2024-03-28T23:31:26Zhttps:/www.ncbi.nlm.nih.gov/pmc/oai/oai.cgioai:pubmedcentral.nih.gov:13932582006-06-12ijicarepmc-open
Following the logic of long-term care: toward an independent, but integrated sector
Kodner, Dennis L.
Int J Integr Care
Editorial
Igitur, Utrecht Publishing & Archiving Services
2004-02-27
/pmc/articles/PMC1393258/
/pubmed/16773143
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932592006-06-12ijicarepmc-open
Economic evaluation of integrated care: an introduction
Vondeling, Hindrik
Int J Integr Care
Research and Theory
BACKGROUND: Integrated care has emerged in a variety of forms in industrialised countries during the past decade. It is generally assumed that these new arrangements result in increased effectiveness and quality of care, while being cost-effective or even cost-saving at the same time. However, systematic evaluation, including an evaluation of the relative costs and benefits of these arrangements, has largely been lacking. OBJECTIVES: To stimulate fruitful dialogue and debate about the need for economic evaluation in integrated care, and to outline possibilities for undertaking economic appraisal studies in this relatively new field. THEORY: Key concepts, including e.g. scarcity and opportunity costs, are introduced, followed by a brief overview of the most common methods used in economic evaluation of health care programmes. Then a number of issues that seem particularly relevant for economic evaluation of integrated care arrangements are addressed in more detail, illustrated with examples from the literature. CONCLUSION AND DISCUSSION: There is a need for well-designed economic evaluation studies of integrated care arrangements, in particular in order to support decision making on the long-term financing of these programmes. Although relatively few studies have been done to date, the field is challenging from a methodological point of view, offering analysts a wealth of opportunities. Guidance to realise these opportunities is provided by the general principles for economic evaluation, which can be tailored to the requirements of this particular field.
Igitur, Utrecht Publishing & Archiving Services
2004-03-01
/pmc/articles/PMC1393259/
/pubmed/16773144
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932602006-06-12ijicarepmc-open
Conceptualizing and validating the human services integration measure
Browne, Gina
Roberts, Jacqueline
Gafni, Amiram
Byrne, Carolyn
Kertyzia, June
Loney, Patricia
Int J Integr Care
Research and Theory
PURPOSES: This paper proposes both a model and a measure of human service integration through strategic alliances with autonomous services as one way to achieve comprehensive health and social services for target populations. THEORY: Diverse theories of integrated service delivery and collaboration were combined reflecting integration along a continuum of care within a service sector, across service sectors and between public, not-for-profit and private sectors of financing services. METHODS: A measure of human service integration is proposed and tested. The measure identifies the scope and depth of integration for each sector and service that make up a total service network. It captures in quantitative terms both intra and inter sectoral service integration. RESULTS: Results are provided using the Human Service Measure in two networks of services involved in promoting Healthy Babies and Healthy Children known to have more and less integration. CONCLUSIONS: The instrument demonstrated discriminate validity with scores correctly distinguishing the two networks. The instrument does not correlate (r=0.13) with Weiss (2001) measure of partnership synergy confirming that it measures a distinct component of integration. DISCUSSION: We recommend the combined use of the proposed measure and the Weiss (2001) measure to more completely capture the scope and depth of integration efforts as well as the nature of the functioning of a service program or network.
Igitur, Utrecht Publishing & Archiving Services
2004-05-19
/pmc/articles/PMC1393260/
/pubmed/16773145
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932612006-06-12ijicarepmc-open
What makes a good healthcare system?: comparisons, values, drivers
Daniilidou, Natasa V.
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-04-21
/pmc/articles/PMC1393261/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932622006-06-12ijicarepmc-open
Healthcare performance and organizational culture
van Linge, R.H.
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-04-14
/pmc/articles/PMC1393262/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932632006-06-12ijicarepmc-open
Interface flow process audit: using the patient's career as a tracer of quality of care and of system organisation
Unger, Jean-Pierre
Marchal, Bruno
Dugas, Sylvie
Wuidar, Marie-Jeanne
Burdet, Daniel
Leemans, Pierre
Unger, Jacques
Int J Integr Care
Research and Theory
OBJECTIVES: This case study aims to demonstrate the method's feasibility and capacity to improve quality of care. Several drawbacks attached to tracer condition and selected procedure audits oblige clinicians to rely on external evaluators. Interface flow process audit is an alternative method, which also favours integration of health care across institutions divide. METHODS: An action research study was carried out to test the feasibility of interface flow process audit and its impact on quality improvement. An anonymous questionnaire was carried out to assess the participants' perception of the process. RESULTS: In this study, interface flow process audit brought together general practitioners and hospital doctors to analyse the co-ordination of their activities across the primary-secondary interface. Human factors and organisational characteristics had a clear influence on implementation of the solutions. In general, the participants confirmed that the interface flow process audit helped them to analyse the quality of case management both at primary and secondary care level. CONCLUSIONS: The interface flow process audit appears a useful method for regular in-service self-evaluation. Its practice enabled to address a wide scope of clinical, managerial and economical problems. Bridging the primary-secondary care gap, interface flow process audit's focus on the patient's career combined with the broad scope of problems that can be analysed are particularly powerful features. The methodology would benefit from an evaluation of its practice on larger scale.
