effect of hospital group on integrated care from the perspectives of both patients and care professionals. METHODS Two cross-sectional surveys were conducted in Shenzhen city of China, in June 2018 and July 2021. All thirty Community Health Stations (CHSs) in the hospital group were included in the intervention group, with 30 CHSs in the same district selected as the control group by simple random sampling. All care professionals within both the intervention and the control groups were invited to participate in the surveys. Twelve CHSs were selected from 30 CHSs in the intervention and the control groups by simple random sampling, and 20 patients with type 2 diabetes mellitus (T2DM) were selected from each of these selected CHSs to participate in the survey by systematic sampling. The Rainbow Model of Integrated Care-Measurement Tool (Chinese version) was used to assess integrated care. Propensity score matching and difference-in-differences regression (PSM-DID) were used to evaluate the effect of the hospital group on integrated care. RESULTS After matching, 528 patients and 1896 care professionals were included in the DID analysis. Results from care professionals indicated that the hospital group significantly increased technical competence of the health system by 0.771 points, and cultural competence by 1.423 points. Results from patients indicated that the hospital group significantly decreased organizational integration of the health system by 0.649 points. CONCLUSION The results suggests that the effect of the hospital group on integrated care over and above routine strategies for integrated care is limited. Therefore, it is necessary to pay attention to implementing professional, clinical and other integration strategies beyond establishing hospital groups, in urban Chinese health systems.
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Affiliation(s)
- Xin Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Caiyun Zheng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yao Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, Australia
| | - Yixiang Huang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Pim Valentijn
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, The Netherlands
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Macq J. Integrated Care Policies and Politics in Belgium: Conceptual, Contextual and Governance Linkages for More Effective Integrated Care Policy Management Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study". Int J Health Policy Manag 2023; 12:7009. [PMID: 37579354 PMCID: PMC10702372 DOI: 10.34172/ijhpm.2023.7009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/12/2023] [Indexed: 08/16/2023] Open
Abstract
The study on the management of integrated care (IC) policies in Belgium from Martens et al illustrates the complex process of the political and stakeholder game in a country whose governance is changing as a result of successive state reforms. We argue that the way forward for putting health back at the centre of IC policy design and management is to improve three types of connections. First, the conceptual connections should help to articulate the different IC policies into a coherent overall picture. Second, contextual connections should allow for the adaptation of policies to different country contexts. This requires a new form of governance, ie, a place-based and adaptive form of governance. This can be developed, provided that a third connection, between the different levels of governance, is fully revised.
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Affiliation(s)
- Jean Macq
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
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Redondo S, De Dios A, Gomis-Pastor M, Esquirol A, Aso O, Triquell M, Moreno ME, Riba M, Ruiz J, Blasco A, Tobajas E, González I, Sierra J, Martino R, García-Cadenas I. Feasibility of a new model of care for allogeneic stem cell transplantation recipients facilitated by eHealth: The MY-Medula pilot study. Transplant Cell Ther 2023:S2666-6367(23)01175-2. [PMID: 36948273 DOI: 10.1016/j.jtct.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The use of allogeneic stem cell transplantation (allo-SCT) for the treatment of hematologic diseases is steadily increasing. However, allo-SCT has the downside of causing considerable treatment-related morbidity and mortality. Mobile technology applied to healthcare (mHealth) has proven to be a cost-effective strategy to improve care and offer new services to people with multimorbidity, but there are few data on its usefulness in allo-SCT recipients. OBJECTIVE The aim of this report was to describe a new integrated healthcare model facilitated by an mHealth platform, named EMMASalud-MY-Medula, and to report the results of a le. STUDY DESIGN The MY-Medula platform development approach consisted of 4 phases. Firstly, patient and healthcare professional needs were identified and technological development and pre-testing tests were conducted (phases 1-3, January 2016-March 2021). Then, a non-randomized, prospective, observational, single-center pilot study was conducted (October 2021-January 2022) at the adult Stem Cell Transplant Unit of a tertiary university hospital. RESULTS Twenty-eight volunteer allo-SCT recipients were included in the pilot study. Fifty percent were outpatients in the first-year post-SCT and the remaining 50% were affected by steroid-dependent graft-versus-host disease (SR-GVHD). All patients used MY-Medula application during the two-month follow-up period with a median number of visits to the application of 143 (range 6-477). A total of 2067 self-monitoring records were made, and 205 text messages were received, most of them related to symptoms description (47%) and doubts about medication (21%). In 3.4% of the cases drug dose adjustments were performed by the pharmacist because of dosing errors or interactions. At the end of the study, a 6-question Likert-type questionnaire for patients and a 22-question test for healthcare professionals showed a high degree of satisfaction (95% and 100% respectively) with the new healthcare pathway. CONCLUSIONS Re-engineering allo-SCT recipients follow-up into an integrated, multidisciplinary model of care facilitated by mHealth tools is feasible and has been associated with a high usability and degree of satisfaction by patients and healthcare professionals. A randomized trial aiming to determine the cost-effectiveness of MY-Medula-based follow-up post-SCT is currently enrolling participants.
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Affiliation(s)
- S Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain.
| | - A De Dios
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau.; Digital Health Department, Hospital de la Santa Creu i Sant Pau
| | - M Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau.; Digital Health Department, Hospital de la Santa Creu i Sant Pau
| | - A Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - O Aso
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - M Triquell
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - M E Moreno
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau
| | - M Riba
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau
| | - J Ruiz
- Nutrition and Dietetics Department, Hospital de la Santa Creu i Sant Pau
| | - A Blasco
- Nutrition and Dietetics Department, Hospital de la Santa Creu i Sant Pau
| | - E Tobajas
- Psycho-Oncology Department, Hospital de la Santa Creu i Sant Pau
| | - I González
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - J Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - R Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - I García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
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Miranda R, Oliveira MD, Nicola P, Baptista FM, Albuquerque I. Towards A Framework for Implementing Remote Patient Monitoring From an Integrated Care Perspective: A Scoping Review. Int J Health Policy Manag 2023; 12:7299. [PMID: 37579426 PMCID: PMC10461888 DOI: 10.34172/ijhpm.2023.7299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) has been increasingly adopted over the last decade, with the COVID-19 pandemic fostering its rapid development. As RPM implementation is recognised as complex and highly demanding in terms of resources and processes, there are multiple challenges in providing RPM in an integrated logic. METHODS To examine the structural elements that are relevant for implementing RPM integrated care, a scoping review was conducted in PubMed, Scopus, and Web of Science, leveraging a search strategy that combines terms relative to (1) conceptual models and reallife initiatives; (2) RPM; and (3) care integration. RESULTS 28 articles were included, covering nine conceptual models and 19 real-life initiatives. Eighteen structural elements of RPM integrated care implementation were identified among conceptual models, defining a structure for assessing real-life initiatives. 78.9% of those initiatives referred to at least ten structural elements, with patient education and self-monitoring promotion, multidisciplinary core workforce, ICTs (information and communications technologies) and telemonitoring devices, and health indicators measurement being present in all studies, and therefore being core elements to the design of RPM initiatives. CONCLUSION RPM goes far beyond technology, with underlying processes and involved actors playing a central role in care provision. The structural elements identified can guide RPM implementation and promote maturity in adoption. Future research may focus on assessing design completeness, evaluating impacts, and analysing related financial arrangements.
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Affiliation(s)
- Rafael Miranda
- Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Enterprise Services, Siemens Healthineers Portugal, Lisboa, Portuga
| | - Mónica Duarte Oliveira
- Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- iBB - Institute for Bioengineering and Biosciences and i4HB - Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Paulo Nicola
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portuga
| | | | - Isabel Albuquerque
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
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Yuan S, Fan F, Zhu D. Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study. Int J Health Policy Manag 2022; 11:1835-1843. [PMID: 34634876 PMCID: PMC9808208 DOI: 10.34172/ijhpm.2021.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/20/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Integrated care is a global trend in international healthcare reform, particularly for piloting vertical integration involving hospitals and primary healthcare institutions (PHIs). However, evidence regarding the impact of vertical integration on primary healthcare has been mixed and limited. Our study aims to evaluate the empirical effects of vertical integration reform on PHIs in China, and examines variations across integration intensity (tight integration vs. loose collaboration). METHODS This study used a longitudinal design. The time-varying difference-in-difference (DID) method with a fixed-effect model for panel data was adopted. A total of 370 PHIs in the eastern, central, and western areas of China from 2009 to 2018 were covered. Outcome measures included the indicators at three dimensions regarding inpatient and outpatient service volume, patient flow between PHIs and hospitals and quality of chronic disease care (hypertension and diabetes). RESULTS Significant increases in absolute (the number) and relative (the ratio between PHIs and hospitals) volume of inpatient admissions have been found after reform under tight integration, peaking at 183% and 15.0% respectively, in the third reform year. The quality of hypertension and diabetes care (by indicators of control rate of blood pressure and blood glucose) showed significant improvements under both types of vertical integration after reform. It was much more distinct for the PHIs under tight integration, which had the most significant increase of 34.0% and 22.8% under tight integration for the control rate of hypertension and diabetes compared to the peak of 21.2% and 22.1% respectively under loose collaboration. CONCLUSION Our findings suggest that vertical integration (especially tight integration) in China significantly contributed to strengthening primary healthcare in terms of inpatient services and quality of hypertension and diabetes care, providing empirical evidence to other countries on integrating primary healthcare-based health systems.
