International Journal of Integrated Care最新文献

[This corrects the article DOI: 10.5334/ijic.7881.].

Introduction: The integration of services is often driven by the belief that integration will lead to better outcomes for service users. However, there is a paucity of robust evidence exploring the relationship between integration and outcomes. This study sought to determine whether the integration of health and social care services via Health and Social Care Partnerships has led to a measurable change in outcomes for Scotland's children and young people.

Methods: Multilevel models were applied to routinely collected administrative data to determine whether different approaches to structural integration were related to changes in a range of outcomes for children and young people. The modelling approach accounted for confounding factors such as economic conditions and the COVID-19 pandemic.

Results: The analysis found no consistent evidence of an association between the structural integration of services and changes in outcomes for children and young people. However, external factors such as deprivation and the COVID-19 pandemic were found to be linked to changes in outcomes across various areas of children's lives.

Conclusions: The findings highlight the complexity in attributing changes in outcomes to a specific intervention or reform, particularly in the presence of wider socio-economic factors. Understanding the influence of systems-level change may not be fully possible using routinely collected data alone, and any methods used to assess impact should be underpinned by an underlying theory of change.

As Singapore's population ages, community hospitals must evolve to meet increasingly complex care needs. In this perspective, we share reflections from leading the Community Hospital of the Future (CHoF) pilot at Jurong Community Hospital-a national initiative to enhance intermediate care. The pilot introduced proactive screening, expanded diagnostic capabilities, and intensified rehabilitation services. We reflect on the operational and policy challenges encountered, including fragmented data systems, workforce limitations, and financing gaps. The CHoF experience offers practical insights for other health systems seeking to strengthen sub-acute care as part of an integrated care strategy for ageing populations.

This thesis shifts attention from networks as well-demarcated governance structures to seeing networks as dynamic and emerging social phenomena. Drawing on ethnographic fieldwork in Dutch older person and hospital care, it explores how networking unfolds in everyday governance actions and interactions of affected actors, and with which consequences for their role and work. This thesis calls for a recalibration of network thinking, highlighting the multiple, ongoing, place-based, multi-layered, and multi-purpose nature of networking. Rather than romanticizing network governance, this thesis offers a critical-pragmatist perspective, inviting a 'romantic-realist' engagement with the lived messiness of networks as a governance order-in-the-making amidst healthcare reforms.

Introduction: The integration of volunteers into healthcare has become increasingly relevant for improving patient care and addressing systemic resource constraints. In pediatric settings, volunteers offer essential emotional and personalized support. However, their collaboration with healthcare professionals is often hindered by challenges such as role ambiguity, limited space, and insufficient communication.

Description: This study investigates the dynamics of collaboration between healthcare professionals and volunteers in pediatric hospital care. Drawing on narrative interviews with 25 volunteers from an Italian organization, it explores lived experiences and identifies key factors shaping volunteer-professional interactions. The findings are categorized into two main dimensions: organizational arrangements and interpersonal dynamics.

Discussion: Facilitators of effective collaboration include temporal continuity, access to dedicated spaces, shared training initiatives, and improved communication. Barriers such as staff turnover, lack of formal recognition, and unclear role boundaries can undermine volunteer engagement. Informal relationship-building and structured information sharing were found to enhance cooperation and care quality.

Conclusion: The study highlights the need to strengthen both structural and relational aspects of volunteer integration in pediatric care. By addressing these dynamics, healthcare institutions can enhance volunteer contributions, improve patient experience, and support the broader implementation of integrated care models.

Objectives: To develop the vertical professional collaborative evaluation tools to promote the establishment of integrated healthcare system in China.

Method: Based on the previous theoretical framework, the evaluation system was developed and 450 doctors and other health professionals in tight county healthcare alliance in D county of H province were selected and interviewed. Through stratified cluster equal proportion random sampling method with an effective recovery rate of 93.33%, reliability and validity were tested with exploratory factor analysis, Cronbach's α and structural equation model method.

Results: The cumulative contribution rate of the five common factors was 72.23%, the Cronbach's α of whole is 0.846. Except for the common factor F4, the Cronbach's α of other common factors were greater than 0.7. The component reliability (CR) of 5 common factors were all greater than 0.7 and the average coefficients of variation extraction (AVE) were all greater than 0.6. In the revised model (M1), the P values of the standard regression coefficients of F1, F2, F3, F4 and those of the corresponding items and factors were all smaller than 0.05, and the model fitting indexes of were all better than those of the initial model (M0).

Conclusions: The vertical professional collaborative evaluation tools of healthcare system constructed in this paper contain 4 dimensions: (1) Value compatibility and trust, defined as the alignment of health-related values, cultural norms, and behavioral expectations across different provider levels (e.g., primary vs. tertiary care) and specialties (e.g., physicians vs. nurses), operationalized through shared decision-making and perceived reliability; (2) Communication and coordination mechanisms, encompassing systems for bidirectional information flow (e.g., standardized referral protocols, interoperable IT platforms) and procedural safeguards to enable cross-disciplinary collaboration; (3) Incentive and constraint mechanisms, referring to policy tools (financial/non-financial rewards, accountability metrics) designed to motivate or regulate collaborative behaviors; and (4) Structure and strength of collaborative relationships, characterized by the topology (e.g., network centrality) and resilience of inter-provider connections, measured through interaction frequency and resource-sharing patterns.,; 8 factors and 15 items whose overall reliability and validity were good and has certain applicability in China. Given regional sociocultural diversity, the findings require validation through broader case studies.

Background: People experiencing homelessness (PEH) face major barriers to accessing healthcare, including cancer preventive services, which results in increased cancer morbidity and mortality. However, tailored integrated care interventions addressing these disparities are scarce.

Methods: Using a qualitative, participatory approach, seven focus group discussions were conducted with 15 PEH and 41 health and social care professionals in Austria, Greece, Spain, and the UK. Data were thematically analysed using a framework based on ten core components of navigation interventions.

Results: Collaborative discussions led to a consensus on the Health Navigator Model (HNM), designed to improve cancer prevention for PEH. This model introduces "health navigators" from health and social care backgrounds to identify health needs, raise cancer awareness, coordinate healthcare access, and provide practical support. Thematic analysis ensured consistency across countries, shaping a person-centred approach. Comprehensive training and supervision were identified as critical for the effectiveness of the HNM.

Conclusion: The co-design approach allowed PEH and professionals to actively shape the intervention, addressing gaps in cancer prevention. The HNM offers a structured, internationally consistent model that could bridge access gaps in cancer care for PEH. Further research using implementation science frameworks is needed to evaluate its effectiveness in real-world settings.

Introduction: The Building an Integrated Community Care Model was a two-year program to support older adults in receiving home and community care services from organizations within the VCS sector in the City of Sarnia and Lambton County, Ontario, Canada.

Description: The ICCM program launched with grant funding from the Ontario Ministry of Health. A goal-based evaluation design was used to assess the implementation and impact of the program. We collected and analyzed data from monthly status reports, surveys of service providers, and client/patient satisfaction surveys, data from key informant interviews, one focus group with service providers, and a reflective discussion.

Discussion: Providers were able to overcome challenges and achieve benefits linked to short-term outcomes. Shared goals amongst providers facilitated the implementation and integration of services. Socially isolated older adults were better served, new partnerships were formed, and community-based initiatives were created. A supportive network of service providers and system planners was created, enhancing the capacity of providers to meet community needs.

Conclusion: This was a complex initiative with multiple organizations coming together in a voluntary governance structure to implement disparate projects. Learnings may be useful to others seeking to implement and assess integrated community care programs for older adults.