Igitur, Utrecht Publishing & Archiving Services
2004-05-19
/pmc/articles/PMC1393263/
/pubmed/16773146
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932642006-06-12ijicarepmc-open
Monitoring the degree of implementation of an integrated delivery system
Hébert, R. Réjean
Veil, A. Anne
Int J Integr Care
Research and Theory
INTRODUCTION: The aim of the study was to develop a method to measure the implementation of specific components of an Integrated Service Delivery system for the frail elderly. The system includes six mechanisms and tools: (1) coordination of all organizations involved in delivering health and social services, (2) a single entry point, (3) case management, (4) a single assessment tool with a case-mix classification system, (5) an individualized service plan, and (6) a computerized clinical chart. METHOD: Focus groups of researchers, clinicians, managers and policy-makers identified quantitative indicators for each component. The six components were weighted according to their relative importance in order to generate a total score. Data were collected every six months over 30 months to establish the implementation degree in the three experimental areas: Sherbrooke, Granit and Coaticook in the Province of Quebec, Canada. RESULTS: After 30 months, coordination is the most developed component in the three experimental areas. Overall, in July 2003, the Integrated Service Delivery system was implemented at the rate of 73%, 71% and 70% in Sherbrooke, Granit and Coaticook, respectively. DISCUSSION: This type of quantitative assessment provides data for managers and researchers to monitor the implementation. Moreover, when there is an outcome study, the results of the outcome study can be correlated with the degree of implementation, thus allowing for dose-response analyzes and helping to decrease the “black box” effect.
Igitur, Utrecht Publishing & Archiving Services
2004-09-20
/pmc/articles/PMC1393264/
/pubmed/16773147
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932652006-06-12ijicarepmc-open
Emergency care should be integrated care
Karlberg, Ingvar
Int J Integr Care
Editorial
Igitur, Utrecht Publishing & Archiving Services
2004-07-09
/pmc/articles/PMC1393265/
/pubmed/16773148
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932662006-06-12ijicarepmc-open
Is it justifiable to treat chronic patients by nurse specialists? Evaluation of effects on quality of care
Kodner, Dennis L.
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-08-16
/pmc/articles/PMC1393266/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932672006-06-12ijicarepmc-open
Developing integrated health and social care services for older persons in Europe
Leichsenring, Kai
Int J Integr Care
Research and Theory
PURPOSE: This paper is to distribute first results of the EU Fifth Framework Project ‘Providing integrated health and social care for older persons—issues, problems and solutions’ (PROCARE—http://www.euro.centre.org/procare/). The project's first phase was to identify different approaches to integration as well as structural, organisational, economic and social-cultural factors and actors that constitute integrated and sustainable care systems. It also served to retrieve a number of experiences, model ways of working and demonstration projects in the participating countries which are currently being analysed in order to learn from success—or failure—and to develop policy recommendations for the local, national and European level. THEORY: The paper draws on existing definitions of integrated care in various countries and by various scholars. Given the context of an international comparative study it tries to avoid providing a single, ready-made definition but underlines the role of social care as part and parcel of this type of integrated care in the participating countries. METHODS: The paper is based on national reports from researchers representing ten organisations (university institutes, consultancy firms, research institutes, the public and the NGO sector) from 9 European countries: Austria, Denmark, Finland, France, Germany, Greece, Italy, the Netherlands, and the UK. Literature reviews made intensive use of grey literature and evaluation studies in the context of at least five model ways of working in each country. RESULTS: As a result of the cross-national overview an attempt to classify different approaches and definitions is made and indicators of relative importance of the different instruments used in integrating health and social care services are provided. CONCLUSIONS: The cross-national overview shows that issues concerning co-ordination and integration of services are high on the agenda in most countries. Depending on the state of service development, various approaches and instruments can be observed. Different national frameworks, in particular with respect to financing and organisation, systemic development, professionalisation and professional cultures, basic societal values (family ethics), and political approaches have to be taken into account during the second phase of PROCARE during which transversal and transnational analysis will be undertaken based on an in-depth analysis of two model ways of working in each country. DISCUSSION: Far from a European vision concerning integrated care, national health and social care systems remain—at best—loosely coupled systems that are facing increasing difficulties, given the current challenges, in particular in long-term care for older persons: increasing marketisation, lack of managerial knowledge (co-operation, co-ordination), shortage of care workers and a general trend towards down-sizing of social care services continue to hamper the first tentative pathways towards integrated care systems.