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Affiliation(s)
- Shasha Yuan
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fengmei Fan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
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Martens M, Danhieux K, Van Belle S, Wouters E, Van Damme W, Remmen R, Anthierens S, Van Olmen J. Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study. Int J Health Policy Manag 2022; 11:1668-1681. [PMID: 34273935 PMCID: PMC9808233 DOI: 10.34172/ijhpm.2021.58] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Globally, health systems have been struggling to cope with the increasing burden of chronic diseases and respond to associated patient needs. Integrated care (IC) for chronic diseases offers solutions, but implementing these new models requires multi-stakeholder action and integrated policies to address social, organisational, and financial barriers. Policy implementation for IC has been little studied, especially through a political lens. This paper examines how IC policies in Belgium were developed over the last decade and how stakeholders have played a role in these policies. METHODS We used a case study design. After an exploratory document review, we selected three IC policies. We then interviewed 25 key stakeholders in the field of IC. The stakeholder analysis entailed a detailed mapping of the stakeholders' power, position, and interest related to the three selected policies. Interview participants included policy-makers, civil servants (from ministry of health and health insurance), representatives of health professionals' associations, academics, and patient organisations. Additionally, a processual analysis of IC policy processes (2007-2020) through literature review was used to frame the interviews by means of a chronic care policy timeline. RESULTS In Belgium, a variety of policy initiatives have been developed in recent years both at central and decentralised levels. The power analysis and policy position maps exposed tensions between federal and federated governments in terms of overlapping competence, as well as the implications of the power shift from federal to federated levels as a consequence of the 2014 state reform. CONCLUSION The 2014 partial decentralisation of healthcare has created fragmentation of decisive power which undermines efforts towards IC. This political trend towards fragmentation is at odds with the need for IC. Further research is needed on how public health policy competences and reform durability of IC policies will evolve.
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Affiliation(s)
- Monika Martens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Katrien Danhieux
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family & Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Roy Remmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Josefien Van Olmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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McBain RK, Cantor JH, Eberhart NK, Huilgol SS, Estrada-Darley I. Adult Psychiatric Bed Capacity, Need, and Shortage Estimates in California-2021. Rand Health Q 2022; 9:16. [PMID: 36238001 PMCID: PMC9519097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Psychiatric beds are essential infrastructure for meeting the needs of individuals with mental health conditions. However, not all psychiatric beds are alike: They represent infrastructure within different types of facilities, ranging from acute psychiatric hospitals to community residential facilities. These facilities, in turn, serve clients with different needs: some who have high-acuity, short-term needs and others who have chronic, longer-term needs and may return multiple times for care. California, much like many parts of the United States, is confronting a shortage of psychiatric beds. In this article, the authors estimated California's psychiatric bed capacity, need, and shortages for adults at each of three levels of care: acute, subacute, and community residential care. They used multiple methods for assessing bed capacity and need in order to overcome limitations to any single method of estimating the potential psychiatric bed shortfall. The authors identified statewide shortfalls in beds at all levels of inpatient and residential care. They also documented regional differences in the shortfall and identified special populations that contributed to bottlenecks in the continuum of inpatient and residential care in the state.
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Smeets M, Baldewijns K, Vaes B, Vandenhoudt H. Integration of Chronic Care in a Fragmented Healthcare System Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study". Int J Health Policy Manag 2022; 12:7143. [PMID: 35964161 PMCID: PMC10125068 DOI: 10.34172/ijhpm.2022.7143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022] Open
Abstract
The authors of "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study" present a fresh perspective on the inertia of integrated care (IC) implementation. They conclude that the decisive power in Belgium is fragmented and undermines efforts towards IC. As researchers in integrated heart failure (HF) care and active primary healthcare professionals, we comment on the three policy initiatives evaluated by Martens et al from a bottom-up perspective. A Learning Healthcare Network (LHCN) was established September 2019 to overcome fragmentation, the lack of evaluation and capacity loss each time a pilot project ends. This commentary wishes to illustrate that a LHCN can be a powerful meso-level mechanism to engage in alignment work and to overcome macro-level barriers that are often difficult to change and not supportive of IC.
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Affiliation(s)
- Miek Smeets
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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Chey WD, Hashash JG, Manning L, Chang L. AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review. Gastroenterology 2022; 162:1737-1745.e5. [PMID: 35337654 DOI: 10.1053/j.gastro.2021.12.248] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/16/2022]
Abstract
DESCRIPTION Irritable bowel syndrome (IBS) is a commonly diagnosed gastrointestinal disorder that can have a substantial impact on quality of life. Most patients with IBS associate their gastrointestinal symptoms with eating food. Mounting evidence supports dietary modifications, such as the low-fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) diet, as a primary treatment for IBS symptoms. The aim of this American Gastroenterological Association (AGA) Clinical Practice Update (CPU) is to provide best practice advice statements, primarily to clinical gastroenterologists, covering the role of diet in IBS treatment. METHODS This expert review was commissioned and approved by the AGA CPU Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPU Committee and external peer review through standard procedures of Gastroenterology. The best practice advice statements were drawn from reviewing existing literature combined with expert opinion to provide practical advice on the role of diet in treating patients with IBS. Because this was not a systematic review, formal rating of the quality of evidence or strength of the presented considerations was not performed. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Dietary advice is ideally prescribed to patients with IBS who have insight into their meal-related gastrointestinal symptoms and are motivated to make the necessary changes. To optimize the quality of teaching and clinical response, referral to a registered dietitian nutritionist (RDN) should be made to patients who are willing to collaborate with a RDN and patients who are not able to implement beneficial dietary changes on their own. If a gastrointestinal RDN is not available, other resources can assist with implementation of diet interventions. BEST PRACTICE ADVICE 2: Patients with IBS who are poor candidates for restrictive diet interventions include those consuming few culprit foods, those at risk for malnutrition, those who are food insecure, and those with an eating disorder or uncontrolled psychiatric disorder. Routine screening for disordered eating or eating disorders by careful dietary history is critical because they are common and often overlooked in gastrointestinal conditions. BEST PRACTICE ADVICE 3: Specific diet interventions should be attempted for a predetermined length of time. If there is no clinical response, the diet intervention should be abandoned for another treatment alternative, for example, a different diet, medication, or other form of therapy. BEST PRACTICE ADVICE 4: In preparation for a visit with a RDN, patients should provide dietary information that will assist in developing an individualized nutrition care plan. BEST PRACTICE ADVICE 5: Soluble fiber is efficacious in treating global symptoms of IBS. BEST PRACTICE ADVICE 6: The low-FODMAP diet is currently the most evidence-based diet intervention for IBS. Healthy eating advice as described by the National Institute of Health and Care Excellence Guidelines, among others, also offers benefit to a subset of patients with IBS. BEST PRACTICE ADVICE 7: The low-FODMAP diet consists of the following 3 phases: 1) restriction (lasting no more than 4-6 weeks), 2) reintroduction of FODMAP foods, and 3) personalization based on results from reintroduction. BEST PRACTICE ADVICE 8: Although observational studies found that most patients with IBS improve with a gluten-free diet, randomized controlled trials have yielded mixed results. BEST PRACTICE ADVICE 9: There are limited data showing that selected biomarkers can predict response to diet interventions in patients with IBS, but there is insufficient evidence to support their routine use in clinical practice.
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Affiliation(s)
- William D Chey
- Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jana G Hashash
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida; Division of Gastroenterology and Hepatology, American University of Beirut, Beirut, Lebanon
| | - Laura Manning
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California.
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Goldman ML, Scharf DM, Brown JD, Scholle SH, Pincus HA. Structural Components of Integrated Behavioral Health Care: A Comparison of National Programs. Psychiatr Serv 2022; 73:584-587. [PMID: 34496629 PMCID: PMC10961247 DOI: 10.1176/appi.ps.201900623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Initiatives that support and incentivize the integration of behavioral health and general medical care have become a focus of government strategies to achieve the triple aim of improved health, better patient experience, and reduced costs. The authors describe the components of four large-scale national initiatives aimed at integrating care for a wide range of behavioral health needs. Commonalities across these national initiatives highlight health care and social services needs that must be addressed to improve care for people with co-occurring behavioral health and general medical conditions. These findings can inform how to design, test, select, and align the most promising strategies for integrated care in a variety of settings.
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Affiliation(s)
- Matthew L. Goldman
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
- San Francisco Department of Public Health, San Francisco, California
| | - Deborah M. Scharf
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | | | | | - Harold Alan Pincus
- Department of Psychiatry, Columbia University Medical Center, New York, NY
- New York State Psychiatric Institute, New York, NY
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De Maeseneer J, Galle A. Belgium's Healthcare System: The Way Forward to Address the Challenges of the 21st Century Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study". Int J Health Policy Manag 2022; 12:7070. [PMID: 35297240 PMCID: PMC10125196 DOI: 10.34172/ijhpm.2022.7070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/12/2022] [Indexed: 11/09/2022] Open
Abstract
In this paper we have tried, starting from the results of an analysis of the functioning of integrated care in the Belgian Health System by Martens et al, to design a strategy that could contribute to better addressing the challenges of the 21st century in Belgium. We proposed health system changes at the macro-, meso- and micro-level. We focused on health policy development and organization of care, emphasizing the importance of a shift from a hospital-centric towards a primary care based approach. Special attention was paid to the need for institutional reforms, in order to facilitate the further development of interprofessional integrated care, that focuses on the achievement of the life-goals of a person.