Igitur, Utrecht Publishing & Archiving Services
2004-09-03
/pmc/articles/PMC1393267/
/pubmed/16773149
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932682006-06-12ijicarepmc-open
Providing integrated health and social care for older persons: a European overview of issues at stake
Petch, Alison
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-08-16
/pmc/articles/PMC1393268/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932692006-06-12ijicarepmc-open
Developing a unified patient record: a practical guide
de Ruiter, Han
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-07-05
/pmc/articles/PMC1393269/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932702006-06-12ijicarepmc-open
Care trusts: partnership working in action
Sinkkonen, Sirkka
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-08-30
/pmc/articles/PMC1393270/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932712006-06-12ijicarepmc-open
A system of networks and continuing education for physical therapists in rheumatology: a feasibility study
Verhoef, J.
Oosterveld, F.G.J.
Hoekman, R.
Munneke, M.
Boonman, D.C.G.
Bakker, M.
Otten, W.
Rasker, J.J.
de Vries-vander Zwan, H.M.
Vliet Vlieland, T.P.M.
Int J Integr Care
Research and Theory
PURPOSE: To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists. METHODS: In two regions in The Netherlands continuing education (CE) programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction. RESULTS: Sixty-three physical therapists out of 193 practices (33%) participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months. CONCLUSIONS: Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale.
Igitur, Utrecht Publishing & Archiving Services
2004-07-23
/pmc/articles/PMC1393271/
/pubmed/16773150
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932722006-06-12ijicarepmc-open
Epidemic of care: a call for safer, better and more accountable health care
Wognum, Peter
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-08-02
/pmc/articles/PMC1393272/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932732006-06-12ijicarepmc-open
Problem-based learning for health improvement: practical public health for every professional
Adamiak, Grazyna Teresa
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-10-11
/pmc/articles/PMC1393273/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932742006-06-12ijicarepmc-open
An evaluation of a multidisciplinary team for intermediate care at home
Beech, Roger
Russell, Wanda
Little, Richard
Sherlow-Jones, Sally
Int J Integr Care
Projects and Developments
BACKGROUND: The implementation of the National Health Service Plan for the UK will see an expansion of services for intermediate care. Such services are usually targeted at older people and aim to: prevent ‘avoidable’ admissions to acute inpatient care; facilitate the timely discharge of patients from acute inpatient care; promote patient rehabilitation. A range of services might fall under the banner of intermediate care. They are usually delivered in patients' homes or in non-acute institutions. This paper describes an evaluation of a multidisciplinary Rapid Response Team (RRT). This service aimed to provide a home based alternative to care previously provided in an acute hospital bed which was acceptable to patients and carers and which maintained clinical care standards. The service was provided for the population of Hereford, a rural town in the middle of England. METHODS: A mixed-method descriptive design using quantitative and qualitative techniques was used to monitor: the characteristics of service users, the types and amounts of care received, any ‘adverse’ events arising from that care, and the acceptability of the service to patients and carers. A collaborative approach involving key stakeholders allowed appropriate data to be gathered from patient case notes, RRT staff, local health and social care providers, and patients and their carers. A suite of self-completed questionnaires was, therefore, designed to capture study data on patients and activities of care, and workshops and semi-structured interview schedules used to obtain feedback from users and stakeholders. RESULTS: Service users (231) were elderly (mean age 75.9), from three main diagnostic categories (respiratory conditions 19.0%, heart/stroke 16.2%, falls 13.4%), with the majority (57.0%) having both medical and social care needs. All patients received care at home (mean duration 5.6 days) with only 5.7% of patients having to be re-admitted to acute care. Overall, patients and carers had positive attitudes to the new service but some expressed concerns about their ability to influence the choice of care option (24.1% and 25.0% of patients and carers, respectively), whilst 22.7% of carers were concerned about the quality of information about care. CONCLUSIONS: Both the nature of schemes for intermediate care, and the policy context in which they are introduced, mean that pragmatic methodologies are often required to evaluate their impacts. Unfortunately, this need for pragmatism can then mean that it is difficult to reach definitive conclusions about the merits of schemes. However, the findings of this evaluation suggest that the Rapid Response Team provided an ‘acceptable’ alternative to an extended period of care in an acute setting. Such schemes may have relevance beyond the NHS of the UK as a means of providing a more appropriate and cost efficient match between patients' needs for care, the types of care provided, and the place in which care is provided.
Igitur, Utrecht Publishing & Archiving Services
2004-10-04
/pmc/articles/PMC1393274/
/pubmed/16773151
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932752006-06-12ijicarepmc-open
Getting health reform right: a guide to improving performance and equity
Karlberg, Ingvar
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-11-05
/pmc/articles/PMC1393275/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932762006-06-12ijicarepmc-open
Primary care in urban disadvantaged communities
Matejic, Bojana
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2004-11-24
/pmc/articles/PMC1393276/
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932772006-06-12ijicarepmc-open
Inter-organisational integration for rehabilitation in Sweden – variation in views on long-term goals
Sandström, Ulla
Axelsson, Runo
Stålsby, Cecilia
Int J Integr Care
Projects and Developments
PURPOSE: The aim was to study variation in views on long-term goals expressed by members in a project concerning rehabilitation of individuals in an area in mid Sweden. The organisations participating were the municipal social services, the county council's health care organisation, the governmental social insurance office, the national employment service and the national labour market institute. THEORY: A number of different meanings of the concept of integration are accounted for and the background of inter-organisational rehabilitation in Sweden is described. METHODS: Qualitative interviews using a semi-structured interview guide with altogether 20 leading representatives of the various organisations, all members of the Steering Committee of the project. The analysis consisted of two parts: an in-depth analysis using a phenomenographically inspired approach and qualitative content analysis. RESULTS: Two main views regarding the goal of inter-organisational integration were identified in the in-depth analysis: Category A, which regards integration as a new approach to rehabilitation, and Category B, which regards integration as a way of rendering the existing organisations more efficient. The content analysis showed a wide variation in spontaneously mentioned topics e.g. on the task of the group. CONCLUSIONS AND DISCUSSION: There exists a risk that divergent views in the Steering Committee concerning the future direction of the collaboration may send mixed messages providing uneven support for the professionals within the different organisations. The study points to the importance of having a common vision and common, well-defined goals at the outset of a collaborative project in order to support micro-level cooperation.
Igitur, Utrecht Publishing & Archiving Services
2004-12-15
/pmc/articles/PMC1393277/
/pubmed/16773152
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13932782006-06-12ijicarepmc-open
Activating chronic kidney disease patients and family members through the Internet to promote integration of care
Trisolini, Michael
Roussel, Amy
Zerhusen, Eileen
Schatell, Dorian
Harris, Shelly
Bandel, Karen
Salib, Philip
Klicko, Kristi
Int J Integr Care
Research and Theory
PURPOSE: To describe the potential role of the Internet as a vehicle for improving integration of care through activating chronic kidney disease patients and their family members. Also, to describe how that potential is being developed through a website sponsored by the Medicare program in the United States. BACKGROUND: The Internet is expanding at a rapid rate, and health-related websites are one of its most popular features. Efforts to promote integration of care have focused mainly on providers up to now, and more emphasis is needed on the potential roles of patients. Chronically ill patients have particular needs for improved education about their conditions and enhanced involvement in care planning and treatment decisions. Medicare developed the Dialysis Facility Compare website to serve those goals for people with chronic kidney disease. METHODS: We conducted qualitative research with 140 chronic kidney disease patients and family members, and 130 renal care professionals to evaluate and improve the Dialysis Facility Compare website. A series of 19 focus groups, 13 triads (small focus groups), and 56 individual interviews were conducted in four regions of the United States and by telephone. RESULTS: We found that the Dialysis Facility Compare website has the potential to improve integration of care for people with chronic kidney disease in at least three ways. First: by expanding the roles of patients as members of the multi-disciplinary team of caregivers treating their disease. Second: through better integration of the informal care provided in the home and community with the formal care provided by health professionals. Third: by improving coordination of between care provided in the pre-dialysis and dialysis phases of the disease. DISCUSSION: We developed recommendations for revising and enhancing the Dialysis Facility Compare website in a number of ways to better promote patient activation and integration of care. The unique features of the Internet, such as its different dimensions of interactivity, and applications of behavioural theories for website design should also be further explored.
Igitur, Utrecht Publishing & Archiving Services
2004-10-15
/pmc/articles/PMC1393278/
/pubmed/16773153
Text
en
Copyright 2004, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955052006-06-12ijicarepmc-open
Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury
Bloemen-Vrencken, J.H.A.
de Witte, L.P.