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Affiliation(s)
- Jan De Maeseneer
- WHO Collaborating Centre on Family medicine and PHC, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Gray CS. Overcoming Political Fragmentation: The Potential of Meso-Level Mechanisms Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study". Int J Health Policy Manag 2022; 12:7075. [PMID: 35297235 PMCID: PMC10125110 DOI: 10.34172/ijhpm.2022.7075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022] Open
Abstract
Martens and colleagues' paper "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study," offers an in-depth examination of integrated care policy efforts in Belgium. A key finding in this case study was that political fragmentation proved too great an obstacle for integration efforts. In this commentary, I draw on the organizational behaviour and integrated care literatures to suggest how meso-level mechanisms related to sensemaking, distributive leadership, and evaluation could help overcome policy (or macro) level challenges like those experienced in Belgium. The commentary also suggests we need to consider and address both the process and normative challenges in these transformation efforts.
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Ratzliff ADH, Toor R, Erickson JM, Bauer A, Duncan M, Chang D, Chwastiak L, Raue PJ, Unutzer J. Development and Implementation of an Integrated Care Fellowship. J Acad Consult Liaison Psychiatry 2022; 63:280-289. [PMID: 35123126 DOI: 10.1016/j.jaclp.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Integrated care is a common approach to leverage scarce psychiatric resources to deliver mental health care in primary care settings. To date, a formal clinical fellowship devoted to professional development for this role has not been described. METHODS The development of a formal year-long clinical fellowship in integrated care is described. The curriculum consists of an Integrated Care Didactic Series, Integrated Care Clinical Skill Experiences, and Integrated Care System-Based Leadership Experiences. Evaluation of impact was assessed with descriptive statistics. RESULTS We successfully recruited three classes of fellows to the Integrated Care Fellowship, with 5 program graduates in the first 3 years. All five graduated fellows were hired into integrated care and/or telepsychiatry positions. Integrated Care fellows had a high participation rate in didactics (mean attendance = 80.6%; n=5). We received a total of 582 didactic evaluations for the 151 didactic sessions. On a scale of 1 (poor) to 6 (fantastic), the mean quality of the interactive learning experience was rated as 5.33 (n=581), and the mean quality of the talk was 5.35 (n=582). Rotations were rated with the mean overall teaching quality of 4.98/5 (n = 76 evaluations from 5 fellows). CONCLUSIONS The Integrated Care clinical fellowship serves as a model for training programs seeking to provide training in clinical and systems-based skills needed for practicing integrated care. Whether such training is undertaken as a standalone fellowship or incorporated into existing Consultation-Liaison Psychiatry programs, such skills are increasingly valuable as integrated care becomes commonplace in practice.
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Affiliation(s)
- Anna D H Ratzliff
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125.
| | - Ramanpreet Toor
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Jennifer M Erickson
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Amy Bauer
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Mark Duncan
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Denise Chang
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Lydia Chwastiak
- University of Washington, Department of Psychiatry and Behavioral Sciences, 325 Ninth Ave; Box 359911: Seattle WA 98104
| | - Patrick J Raue
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Jurgen Unutzer
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
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Small LA, Huynh AK, Parchment TM. The association between self-Esteem, stigma, and mental health among South African youth living with HIV: the need for integrated HIV care services. AIDS Care 2022; 34:86-94. [PMID: 34839770 PMCID: PMC8785656 DOI: 10.1080/09540121.2021.2002253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Treatment among pYLHIV focuses on their physical health. However, they also experience depression and anxiety, compounded by developmental challenges and the stress of managing a chronic illness. However, limited services are available to help pYLHIV manage the emotional stressors of living with a stigmatized condition. Data are from 37 caregiver-child dyads in the VUKA EKHAYA study, in Durban, South Africa. Outcomes were self-esteem and stigma. Predictors included symptoms of depression and anxiety, and HIV treatment and transmission knowledge. Outcomes and predictors were standardized (mean: 0, standard deviation: 1). Pearson correlation, bivariate and multivariate associations between predictors and outcomes were examined. Self-esteem was negatively correlated with symptoms of anxiety (r=-0.5675; p<0.001) and depression (r=-0.6836; p<0.001), suggesting higher self-concept was correlated with fewer symptoms. In multivariate analyses, increased depressive and anxiety symptoms were associated with lower self-esteem, B=0.68 and 0.57, respectively. Higher depressive and anxiety symptoms connected to more internalized stigma B=0.38 and 0.34, respectively. Conversely, HIV knowledge was not related to self-esteem or stigma. HIV treatment and transmission knowledge are not enough to reduce stigma and improve the self-esteem of pYLHIV. Integrated mental and physical health care is needed to help pYLHIV manage psychological stressors that can mitigate their emotional wellbeing.
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Affiliation(s)
- Latoya A. Small
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles
| | - Alexis K. Huynh
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), V.A. Greater Los Angeles Healthcare System
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Saggu H, Jones C, Lewis A, Baynam G. mEDUrare: Supporting Integrated Care for Rare Diseases by Better Connecting Health and Education Through Policy. Yale J Biol Med 2021; 94:693-702. [PMID: 34970108 PMCID: PMC8686785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Rare diseases affect an estimated 6-10% of the Australian population, a prevalence similar to that seen in other regions worldwide. These multi-system conditions are often severely debilitating and affect multiple domains of a person's life. A salient necessity for effective care provision thus, is holistic care, achieved by appropriate and continual multi-disciplinary and cross-sectoral collaboration. Synonymous with this priority for collaborative care, is the need for increased partnerships between the health and education sectors. This partnership has the potential to benefit people with rare disease of all educational ages, but in particular, school-aged children and young adults. More than 70% of rare diseases affect children, and this population often experiences difficulties with overall well-being and functioning, including impaired school performance and confounding mental and social comorbidities. Ensuring adequate schooling needs and experiences along with provision of adequate medical care, is crucial in ensuring overall well-being for this population. For this, effective partnerships between the health and education sectors are paramount. This article highlights fundamental elements of health and education priorities, ingrained in current strategic documents, to build a policy foundation that informs and supports increased inter-sectoral partnerships between health and education services. Shared priorities identified in both sectors' guidelines, co-developed with those with lived experience of rare diseases, build a strong policy base for future advocative initiatives to mold better integration between the sectors, a partnership which is vital to improving the overall quality of life, experiences and journeys of people living with rare disease.
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Affiliation(s)
- Harleen Saggu
- Faculty of Health & Medical Sciences, The
University of Western Australia, Perth, Australia,To whom all correspondence should be addressed:
Harleen Saggu, Faculty of Health & Medical Sciences, The University of
Western Australia, Perth, Australia;
| | - Caleb Jones
- Department of Education, School of Special Education
Needs, Government of Western Australia, Perth, Australia
| | - Amber Lewis
- Methodist Ladies College, Claremont, Western
Australia, Australia
| | - Gareth Baynam
- Genetic Services of Western Australia, Perth,
Australia
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Abstract
The accompanying article set out why it is important to identify autistic people and the negative consequences of not recognising or understanding autism, including more severe illness and premature death. This article sets out what clinicians can do to help reduce those negative consequences by making 'reasonable adjustments' in any healthcare service in which they work.
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Affiliation(s)
- Clair Haydon
- Department of Adult Autism Services, Cheshire and Wirral Partnership NHS Foundation Trust and Centre for Autism, Neuro-Developmental Disorders and Intellectual Disability (CANDDID), Chester, UK
| | - Mary Doherty
- Department of Anaesthesia, Our Lady's Hospital, Navan, Ireland
| | - Ian A Davidson
- Department of Adult Mental Health, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
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Yen KH, Hsu CC, Yu PC, Liu HY, Chen ZJ, Chen YW, Peng LN, Lin MH, Chen LK. Determinants of improved quality of life among older adults with multimorbidity receiving integrated outpatient services: A hospital-based retrospective cohort study. Arch Gerontol Geriatr 2021; 97:104475. [PMID: 34304112 DOI: 10.1016/j.archger.2021.104475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Older adults with multiple complex care needs tend to receive fragmented care that may jeopardize their quality of life (QoL) and health outcomes. This study evaluated the determinants of improved QoL among integrated outpatient service recipients with multimorbidity. METHODS We conducted a retrospective cohort study of integrated geriatric outpatient services (IGOS) at a tertiary medical center in Taiwan. Data from 2018 to 2019 were retrieved. All patients underwent comprehensive geriatric assessment, which included demographic information, serial functional assessments, and assessment for QoL. QoL was reassessed through a telephone survey 6 months after the patients' first visit to IGOS. Factors associated with the interval changes in QoL were identified using multivariate logistic regression. RESULTS Data from 995 patients receiving IGOS (mean age: 82.21 ± 7.96 years, 54.5% males) were analyzed. An overall mean improvement in QoL was noted (EQ-5D index: +0.055±0.26, p <0.001) while 747 recipients reported maintained or improved QoL. The results of the multivariate logistic regression showed that poorer nutritional status (OR = 1.56, 95% CI: 1.07-2.28), depressive symptoms (OR = 1.99, 95% CI: 1.38-2.86), and frailty (OR = 1.66, 95% CI: 1.10-2.52) were independent risk factors for poorer QoL after adjustment for baseline QoL. CONCLUSIONS Integrated outpatient services improved the quality of life of older adults with multimorbidity. Those with poorer nutritional status, depressive symptoms and frailty were less likely to show improvement in their QoL.