Engels, J.P.G.M.
van den Heuvel, W.J.A.
Post, M.W.M.
Int J Integr Care
Projects and Developments
PURPOSES: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. METHODS: The transmural care model was developed in cooperation with the Dutch Association of Spinal Cord Injured Patients, community nurses, general practitioners, rehabilitation nurses, rehabilitation managers, physiatrists and researchers. The core component of the care model consists of a transmural nurse, who ‘liaises’ between people with SCI living in the community, professional primary care professionals and the rehabilitation centre. The transmural care model provides a job description containing activities to support people with SCI and their family/partners and activities to promote continuity of care. The transmural care model was implemented in two Dutch rehabilitation centres. The following three aspects, as experienced by the transmural nurses, were evaluated: the extent to which the care model was implemented; enabling factors and barriers for implementation; strength and weakness of the care model. RESULTS: The transmural care model was not implemented in all its details, with a clear difference between the two rehabilitation centres. Enabling factors and barriers for implementation were found at three levels: 1. the level of the individual professional (e.g. competencies, attitude and motivation), 2. the organisational and financing level (e.g. availability of facilities and finances), and 3. the social context (the opinion of colleagues, managers and other professionals involved with the care). The most important weakness experienced was that there was not enough time to put all the activities into practice. The strength of the care model lies in the combination of support of patients after discharge, support of and cooperation with primary care professionals, and feedback of experiences to the clinical rehabilitation teams. CONCLUSION: We recommend further improving and implementing the care model and encourage other care professionals and researchers to share their implementation experiences of follow-up care innovations for people with SCI.
Igitur, Utrecht Publishing & Archiving Services
2005-06-01
/pmc/articles/PMC1395505/
/pubmed/16773154
Text
en
Copyright 2005, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955062006-06-12ijicarepmc-open
Keep primary health care personal!
Schrijvers, Guus
Freeman, George K.
Int J Integr Care
Editorial
Igitur, Utrecht Publishing & Archiving Services
2005-05-25
/pmc/articles/PMC1395506/
/pubmed/16773155
Text
en
Copyright 2005, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955072006-06-12ijicarepmc-open
Publishing the names of reviewers
Schrijvers, Guus
Manten, Erika
Int J Integr Care
Editorial
Igitur, Utrecht Publishing & Archiving Services
2005-06-08
/pmc/articles/PMC1395507/
Text
en
Copyright 2005, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955082006-06-12ijicarepmc-open
Quebec mental health services networks: models and implementation
Fleury, Marie-Josée
Int J Integr Care
Research and Theory
PURPOSE: In the transformation of health care systems, the introduction of integrated service networks is considered to be one of the main solutions for enhancing efficiency. In the last few years, a wealth of literature has emerged on the topic of services integration. However, the question of how integrated service networks should be modelled to suit different implementation contexts has barely been touched. To fill that gap, this article presents four models for the organization of mental health integrated networks. DATA SOURCES: The proposed models are drawn from three recently published studies on mental health integrated services in the province of Quebec (Canada) with the author as principal investigator. DESCRIPTION: Following an explanation of the concept of integrated service network and a description of the Quebec context for mental health networks, the models, applicable in all settings: rural, urban or semi-urban, and metropolitan, and summarized in four figures, are presented. DISCUSSION AND CONCLUSION: To apply the models successfully, the necessity of rallying all the actors of a system, from the strategic, tactical and operational levels, according to the type of integration involved: functional/administrative, clinical and physician-system is highlighted. The importance of formalizing activities among organizations and actors in a network and reinforcing the governing mechanisms at the local level is also underlined. Finally, a number of integration strategies and key conditions of success to operationalize integrated service networks are suggested.
Igitur, Utrecht Publishing & Archiving Services
2005-06-01
/pmc/articles/PMC1395508/
/pubmed/16773157
Text
en
Copyright 2005, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955092006-06-12ijicarepmc-open
Values in professional practice: lessons for health, social care and other professionals
Freeman, George
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-04-27
/pmc/articles/PMC1395509/
Text
en
Copyright 2005, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955102006-06-12ijicarepmc-open
Integrated service delivery to ensure persons’ functional autonomy
Haneveld, R.W.
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-04-27
/pmc/articles/PMC1395510/
Text
en
Copyright 2005, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955112006-06-12ijicarepmc-open
Complexity and healthcare organization: a view from the street
Sturmberg, Joachim P.
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-04-27
/pmc/articles/PMC1395511/
Text
en
Copyright 2005, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955122006-06-12ijicarepmc-open
Integrating services for older people: a resource book for managers
Tousignant, Michel
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-06-20
/pmc/articles/PMC1395512/
Text
en
Copyright 2005, International Journal of Integrated Care (IJIC)
oai:pubmedcentral.nih.gov:13955132006-06-12ijicarepmc-open
Evaluating integrated health care: a model for measurement
Ahgren, Bengt
Axelsson, Runo
Int J Integr Care
Research and Theory
PURPOSE: In the development of integrated care, there is an increasing need for knowledge about the actual degree of integration between different providers of health services. The purpose of this article is to describe the conceptualisation and validation of a practical model for measurement, which can be used by managers to implement and sustain integrated care. THEORY: The model is based on a continuum of integration, extending from full segregation through intermediate forms of linkage, coordination and cooperation to full integration. METHODS: The continuum was operationalised into a ratio scale of functional clinical integration. This scale was used in an explorative study of a local health authority in Sweden. Data on integration were collected in self-assessment forms together with estimated ranks of optimum integration between the different units of the health authority. The data were processed with statistical methods and the results were discussed with the managers concerned. RESULTS: Judging from this explorative study, it seems that the model of measurement collects reliable and valid data of functional clinical integration in local health care. The model was also regarded as a useful instrument for managers of integrated care. DISCUSSION: One of the main advantages with the model is that it includes optimum ranks of integration beside actual ranks. The optimum integration rank between two units is depending on the needs of both differentiation and integration.
Igitur, Utrecht Publishing & Archiving Services
2005-08-31
/pmc/articles/PMC1395513/
/pubmed/16773158
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Commentary: “Evaluating integrated health care: a system of measurement”
Browne, Gina
Int J Integr Care
Guest Editorial
Igitur, Utrecht Publishing & Archiving Services
2005-08-31
/pmc/articles/PMC1395514/
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Brief commentary on “Evaluating integrated health care: a model for measurement”
Gould, Nick
Warner, Morton
Int J Integr Care
Guest Editorial
Igitur, Utrecht Publishing & Archiving Services
2005-08-31
/pmc/articles/PMC1395515/
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A managed clinical network for cardiac services: set-up, operation and impact on patient care
E StC Hamilton, Karen
M Sullivan, Frank
T Donnan, Peter
Taylor, Rex
Ikenwilo, Divine
Scott, Anthony
Baker, Chris
Wyke, Sally
Int J Integr Care
Research and Theory
PURPOSE: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. METHODS: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. RESULTS: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference in resource use. DISCUSSION AND CONCLUSIONS: The Managed Clinical Network made a difference to ways of working, particularly in breaching traditional boundaries and involving the public, and made modest changes in patient care. However, it required a two-year “set-up” period. Managed clinical networks are complex initiatives with an increasing profile in health care policy. This study suggests that they require energetic leadership and improvements are likely to be slow and incremental.
Igitur, Utrecht Publishing & Archiving Services
2005-09-09
/pmc/articles/PMC1395516/
/pubmed/16773161
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Nurses’ information management at patients’ discharge from hospital to home care
Hellesø, Ragnhild
Sorensen, Lena
Lorensen, Margarethe
Int J Integr Care
Research and Theory
PURPOSE: The purpose of this paper is to explore and compare hospital and home care nurses’ assessment of their information management at patients’ discharge from hospital to home care before and after the hospital implemented an electronic nursing discharge note. THEORY: This paper draws on the concept of inter-organizational continuity of care, and specifically addresses the contribution of the implementation of an electronic patient record (EPR). METHODS: The study has a prospective descriptive design. A questionnaire addressing the information that hospital and home care nurses exchange when patients need continuing care after hospitalization was developed and used. RESULTS: Hospital and home care nurses differed in the way they assessed the structures and content of the information they exchanged, both before and after the EPR implementation. CONCLUSION AND DISCUSSION: There is a need to take account of the different organizational contexts within which the two nursing groups work. The organizational context (hospital versus home care) has implications for the nurses’ assessment of the information they exchange. In further development of EPR, it is therefore essential to clarify the context-related information needs of the various health care provider groups as part of the commitment to patient safety.
Igitur, Utrecht Publishing & Archiving Services
2005-07-08
/pmc/articles/PMC1395517/
/pubmed/16773162
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oai:pubmedcentral.nih.gov:13955182006-06-12ijicarepmc-open
Vernetzte Versorgung für ältere Menschen in Deutschland
Jedeloo, Susan
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-07-06
/pmc/articles/PMC1395518/
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Organisational development in healthcare: approaches, innovations, achievements
Mur-Veeman, Ingrid
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-09-09
/pmc/articles/PMC1395519/
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en
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A cross sectional study of assessed need and multiple service use among a self harm population: informing the development of inter-agency integrated care
Keene, J.