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Cushen B, Madden A, Long D, Whelan Y, O'Brien ME, Carroll D, O'Flynn D, Forde M, Pye V, Grogan L, Casey M, Farrell K, Costello RW, Lewis C. Integrating hospital and community care: using a community virtual ward model to deliver combined specialist and generalist care to patients with severe chronic respiratory disease in their homes. Ir J Med Sci 2021; 191:615-621. [PMID: 33956325 PMCID: PMC8100740 DOI: 10.1007/s11845-021-02633-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Abstract
Background Chronic respiratory diseases are responsible for significant patient morbidity, mortality, and healthcare use. Community virtual ward (CVW) models of care have been successfully implemented to manage patients with complex medical conditions. Aims To explore the feasibility and clinical outcomes of a CVW model of care in patients with chronic respiratory disease. Methods Patients known to specialist respiratory services with Chronic Obstructive Pulmonary Disease (COPD) and/or asthma were admitted to the CVW for disease optimisation and exacerbation management. Individualised management plans were delivered in the patients’ home by hospital-based respiratory and community nursing teams, incorporating remote technology to monitor vital signs. Symptoms and health status at admission and discharge were compared. Results Twenty patients were admitted. One-quarter of patients had asthma, 50% COPD, and 25% combined asthma/COPD. Patients had severe disease, mean (SD) FEV1 50(20) % predicted, and an average 6.4(5.7) exacerbations of disease in the previous 12 months. Patients received personalised disease and self-management education. All acute exacerbations (n = 11) were successfully treated in the community. The average length of CVW admission was 10(4) days. By discharge, 60% of COPD and 66% of asthma patients recorded improvements in symptoms score exceeding the minimal clinically important difference. Fifty percent had clinically meaningful improvements in health status. Conclusion A CVW model facilitates the delivery of combined specialist and generalist care to patients with chronic respiratory disease in the community and improves symptoms and health status. The principles of the model are transferable to other conditions to improve overall health and reduce emergency hospital care.
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Affiliation(s)
- Breda Cushen
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland.
| | - Aisling Madden
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Deirdre Long
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Yvonne Whelan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | | | - Deirdre Carroll
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Des O'Flynn
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Michelle Forde
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Virginia Pye
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | - Margaret Casey
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | | | - Richard W Costello
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Clare Lewis
- Department of Health, Chief Nurse's Office, Dublin, Ireland
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McBride K, Bacong AM, Reynoso A, Benjamin AE, Wallace SP, Kietzman KG. Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California. J Immigr Minor Health 2021; 22:494-502. [PMID: 31350680 DOI: 10.1007/s10903-019-00922-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To improve the coordination of long-term services and supports for dual-eligibles (those with both Medicare and Medicaid), California created Cal MediConnect (CMC), an Affordable Care Act-authorized managed care demonstration program. Beneficiaries were "passively enrolled" into CMC, meaning they were automatically enrolled unless they actively opted out. The aim of this study was to examine differences in factors influencing the enrollment decisions of U.S. born and immigrant dual-eligible beneficiaries. To explore differences in decision-making processes, we conducted in-depth interviews with dual-eligible consumers (39 native and 14 immigrant) in Los Angeles County. Interviews were analyzed using a constructivist grounded theory approach. Our findings illustrate a heightened sense of vulnerability and disempowerment experienced by immigrant participants. Immigrant participants also faced greater challenges in accessing healthcare and eliciting healthcare information compared to U.S.-born participants. Understanding the diverse perspectives of dual-eligible immigrant healthcare decision-making has implications for health care reform strategies aimed at ameliorating disparities for vulnerable immigrant populations.
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Affiliation(s)
- Kaitlyn McBride
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Campus Box 951772, Los Angeles, CA, 90095-1772, USA. .,UCLA Center for Health Policy Research, Los Angeles, CA, USA.
| | - Adrian M Bacong
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Ana Reynoso
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - A E Benjamin
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Steven P Wallace
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Kathryn G Kietzman
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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van Gurp J, van Wijngaarden J, Payne S, Radbruch L, van Beek K, Csikós Á, Herder-van der Eerden M, Hasselaa J. Integrating Palliative Care by Virtue of Diplomacy; A Cross-sectional Group Interview Study of the Roles and Attitudes of Palliative Care Professionals to Further Integrate Palliative Care in Europe. Int J Health Policy Manag 2020; 11:786-794. [PMID: 33300764 PMCID: PMC9309904 DOI: 10.34172/ijhpm.2020.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/14/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Palliative care involves the care for patients with severe and advanced diseases with a focus on quality of life and symptom management. Integration of palliative care with curative and/or chronic care is expected to lead to better results in terms of quality of life and reduced costs. Although initiatives in different countries in Europe choose different structures to integrate care, they face similar challenges when it comes to creating trust and aligning visions, cultures and professional values. This paper sets out to answer the following research question: what roles and attitudes do palliative care professionals need to adopt to further integrate palliative care in Europe?
Methods: As part of the European Union (EU)-funded research project InSup-C (Integrated Supportive and Palliative Care). (2012-2016), 19 semi-structured group interviews with 136 (palliative) care professionals in 5 European countries (Germany, the United Kingdom, Belgium, the Netherlands, Hungary) were conducted. A thematic analysis was conducted.
Results: Integration of palliative care calls for diplomatic professionals that can bring a cultural shift: to get palliative care, with its particular focus on the four dimensions (physical, psychological, social, spiritual), integrated into historically established medical procedures and guidelines. This requires (a) to find an entrance (for telling a normative story), and (b) to maintain and deepen relationships (in order to build trust). It means using the appropriate words and sending a univocal team message to patients and being grateful, modest, and aiming for a quiet revolution with curation oriented healthcare professionals. Conclusion: Diplomacy appears to be essential to palliative care providers for realizing trust and what can be defined as normative integration between palliative and curative and/or chronic medicine. It requires a practical wisdom about the culture and goals of regular care, as well as keeping a middle road between assimilating with values in regular medicine and standing up for the basic values central to palliative care.
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Affiliation(s)
- Jelle van Gurp
- Department of IQ healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jeroen van Wijngaarden
- Erasmus School of Health Policy & Management, Health Service Management and Organisation, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Karen van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ágnes Csikós
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Marlieke Herder-van der Eerden
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jeroen Hasselaa
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Kataria I, Siddiqui M, Gillespie T, Goodman M, Dhillon PK, Bann C, Squiers L. A research agenda for non-communicable disease prevention and control in India. Health Res Policy Syst 2020; 18:126. [PMID: 33121498 DOI: 10.1186/s12961-020-00639-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background Non-communicable diseases contribute to 62% of total deaths in India; of concern are the preventable premature deaths, which account for a staggering 48% of mortality. The objective of this study was to establish a consensus research agenda for non-communicable disease prevention and control that has the potential to impact polices, programmes and healthcare delivery in India. Methods To develop a non-communicable disease research agenda, we engaged our community collaborative board and scientific advisory group in a three-step process using two web-based surveys and one in-person meeting. First, the Delphi methodology was used to generate topics. Second, these ideas were deliberated upon during the in-person meeting, leading to the prioritisation of 23 research questions, which were subjected to Strength, Weakness, Opportunities and Threat analysis by the stakeholders using the Snow Card methodology with the scientific advisory group and community collaborative board. This step resulted in the identification of 15 low effort, high impact priority research questions for various health outcomes across research disciplines based on discussion with the larger group to reach consensus. Finally, the second web-based survey resulted in the identification of 15 key priority research questions by all stakeholders as being the most important using a linear mixed effect regression model. Results The final set of 15 priority research questions focused on interventions at the individual, community, systems and policy levels. Research questions focused on identifying interventions that strengthen healthcare systems and healthcare delivery, including models of care and improved access to non-communicable disease screening, diagnosis and treatment, determining the impact of government policies, assessing the effectiveness of prevention programmes (e.g. tobacco, environmental improvements), and testing research tools and resources to monitor non-communicable diseases at the population level. Conclusion To produce the evidence base for selecting and implementing non-communicable disease programmes and policies in India, investments are needed. These investments should be guided by a national research agenda for the prevention and control of non-communicable diseases in India. Our findings could form the backbone of a national research agenda for non-communicable diseases in India that could be refined and then adopted by government agencies, the private sector, non-governmental and community-based organisations.
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Prajankett O, Markaki A. Integrated older people care and advanced practice nursing: an evidence-based review. Int Nurs Rev 2020; 68:67-77. [PMID: 32893354 DOI: 10.1111/inr.12606] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/12/2020] [Accepted: 06/07/2020] [Indexed: 12/01/2022]
Abstract
AIM To critically appraise and synthesize evidence of integrated care stemming from advanced practice nursing in elderly primary care settings throughout the United States and Thailand. BACKGROUND Advanced practice nurses are key to accelerating integrated elderly care in the community. Yet, their scope and capacity vary greatly across countries, making impact measurement highly challenging. METHODS A systematic search of PubMed, CINAHL, Scopus and ThaiJo databases was performed. Full-text articles in English or Thai language were reviewed using an inductive thematic approach from the integrated people-centred Health Services framework, adopted by the World Health Organization. RESULTS A total of 42 articles were appraised according to framework strategies: (1) people and community empowerment/engagement; (2) governance and accountability strengthening; (3) model of care reorientation; (4) service coordination; and (5) enabling environment creation. Collaborative roles and empowerment of older people were associated with higher quality of care. Thai nurses empowered individuals through community networks and resources, incorporating care models (strategy 1). In contrast, US nurses adopted a quality improvement and safety approach, incorporating technology into nursing interventions (strategy 5). CONCLUSION Advanced practice nurses employ an array of strategies and approaches in caring for older people. Although their role varies from mostly substitute (US) to supplemental (Thailand), nurses in both countries contribute towards integrated person-centred care. IMPLICATION FOR NURSING PRACTICE AND NURSING POLICY Preparing advanced practice nurses to work in the community is a prerequisite for meeting ageing population health needs in a sustainable manner. Education, professional development and leadership training opportunities should focus on capacity building in: a) strengthening mutual accountability, b) reorienting the work environment through innovative care models and c) coordinating services through partnerships to achieve universal health and ensure healthy ageing.
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Affiliation(s)
- O Prajankett
- International Visiting Scholar, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Community Health Nursing Department, Academic Affairs Division, The Royal Thai Army Nursing College, Ratchathewi, Bangkok, Thailand
| | - A Markaki
- WHO Collaborating Center for International Nursing, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Carlo AD, Drake L, Ratzliff ADH, Chang D, Unützer J. Sustaining the Collaborative Care Model (CoCM): Billing Newly Available CoCM CPT Codes in an Academic Primary Care System. Psychiatr Serv 2020; 71:972-974. [PMID: 32290809 PMCID: PMC7480471 DOI: 10.1176/appi.ps.201900581] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Novel Current Procedural Terminology (CPT) codes specific to the collaborative care model (CoCM) offer advantages over traditional billing options, but their uptake may require considerable billing and clinical workflow adjustments. This column presents a case study addressing the challenges of using these codes within the University of Washington Neighborhood Clinics (UWNC), an academically affiliated primary care clinic system in western Washington State. The UWNC experience thus far demonstrates that CoCM CPT codes can successfully be used in a large academic primary care system to help move this evidence-based service model toward financial sustainability.
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Affiliation(s)
- Andrew D Carlo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Ratzliff, Chang, Unützer); Department of Population Health Management, University of Washington School of Medicine, Seattle (Drake). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Lauren Drake
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Ratzliff, Chang, Unützer); Department of Population Health Management, University of Washington School of Medicine, Seattle (Drake). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Anna D H Ratzliff
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Ratzliff, Chang, Unützer); Department of Population Health Management, University of Washington School of Medicine, Seattle (Drake). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Denise Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Ratzliff, Chang, Unützer); Department of Population Health Management, University of Washington School of Medicine, Seattle (Drake). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Ratzliff, Chang, Unützer); Department of Population Health Management, University of Washington School of Medicine, Seattle (Drake). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
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MacInnes J, Baldwin J, Billings J. The Over 75 Service: Continuity of Integrated Care for Older People in a United Kingdom Primary Care Setting. Int J Integr Care 2020; 20:2. [PMID: 32742248 DOI: 10.5334/ijic.5457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Continuity of care is concerned with quality of care over a period of time. It describes a process by which service users and their families are co-operatively involved with health and social care professionals in managing their care needs. Continuity of care can be divided into informational, managerial and relational and has been associated with improved user- and service-related outcomes. To date, there have been few studies which examine how continuity of care is developed and maintained in integrated primary care systems. This paper explores continuity of care in an integrated Over 75 Service for people living at home with complex health and social care needs. Using a case study approach, qualitative data was collected from multiple sources including interviews with managers and professionals, users and carers, care plans, steering group minutes and field notes. Data was analysed thematically. A number of factors are identified which characterise continuity of care, namely: information sharing through direct communication between providers and the development of trusted relationships within the team; identified care co-ordinators who acted as a conduit for information and communication; the development of ongoing relationships with users and carers requiring dedicated time and accessible and flexible services delivered in the users’ own home.
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Pecoraro F, Luzi D, Pourabbas E, Ricci FL, Rossi Mori A. Extending Contsys Standard with Social Care Concepts: A Methodology Proposed by the UNINFO Working Group in Italy. Stud Health Technol Inform 2020; 270:223-227. [PMID: 32570379 DOI: 10.3233/shti200155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The increasing demand for territorial services requires the improvement of the coordination and cooperation among stakeholders in planning and delivery of integrated health and social services. In this scenario, to improve the communication among stakeholders there is a need of a formal conceptual model that facilitates the interoperability between organizations and professionals. This paper presents the methodology adopted by a UNINFO working group established in Italy to extend the ContSys standard with social care concepts to integrate health and social care contexts in a continuity of care perspective. An example of this extension is also provided considering the definition of patient's care plans.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council, Italy
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, National Research Council, Italy
| | - Elaheh Pourabbas
- Institute for System Analysis and Computer Science "Antonio Ruberti", National Research Council, Italy
| | - Fabrizio L Ricci
- Institute for Research on Population and Social Policies, National Research Council, Italy.,Institute for System Analysis and Computer Science "Antonio Ruberti", National Research Council, Italy
| | - Angelo Rossi Mori
- Institute for Research on Population and Social Policies, National Research Council, Italy
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Tom L, Alex S, Jack P. Better Evaluations to Support the Needs of Older People in the UK. Rand Health Q 2020; 8:RR-2932-AGEUK. [PMID: 32582466 PMCID: PMC7302316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Transforming health and care for older people is complex and demanding. Evaluating such efforts requires a range of approaches and ideas, and a reflection on ways to improve how evaluations are commissioned, completed and used in a changing policy landscape. This article by researchers at RAND Europe summarises three workshops undertaken with evaluators, commissioners of evaluations and services, and those delivering services that are evaluated with the explicit aim of addressing these questions.
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Nooteboom LA, van den Driesschen SI, Kuiper CHZ, Vermeiren RRJM, Mulder EA. An integrated approach to meet the needs of high-vulnerable families: a qualitative study on integrated care from a professional perspective. Child Adolesc Psychiatry Ment Health 2020; 14:18. [PMID: 32411295 PMCID: PMC7211334 DOI: 10.1186/s13034-020-00321-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To meet the needs of high-vulnerable families with severe and enduring problems across several life domains, professionals must improve their ability to provide integrated care timely and adequately. The aim of this study was to identify facilitators and barriers professionals encounter when providing integrated care. METHODS Experiences and perspectives of 24 professionals from integrated care teams in the Netherlands were gathered by conducting semi-structured interviews. A theory-driven framework method was applied to systematically code the transcripts both deductively and inductively. RESULTS There was a consensus among professionals regarding facilitators and barriers influencing their daily practice, leading to an in depth, thematic report of what facilitates and hinders integrated care. Themes covering the facilitators and barriers were related to early identification and broad assessment, multidisciplinary expertise, continuous pathways, care provision, autonomy of professionals, and evaluation of care processes. CONCLUSIONS Professionals emphasized the need for flexible support across several life domains to meet the needs of high-vulnerable families. Also, there should be a balance between the use of guidelines and a professional's autonomy to tailor support to families' needs. Other recommendations include the need to improve professionals' ability in timely stepping up to more intensive care and scaling down to less restrictive support, and to further our insight in risk factors and needs of these families.