Int J Integr Care
Research and Theory
PURPOSE: To examine assessed need and wider health and social care service contact for a total Deliberate Self Harm (DSH) population in the UK. METHODS: The study first recorded assessed needs and referrals for this population, then used a new method of identifying and describing all other agency contacts for this population by combining the total anonymised DSH population data with total mental health, health and social care agency populations for one geographical area. RESULTS: For a DSH unit population of 427, half (53%) were assessed with mental health and 18% with drug or alcohol problems; two thirds were referred to appropriate services. Wider service contact for a total DSH population (n=2,205 over three years) confirmed that 53% had contacted mental health (compared to 2.9% of the geographical area population (n=646,239) and 7.4% of the total hospital Emergency population (n=91,911). The DSH population was three times more likely to contact social care agencies (21.1%: 7.2%) and ten times more likely to attend drug (7.3%: 0.7%) and alcohol agencies (8.8%: 0.8%) CONCLUSIONS: This new method described the wider service use of one vulnerable shared care population, it is suggested that the method could be used to inform the development of integrated care initiatives in different areas.
Igitur, Utrecht Publishing & Archiving Services
2005-09-22
/pmc/articles/PMC1395520/
/pubmed/16773163
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Making a difference?: exploring the impact of multi-agency working on disabled children with complex health care needs, their families and the professionals who support them
Glendinning, Caroline
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-10-03
/pmc/articles/PMC1395521/
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en
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Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period
Leutz, Walter
Nonnenkamp, Lucy
Dickinson, Lynn
Brody, Kathleen
Int J Integr Care
Research and Theory
PURPOSE: Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO) demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB) care at Kaiser Permanente Northwest (KPNW), serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC). METHODS: We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. RESULTS: During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180) and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day care, respite care, and dentures. Rising costs per month per SHMO member reflected increasing HCB eligibility rather than costs per member with HCB care, which actually fell from $6,164 in 1989 to $4,328 in 2002. Care management accounted for about one-quarter of community care costs since 1992. CONCLUSIONS: The Kaiser Permanente Northwest SHMO served an increasingly aged and disabled membership by reducing costs per HCB member care plan and shifting utilization to a broad range of community care services. Supported by a disability-based Medicare payment formula and by SHMO beneficiaries willing to pay increasing premiums, KPNW has been able to offer comprehensive community care. The model could be replicated by other HMOs with the support of favorable federal policies.
Igitur, Utrecht Publishing & Archiving Services
2005-10-19
/pmc/articles/PMC1395522/
/pubmed/16773166
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Steering integrated care in England and the Netherlands: the case of dementia care: a neo-institutionalist comparative study
Manthorpe, Jill
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-10-12
/pmc/articles/PMC1395523/
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Prevention and cure should be integrated
Schrijvers, Guus
Int J Integr Care
Editorial
Igitur, Utrecht Publishing & Archiving Services
2005-11-02
/pmc/articles/PMC1395524/
/pubmed/16773167
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Involving patients and the public: how to do it better. Second edition
De Paepe, Pierre
Unger, Jean-Pierre
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-03-16
/pmc/articles/PMC1395525/
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Integrated care for patients with a stroke in the Netherlands: results and experiences from a national Breakthrough Collaborative Improvement project
Minkman, M.M.N.
Schouten, L.M.T.
Huijsman, R.
van Splunteren, P.T.
Int J Integr Care
Projects and Developments
PURPOSE: This article considers the question if measurable improvements are achieved in the quality of care in stroke services by using a Breakthrough collaborative quality improvement model. CONTEXT OF CASE: Despite the availability of explicit criteria, evidence based guidelines, national protocols and examples of best practices; stroke care in the Netherlands did not improve substantially yet. For that reason a national collaborative started in 2002 to improve integrated stroke care in 23 self selected stroke services. DATA SOURCES: Characteristics of sites, teams, aims and changes were assessed by using a questionnaire and monthly self-reports of teams. Progress in achieving significant quality improvement has been assessed on a five point Likert scale (IHI score). CASE DESCRIPTION: The stroke services (n=23) formed multidisciplinary teams, which worked together in a collaborative based on the IHI Breakthrough Series Model. Teams received instruction in quality improvement, reviewed self reported performance data, identified bottlenecks and improvement goals, and implemented “potentially better practices” based on criteria from the Edisse study, evidence based guidelines, own ideas and expert opinion. CONCLUSION AND DISCUSSION: Quality of care has been improved in most participating stroke services. Eighty-seven percent of the teams have improved their care significantly on at least one topic. About 34% of the teams have achieved significant improvement on all aims within the time frame of the project. The project has contributed to the further development and spread of integrated stroke care in the Netherlands.