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Affiliation(s)
- L. A. Nooteboom
- grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Post Box 15, 2300 AA Leiden, The Netherlands
| | - S. I. van den Driesschen
- grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Post Box 15, 2300 AA Leiden, The Netherlands
| | - C. H. Z. Kuiper
- grid.5477.10000000120346234Leiden University of Applied Sciences, Zernikedreef 11, 2311 CK Leiden, The Netherlands ,Horizon Youth Care and Special Education, Mozartlaan 150, 3055 KM Rotterdam, The Netherlands
| | - R. R. J. M. Vermeiren
- grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Post Box 15, 2300 AA Leiden, The Netherlands ,Youz: Parnassia Group, Dr. van Welylaan 2, 2566 ER, The Hague, The Netherlands
| | - E. A. Mulder
- grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Post Box 15, 2300 AA Leiden, The Netherlands ,Intermetzo-Pluryn, Post Box 53, 6500 AB Nijmegen, The Netherlands ,grid.7177.60000000084992262Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre - location VUMC, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
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Anjara SG, Ní Shé É, O'Shea M, O'Donoghue G, Donnelly S, Brennan J, Whitty H, Maloney P, Claffey A, Quinn S, McMahon N, Bourke N, Lang D, Reilly P, McGuigan C, Cosgrave S, Lawlor L, O'Shea D, McAuliffe E, O'Donnell D. Embedding collective leadership to foster collaborative inter-professional working in the care of older people (ECLECTIC): Study protocol. HRB Open Res 2020; 3:8. [PMID: 32789287 PMCID: PMC7359747 DOI: 10.12688/hrbopenres.13004.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The National Integrated Care Programme for Older People (NICPOP), formerly NCPOP aims to support older people to live well in their homes by developing primary and secondary care services for older people, especially those with complex needs. The programme develops integrated intermediate care which traverses both hospital and community settings through multidisciplinary and interagency teams. This team-based approach to the integration of health services is a novel innovation in Irish health service delivery and will require, over time, a shift in cultures of care to allow for the development of competencies for inter-professional collaboration across the care continuum. The ECLECTIC project will develop an implementation framework for achieving, maintaining and monitoring competencies for interprofessional collaboration among multi-disciplinary teams charged with delivering care for older people across the continuum from acute to community settings. Design: The ECLECTIC research design has been developed in collaboration with the NICPOP. In phase one of the project, a co-design team will collaborate to define and shape competencies for interprofessional collaboration. Phase two will involve the delivery of a collective leadership intervention over a 10-month period with multidisciplinary professionals working with older people across two geographical regions (Mullingar/Midlands and Beaumont/Dublin North). Each group will comprise of members of two multidisciplinary teams charged with coordinating and delivering care to older people across the continuum of acute to community care. Observations of collaborative inter-professional working will take place before, during, and after intervention. In phase three of the study, analysis of the interview and observation data will be presented to the co-design team in order to develop an implementation framework for future teams. Discussion: The co-design process will develop core competencies and performance indicators for collaborative interprofessional working. The resulting implementation framework will be implemented nationally as part of the NICPOP.
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Affiliation(s)
- Sabrina G Anjara
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Marie O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin, 4, Ireland
| | - John Brennan
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, 2, Ireland
| | - Hellen Whitty
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, 2, Ireland
| | | | - Anne Claffey
- Regional Hospital Mullingar, Mullingar, N91 NA43, Ireland
| | | | - Niamh McMahon
- St. James's University Hospital, Dublin, 8, Ireland.,School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, 2, Ireland
| | - Noeleen Bourke
- Regional Hospital Mullingar, Mullingar, N91 NA43, Ireland.,Health Service Executive CHO 8 (Longford and Westmeath), Mullingar, Ireland
| | | | - Patrice Reilly
- Health Service Executive CHO 9 (Dublin North City and County), Dublin, Ireland
| | | | | | | | | | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
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Marcus S, Malas N, Dopp R, Quigley J, Kramer AC, Tengelitsch E, Patel PD. The Michigan Child Collaborative Care Program: Building a Telepsychiatry Consultation Service. Psychiatr Serv 2019; 70:849-852. [PMID: 31272335 DOI: 10.1176/appi.ps.201800151] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column describes the establishment of the Michigan Child Collaborative Care (MC3), a statewide telepsychiatry consultation program that provides support to primary care providers (PCPs) in meeting the mental health needs of youths and perinatal women. The MC3 program provides cost-effective, timely, remote consultation to primary care providers in an effort to address the lack of access and scarcity of resources in child, adolescent, and perinatal psychiatry. Data from 10,445 service requests are summarized. Common diagnoses included attention-deficit hyperactivity disorder, mood disorders, anxiety disorders, and autistic spectrum disorders, with many cases (58%) deemed moderate to severe. Co-occurring psychological trauma was suspected in 9% of service requests. Partnerships, stakeholder roles, PCP engagement, and workflow integration are highlighted as keys to the program's success.
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Affiliation(s)
- Sheila Marcus
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Nasuh Malas
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Richard Dopp
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Joanna Quigley
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Anne C Kramer
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Elizabeth Tengelitsch
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Paresh D Patel
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
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Eastwood JG, Shaw M, Garg P, De Souza DE, Tyler I, Dean L, MacSween M, Moore M. Designing an Integrated Care Initiative for Vulnerable Families: Operationalisation of Realist Causal and Programme Theory, Sydney Australia. Int J Integr Care 2019; 19:10. [PMID: 31367209 DOI: 10.5334/ijic.3980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: In July 2015 Sydney Local Health District (SLHD) implemented an integrated care initiative for vulnerable families in the Inner West region of Sydney, Australia. The initiative was designed as a cross-agency care coordination network that would ensure that vulnerable families: had their complex health and social needs met; kept themselves and their children safe; and were connected to society. We will describe the development of the design that drew on earlier realist causal and program theoretical work. Methods: Realist causal and program theory were used to inform the collaborative design of an initiative for vulnerable families. The collaborative design process included: identification of desirable and undesirable outcomes and contextual factors, stakeholder consultation, interagency planning, and development of a service proposal. Results: The design elements included: identification of vulnerable family cohorts; care coordination; evidence-informed intervention(s); general practice engagement and support; family health improvement; placed-based neighbourhood initiatives; interagency system change and collaborative planning; monitoring of individual and family outcomes; and evaluation. Conclusions: The design study described advances toward the implementation of a whole-of-government integrated health and social care initiative. The initiative was designed as a cross-agency care coordination network that would ensure that vulnerable families: had their complex health and social needs met; kept themselves and their children safe; and were connected to society. In so doing we aim to break intergenerational cycles of poverty, violence and crime, poor education and employment opportunities, psychopathology, and poor lifestyle and health behaviours, through strengthening family resilience, improving access to services, and addressing the social determinants of health and wellbeing.
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Eastwood J. Making a Realist Turn: Applying a Critical Realist Translational Social Epidemiology Methodology to the Design and Evaluation of Complex Integrated Care Interventions. Int J Integr Care 2019; 19:7. [PMID: 31367206 DOI: 10.5334/ijic.4725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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McGregor B, Belton A, Henry TL, Wrenn G, Holden KB. Improving Behavioral Health Equity through Cultural Competence Training of Health Care Providers. Ethn Dis 2019; 29:359-364. [PMID: 31308606 DOI: 10.18865/ed.29.s2.359] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Racial/ethnic disparities have long persisted in the United States despite concerted health system efforts to improve access and quality of care among African Americans and Latinos. Cultural competence in the health care setting has been recognized as an important feature of high-quality health care delivery for decades and will continue to be paramount as the society in which we live becomes increasingly culturally diverse. Unfortunately, there is limited empirical evidence of patient health benefits of a culturally competent health care workforce in integrated care, its feasibility of implementation, and sustainability strategies. This article reviews the status of cultural competence education in health care, the merits of continued commitment to training health care providers in integrated care settings, and policy and practice strategies to ensure emerging health care professionals and those already in the field are prepared to meet the health care needs of racially and ethnically diverse populations.
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Lombardi BM, Zerden LDS, Guan T, Prentice A. The role of social work in the opioid epidemic: office-based opioid treatment programs. Soc Work Health Care 2019; 58:339-344. [PMID: 30596348 DOI: 10.1080/00981389.2018.1564109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/01/2018] [Accepted: 12/22/2018] [Indexed: 06/09/2023]
Abstract
The opioid epidemic is a national emergency in the United States. To meet the needs of individuals diagnosed with Opioid Use Disorder (OUD) office-based opioid treatment programs (OBOT) are quickly expanding. However, social workers roles in OBOT programs are not clearly described. This paper will emphasize three roles social workers may fulfill in OBOT programs to combat the opioid crisis.
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Affiliation(s)
| | - Lisa de Saxe Zerden
- b School of Social Work , University of North Carolina at Chapel Hill , Chapel Hill , NC
| | - Ting Guan
- b School of Social Work , University of North Carolina at Chapel Hill , Chapel Hill , NC
| | - Amy Prentice
- c Family Medicine , UNC Health Care , Chapel Hill , NC
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Cash-Gibson L, Tigova O, Alonso A, Binkley G, Rosenmöller M. Project INTEGRATE: Developing a Framework to Guide Design, Implementation and Evaluation of People-centred Integrated Care Processes. Int J Integr Care 2019; 19:3. [PMID: 30828273 DOI: 10.5334/ijic.4178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: People-centred integrated care is an acknowledged approach to improve the quality and effectiveness of health systems in delivering care around people’s needs and preferences. Nevertheless, more guidance on how to effectively design, implement and evaluate the care process of people-centred integrated care services is needed. Under Project INTEGRATE, a framework was developed to guide managers in the assessment, transformation and delivery of these health service innovations. Methods: The framework is a product of the synthesis of operations, service and project management literature, relevant health care literature, and the analysis of four good practice integrated care case studies analysed under Project INTEGRATE. A first iteration of the framework was developed and then applied to one of the integrated care case studies to test its validity and utility. Results and Discussion: The tool combines a number of important considerations and criteria that have not been previously included in integrated care assessment frameworks, allowing for a pragmatic and comprehensive analysis of the care process. Conclusion: This framework can be used as a stand-alone or combined tool to guide managers to plan and evaluate the care process design of people-centred integrated care services; future work should apply this tool to other settings.
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Abstract
OBJECTIVE This study examined organizational variability of process-of-care and depression outcomes at eight community health centers (CHCs) in the years following implementation of collaborative care (CC) for depression. METHODS The authors used 8 years of observational data for 13,362 unique patients at eight CHCs that participated in Washington State's Mental Health Integration Program. Organization-level changes in depression and process-of-care outcomes over time were studied. RESULTS On average, depression outcomes improved for the first 2 years before improvement slowed, peaking at year 5. Significant organization-level variation was noted in outcomes. Improvements in depression outcomes tended to follow process-of-care measures. CONCLUSIONS Findings suggest that it may take 2 years after implementation of CC to fully observe depression outcome improvement at an organization level. Substantial variation between organizations in depression outcomes over time suggests that sustained attention to processes of care may be necessary to maintain initially achieved gains.
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Affiliation(s)
- Andrew D Carlo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Unützer); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Jeng, Bao)
| | - Philip J Jeng
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Unützer); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Jeng, Bao)
| | - Yuhua Bao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Unützer); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Jeng, Bao)
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Carlo, Unützer); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Jeng, Bao)
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Myers R. Fully-integrated medical home for people with severe and persistent mental illness: A description and outcome analysis of a Medicare Advantage Chronic Special Needs Program. Ment Illn 2018; 10:7819. [PMID: 30746056 PMCID: PMC6342024 DOI: 10.4081/mi.2018.7819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/12/2018] [Indexed: 11/23/2022] Open
Abstract
People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.
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Affiliation(s)
- Robert Myers
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
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Joober H, Chouinard MC, King J, Lambert M, Hudon É, Hudon C. The Patient Experience of Integrated Care Scale: A Validation Study among Patients with Chronic Conditions Seen in Primary Care. Int J Integr Care 2018; 18:1. [PMID: 30483034 DOI: 10.5334/ijic.4163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Valid and comprehensive instruments to measure integrated care are required to capture patient experience and improve quality of patient care. This study aimed to validate the Patient Experience of Integrated Care Scale (PEICS), among patients with chronic conditions seen in primary care. Methods: One hundred and fifty-nine (159) French-speaking adults with at least one chronic condition were recruited in two family medicine clinics in Quebec (Canada) and completed the 17-item PEICS (T1). Fifty (50) participants completed it a second time 2 weeks later (T2). The internal consistency of the scale was assessed using Cronbach’s alpha, the test-retest reliability with the intraclass correlation coefficient (ICC), and concurrent validity using three dimensions of the Continuity of Care from Multiple Clinicians (CC-MC), with Spearman’s rank correlation coefficients. Results: Cronbach’s alpha for the questionnaire was 0.88 (95% CI: 0.85 to 0.91). The intraclass correlation coefficient was 0.81 (95% CI: 0.64 to 0.90) and Spearman’s rank correlation coefficient with the three dimensions of the CC-MC varied from 0.44 to 0.54. Conclusions and discussion: The PEICS showed good psychometric properties. This scale could be used in a population with chronic conditions followed in primary care to measure patient experience of integrated care.
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Zima BT, McCreary M, Kenan K, Churchey-Mims M, Chi H, Brady M, Davies J, Rompala V, Leventhal B. Development and Evaluation of Two Integrated Care Models for Children Using a Partnered Formative Evaluation Approach. Ethn Dis 2018; 28:445-456. [PMID: 30202198 DOI: 10.18865/ed.28.s2.445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the development and evaluation of two integrated care models using a partnered formative evaluation approach across a private foundation, clinic leaders, providers and staff, and a university-based research center. Design Retrospective cohort study using multiple data sources. Setting Two federal qualified health care centers serving low-income children and families in Chicago. Participants Private foundation, clinic and academic partners. Interventions Development of two integrated care models and partnered evaluation design. Main Outcome Measures Accomplishments and early lessons learned. Results Together, the foundation-clinic-academic partners worked to include best practices in two integrated care models for children while developing the evaluation design. A shared data collection approach, which empowered the clinic partners to collect data using a web-based tool for a prospective longitudinal cohort study, was also created. Conclusion Across three formative evaluation stages, the foundation, clinic, and academic partners continued to reach beyond their respective traditional roles of project oversight, clinical service, and research as adjustments were collectively made to accommodate barriers and unanticipated events. Together, an innovative shared data collection approach was developed that extends partnered research to include data collection being led by the clinic partners and supported by the technical resources of a university-based research center.
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Affiliation(s)
- Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Kristen Kenan
- Department of Pediatrics, University of Illinois at Chicago, IL
| | | | - Hannah Chi
- Erie West Town Family Health Center, Chicago, IL
| | | | | | | | - Bennett Leventhal
- Department of Psychiatry, University of California at San Francisco, CA
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Sheaff R. Achieving Integrated Care for Older People: What Kind of Ship? Comment on "Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight for the Future?". Int J Health Policy Manag 2018; 7:870-873. [PMID: 30316236 PMCID: PMC6186479 DOI: 10.15171/ijhpm.2018.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/28/2018] [Indexed: 11/09/2022] Open
Abstract
This paper considers an implication of the idea that proposals for integrated care for older people should start from a focus on the patient, consider co-production solutions to the problems of care fragmentation, and be at a system-wide, cross-organisational level. It follows that the analysis, design and therefore evaluation of integrated care projects should be based upon the journeys which older patients with multiple chronic conditions usually have to make from professional to professional and service to service. A systematic realistic review of recent research on integrated care projects identified a number of key mechanisms for care integration, including multidisciplinary care teams, care planning, suitable IT support and changes to organisational culture, besides other activities and contexts which assist care 'integration.' Those findings suggest that bringing the diverse services that older people with multiple chronic conditions need into a single organisation would remove many of the inter-organisational boundaries that impede care 'integration' and make it easier to address the interprofessional and inter-service boundaries.
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Abstract
For decades, depression in older adults was overlooked and not treated. Most treatment was by primary care providers and typically poorly managed. Recent interventions that integrate mental health services into primary care have increased the number of patients who are treated for depression and the quality of that treatment. The most effective models involve systematic depression screening and monitoring, multidisciplinary teams that include primary care providers and mental health specialists, a depression care manager to work directly with patients over time and the use of guideline-based depression treatment. The article reviews the challenges and opportunities for providing high-quality depression treatment in primary care; describes the 3 major integrated care interventions, PRISM-E, IMPACT, and PROSPECT; reviews the evidence of their effectiveness, and adaptations of the model for other conditions and settings; and explores strategies to increase their scalability into real world practice.
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Affiliation(s)
- Martha L. Bruce
- Dartmouth Centers for Health and Aging, Geisel School of Medicine, Hanover, NH, USA
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Evison K, Roy DA, Scarth F. Reflections from Key Policy Decision-makers on Integrated Care and the Value of Decision-maker Involvement in Research. Int J Integr Care 2018; 18:10. [PMID: 30127694 DOI: 10.5334/ijic.4161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The iCOACH study involved key health care system decision-makers from Ontario, Quebec and New Zealand. This article is written by the key decision-makers involved in the iCOACH study and discusses their motivations to engage in the research project, the value of participation and key recommendations for best practices to engage decision-makers in research projects. Suggestions for knowledge translation are identified including practical tools for decision-makers and providers to use to assess readiness to implement integrated community-based primary health care. Case study briefs with key enablers and 'talking-points' and infographics are similarly recommended as approaches to transfer knowledge gained from this research study.
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Harvey G, Dollard J, Marshall A, Mittinty MM. Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future? Int J Health Policy Manag 2018; 7:290-293. [PMID: 29626395 PMCID: PMC5949218 DOI: 10.15171/ijhpm.2017.144] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/19/2017] [Indexed: 11/09/2022] Open
Abstract
Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multifactorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. This approach of fixing parts of the system may be akin to shuffling the deckchairson the Titanic, rather than dealing with the fundamental reasons why the ship is sinking. Attempts to make the ship more watertight need to be firmly centred on the older person, pay close attention to implementation and embrace approaches that promote collaborative working between all the stakeholders involved.
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Affiliation(s)
- Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Amy Marshall
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Manasi Murthy Mittinty
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia.,Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
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Ní Shé É, McCarthy M, O'Donnell D, Collins O, Hughes G, Salter N, Cogan L, O'Donoghue C, McGrath E, O'Donovan J, Patton A, McAuliffe E, O'Shea D, Cooney MT. The systematic approach to improving care for Frail Older Patients (SAFE) study: A protocol for co-designing a frail older person's pathway. HRB Open Res 2018; 1:9. [PMID: 32002503 PMCID: PMC6973535 DOI: 10.12688/hrbopenres.12804.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Frailty is the age-accelerated decline across multiple organ systems which leads to vulnerability to poor resolution of homeostasis after a stressor event. This loss of reserve means that a minor illness can result in a disproportionate loss of functional ability. Improving acute care for frail older patients is now a national priority and an important aspect of the National Programme for Older People in Ireland. Evidence suggests that an interdisciplinary approach incorporating rapid comprehensive geriatric assessment and early intervention by an interdisciplinary team can reduces susceptibility to hospitalisation related functional decline. The aim of the Systematic Approach to Improving Care for Frail Older Patients (SAFE) is to develop and explore the process of implementing a model of excellence in the delivery of patient-centred integrated care within the context of frail older people’s acute admissions. Methods: The SAFE study will employ a mixed methodology approach, including a rapid realist review of the current literature alongside a review of baseline data for older people attending the emergency department. Semi-structured interviews will be undertaken to document the current pathway. The intervention processes and outcomes will be jointly co-designed by a patient and public involvement (PPI) group together with the interdisciplinary healthcare professionals from hospital, community and rehabilitation settings. Successive rounds of Plan-Do-Study-Act cycles will then be undertaken to test and refine the pathway for full implementation. Discussion: This research project will result in a plan for implementing an integrated, patient-centred pathway for acute care of the frail older people which has been tested in the Irish setting. During the process of development, each element of the new pathway will be tested in turn to ensure that patient centred outcomes are being realised. This will ensure the resulting model of care is ready for implementation in the context of the Irish health service.