Igitur, Utrecht Publishing & Archiving Services
2005-03-23
/pmc/articles/PMC1395526/
/pubmed/16773169
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Clinical governance in primary care. Second edition
van Oosterbos, Han
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-01-19
/pmc/articles/PMC1395527/
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en
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A literature review to explore integrated care for older people
Reed, Jan
Cook, Glenda
Childs, Sue
McCormack, Brendan
Int J Integr Care
Research and Theory
PURPOSE: This paper reports on some of the findings of a literature review commissioned to explore integrated care for older people. METHODS: The process of revising included finding and selecting literature from multidisciplinary sources, and encompassed both published papers and ‘grey’ literature, i.e. material which had not been reviewed for publication. RESULTS: The study found that thinking has moved on from a focus on the problems of accessing services to exploring ways in which they may function in an integrated way. CONCLUSIONS: The study shows how thinking on integrated care for older people has developed, and knowledge of micro, mezzo and macro strategies is now more available.
Igitur, Utrecht Publishing & Archiving Services
2005-01-14
/pmc/articles/PMC1395528/
/pubmed/16773170
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Patient-centered medicine: transforming the clinical method. Second edition
Wang, Ying Ying
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-01-21
/pmc/articles/PMC1395529/
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Advancing integrated care for older people through EU policy & a European research agenda on integrated care for older people
Kodner, Dennis L.
Int J Integr Care
Books
Igitur, Utrecht Publishing & Archiving Services
2005-10-19
/pmc/articles/PMC1475727/
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en
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Integrated mental health services in England: a policy paradox
England, Elizabeth
Lester, Helen
Int J Integr Care
Policy
PURPOSE: The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. DATA SOURCES: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. CONCLUSION: We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. DISCUSSION: We conclude with suggestions for strategies that may facilitate more integrated working.
Igitur, Utrecht Publishing & Archiving Services
2005-10-03
/pmc/articles/PMC1475728/
/pubmed/16773165
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Coordinating health care: lessons from Norway
Tjerbo, Trond
Kjekshus, LarsErik
Int J Integr Care
Research and Theory
OBJECTIVE: What influences the coordination of care between general practitioners and hospitals? In this paper, general practitioner satisfaction with hospital—GP interaction is revealed, and related to several background variables. METHOD: A questionnaire was sent to all general practitioners in Norway (3388), asking their opinion on the interaction and coordination of health care in their district. A second questionnaire was sent to all the somatic hospitals in Norway (59) regarding formal routines and structures. The results were analysed using ordinary least squares regression. RESULTS: General practitioners tend to be less satisfied with the coordination of care when their primary hospital is large and cost-effective with a high share of elderly patients. Together with the degree to which the general practitioner is involved in arenas where hospital physicians and general practitioners interact, these factors turned out to be good predictors of general practitioner satisfaction. IMPLICATION: To improve coordination between general practitioners and specialists, one should focus upon the structural traits within the hospitals in different regions as well as creating common arenas where the physicians can interact.
Igitur, Utrecht Publishing & Archiving
2005-11-02
/pmc/articles/PMC1475729/
/pubmed/16773168
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Functional status measures for integrating medical and social care
Stineman, Margaret G.
Ross, Richard N.
Maislin, Greg
Int J Integr Care
Research and Theory
PURPOSE: Identify standard self-report questions about functioning suitable for measuring disability across integrated health and social services. THEORY: Functional activities can be validly grouped according to the International Classification of Functioning, Disability and Health (ICF) chapters of mobility, self-care, and domestic life. METHODS: Cross-sectional analysis using information on 112,601 persons interviewed as part of the United States National Health Interview Survey on Disability. We combined related sets of questions and tested the appropriateness of their groupings through confirmatory factor analyses. Construct validity was addressed by seeking to confirm clinically logical relationships between the resulting functional scales and related health concepts, including number of physician contacts, number of bed days, perception of illness, and perception of disability. RESULTS: Internal consistency for the summed scales ranged from 0.78 to 0.92. Correlations between the functional scales and related concepts ranged from 0.12 to 0.52 in directions consistent with expectations. CONCLUSIONS: Analyses supported the 3 ICF chapters. DISCUSSIONS: The routine collection of this core set of functions could enhance decision-making at the client, professional, organizational, and policy levels encouraging cooperation among the medical and social service sectors when caring for people with disabilities.
Igitur, Utrecht Publishing & Archiving
2005-12-21
/pmc/articles/PMC1475730/
/pubmed/16773164
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