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Affiliation(s)
- Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D4, Ireland
| | - Mary McCarthy
- Older Person's Empowerment Network and Patient and Public Involvement Representative in Healthcare at the Health Service Executive, Dublin, D8, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D4, Ireland
| | - Orla Collins
- St Vincent's University Hospital, Dublin, Dublin, D4, Ireland
| | - Graham Hughes
- St Vincent's University Hospital, Dublin, Dublin, D4, Ireland
| | - Nigel Salter
- St Vincent's University Hospital, Dublin, Dublin, D4, Ireland
| | - Lisa Cogan
- Royal Hospital Donnybrook, Dublin, D4, Ireland
| | | | - Emmet McGrath
- St Vincent's University Hospital, Dublin, Dublin, D4, Ireland
| | - John O'Donovan
- Health Service Executive , Dun Laoghaire, County Dublin, Ireland
| | - Andrew Patton
- St Vincent's University Hospital, Dublin, Dublin, D4, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D4, Ireland
| | - Diarmuid O'Shea
- St Vincent's University Hospital, Dublin, Dublin, D4, Ireland
| | - Marie Therese Cooney
- St Vincent's University Hospital, Dublin, Dublin, D4, Ireland.,School of Medicine, University College Dublin, Dublin, D4, Ireland
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Nurjono M, Shrestha P, Lee A, Lim XY, Shiraz F, Tan S, Wong SH, Foo KM, Wee T, Toh SA, Yoong J, Maria Vrijhoef HJ. Realist evaluation of a complex integrated care programme: protocol for a mixed methods study. BMJ Open 2018; 8:e017111. [PMID: 29500199 PMCID: PMC5855239 DOI: 10.1136/bmjopen-2017-017111] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The lack of understanding of how complex integrated care programmes achieve their outcomes due to the lack of acceptable methods leads to difficulties in the development, implementation, adaptation and scaling up of similar interventions. In this study, we evaluate an integrated care network, the National University Health System (NUHS) Regional Health System (RHS), consisting of acute hospitals, step down care, primary care providers, social services and community partners using a theory-driven realist evaluation approach. This study aims to examine how and for whom the NUHS-RHS works to improve healthcare utilisations, outcomes, care experiences and reduce healthcare costs. By using a realist approach that balances the needs of context-specific evaluation with international comparability, this study carries the potential to address current research gaps. METHODS AND ANALYSIS This evaluation will be conducted in three research phases: (1) development of initial programme theory (IPT) underlying the NUHS-RHS; (2) testing of programme theory using empirical data; and (3) refinement of IPT. IPT was elicited and developed through reviews of programme documents, informal discussions and in-depth interviews with relevant stakeholders. Then, a convergent parallel mixed method study will be conducted to assess context (C), mechanisms (M) and outcomes (O) to test the IPT. Findings will then be analysed according to the realist evaluation formula of CMO in which findings on the context, mechanisms will be used to explain the outcomes. Finally, based on findings gathered, IPT will be refined to highlight how to improve the NUHS-RHS by detailing what works (outcome), as well as how (mechanisms) and under what conditions (context). ETHICS AND DISSEMINATION The National Healthcare Group, Singapore, Domain Specific Review Board reviewed and approved this study protocol. Study results will be published in international peer-reviewed journals and presented at conferences and internally to NUHS-RHS and Ministry of Health, Singapore.
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Affiliation(s)
- Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Pami Shrestha
- Regional Health System Planning Office, National University Health System, Singapore
| | - Alice Lee
- Regional Health System Planning Office, National University Health System, Singapore
| | - Xin Ya Lim
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Farah Shiraz
- Regional Health System Planning Office, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shermin Tan
- Regional Health System Planning Office, National University Health System, Singapore
| | - Shing Hei Wong
- Regional Health System Planning Office, National University Health System, Singapore
| | - Kah Mun Foo
- Regional Health System Planning Office, National University Health System, Singapore
| | - Thomas Wee
- Regional Health System Planning Office, National University Health System, Singapore
| | - Sue-Anne Toh
- Regional Health System Planning Office, National University Health System, Singapore
| | - Joanne Yoong
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Center for Economic and Social Research, University of Southern California, California, USA
| | - Hubertus Johannes Maria Vrijhoef
- Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea B.V., Amsterdam, The Netherlands
- Department of Patient and Care, University Hospital Maastricht, Maastricht, The Netherlands
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Fullerton CA, Henke RM, Crable EL, Hohlbauch A, Cummings N. The Impact Of Medicare ACOs On Improving Integration And Coordination Of Physical And Behavioral Health Care. Health Aff (Millwood) 2018; 35:1257-65. [PMID: 27385242 DOI: 10.1377/hlthaff.2016.0019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The accountable care organization (ACO) model holds the promise of reducing costs and improving the quality of care by realigning payment incentives to focus on health outcomes instead of service volume. One key to managing the total cost of care is improving care coordination for and treatment of people with behavioral health disorders. We examined qualitative data from ninety organizations participating in Medicare ACO demonstration programs from 2012 through 2015 to determine whether and how they focused on behavioral health care. These ACOs had mixed degrees of engagement in improving behavioral health care for their populations. The biggest challenges included a lack of behavioral health care providers, data availability, and sustainable financing models. Nonetheless, we found substantial interest in integrating behavioral health care into primary care across a majority of the ACOs.
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Affiliation(s)
- Catherine A Fullerton
- Catherine A. Fullerton is a senior research leader in the Center for Behavioral Health Services Research at Truven Health Analytics, an IBM company, in Cambridge, Massachusetts
| | - Rachel M Henke
- Rachel M. Henke is director of research in the Center for Behavioral Health Services Research at Truven Health Analytics in Cambridge
| | - Erika L Crable
- Erica Crable is a research analyst II in the Center for Behavioral Health Services Research at Truven Health Analytics in Cambridge
| | - Andriana Hohlbauch
- Andriana Hohlbauch is a research leader in the Center for Behavioral Health Services Research at Truven Health Analytics in Santa Barbara, California
| | - Nicholas Cummings
- Nicholas Cummings is a research analyst II in the Center for Behavioral Health Services Research at Truven Health Analytics in Bethesda, Maryland
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Cui Y, Gong D, Yang B, Chen H, Zhang C, Li H, Jiang L, Kuo MC, Chang P. How Key Stakeholders Perceive a Smart Mobile Integrated Care System for the Elderly. Stud Health Technol Inform 2018; 250:153. [PMID: 29857416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Integrated care has been an important model for caring the elderly. In China, it is still at its very early stage. We proposed a new model to develop a smart mobile system, taking the CARE instrument as the base and composed of apps for stakeholders. We did an usability study using the TAMM tool and, from a convenience sample of 11 elderly and 18 nurses, the results indicated the system was well appreciated.
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Affiliation(s)
- Yanyan Cui
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | | | - Bo Yang
- Shanghai Kongjiang Hospital, Shanghai, China
| | - Hua Chen
- Shanghai Kongjiang Hospital, Shanghai, China
| | - Chaonan Zhang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Li
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming-Chuan Kuo
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Polun Chang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
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Cui Y, Gong D, Yang B, Chen H, Tu MH, Zhang C, Li H, Liang N, Jiang L, Chang P. Making the CARE Comprehensive Geriatric Assessment as the Core of a Total Mobile Long Term Care Support System in China. Stud Health Technol Inform 2018; 247:770-774. [PMID: 29678065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Comprehensive Geriatric Assessments (CGAs) have been recommended to be used for better monitoring the health status of elder residents and providing quality care. This study reported how our nurses perceived the usability of CGA component of a mobile integrated-care long term care support system developed in China. We used the Continuity Assessment Record and Evaluation (CARE), developed in the US, as the core CGA component of our Android-based support system, in which apps were designed for all key stakeholders for delivering quality long term care. A convenience sample of 18 subjects from local long term care facilities in Shanghai, China were invited to assess the CGA assessment component in terms of Technology Acceptance Model for Mobile based on real field trial assessment. All (100%) were satisfied with the mobile CGA component. 88.9% perceived the system was easy to learn and use. 99.4% showed their willingness to use for their work. We concluded it is technically feasible to implement a CGA-based mobile integrated care support system in China.
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Affiliation(s)
- Yanyan Cui
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | | | - Bo Yang
- Yangpu Kongjiang Hospital, Shanghai, China
| | - Hua Chen
- Yangpu Kongjiang Hospital, Shanghai, China
| | - Ming-Hsiang Tu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Chaonan Zhang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Li
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naiwen Liang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Liping Jiang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Polun Chang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
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