International Journal of Integrated Care最新文献

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.

Introduction: Patients with multiple autoimmune diseases lack continuity of care due to increasing specialisation and siloed practice in healthcare. Despite improvements in quality, this organisation has led to fragmented patient pathways, as related diseases are treated separately. Limited research has investigated approaches to integrate care for patients with co-occurrent Inflammatory Joint Disease and Inflammatory Bowel Disease, with minimal emphasis on the patient perspective. The aim was to describe the Rheumatology-Gastroenterology Clinic (ReGa), characterise its population, and investigate patient experiences.

Description: A Danish outpatient clinic combining rheumatology and gastroenterology.

Results: During the study period, 54 patients attended the ReGa clinic. Prior to integration, these patients had an average of 29.6 outpatient visits. With most working-age patients, this frequent attendance poses individual and societal challenges. Based on Haggerty et al.'s definition of continuity of care, relational elements emerged as particularly important for patients but not independent of informational and management factors.

Conclusion: The integrated approach was experienced to improve continuity of care for patients with multiple autoimmune diseases. The findings highlight the potential to bridge healthcare gaps and address challenges arising from organisational structures shaped by specialisation and compartmentalisation of knowledge. This approach may also benefit other patient groups with comorbid conditions.

Current insights into how to personalise supportive care for patients with immune-mediated inflammatory disorders (IMIDs) remain limited. Enhancing supportive care can significantly improve patients' quality of life and overall healthcare. The Subjective Health Experience (SHE) model offers a practical framework for segmenting patients based on disease acceptance and control, potentially guiding tailored supportive care. This qualitative study had two aims: explore patient characteristics (behaviours, questions, and needs) within each SHE Segment; and determine required supportive care per Segment by identifying the what (specific types of supportive healthcare) and the how (approach of healthcare delivery). Group discussions and individual interviews were conducted with 19 healthcare professionals in rheumatology, gastroenterology, and dermatology, and 18 patients diagnosed with rheumatoid arthritis/spondyloarthritis, Crohn's disease/ulcerative colitis, or psoriasis/hidradenitis suppurativa. Findings revealed consistent patterns across IMIDs regarding healthcare needs. Patients emphasised the importance of attention and acknowledgement, while healthcare professionals focused on structure and planning. Detailed Segment descriptions supported development of a structured framework aligning supportive care types and delivery approaches with each SHE Segment. Overall, these results support the SHE framework as a guidance for coordinating supportive care across conditions, professionals, and care levels, enhancing its operational use in IMID care to improve personalisation and continuity.

Background: Complex interventions are frequently used at different levels in healthcare. The main aim of this paper is to describe a method for conducting a feasibility study in preparation of an evaluation study for a complex intervention by substantiating several essential methodological choices. These choices are (A) establishing the most appropriate outcomes and instruments to measure them, including comprehensibility of questionnaires for study participants, (B) exploring the distribution and size of these outcomes in the patient target population and (C) quantifying key assumptions for the sample size calculation. We describe this method through the example of our feasibility study on a person-centered and integrated care (PC-IC) approach for multimorbidity and chronic conditions in general practice.

Methods: In 2021 we conducted a feasibility study in 7 general practices in three regions in the Netherlands. These practices replaced their standard disease management programs for diabetes mellitus type 2, cardiovascular disease, chronic obstructive pulmonary disease, and asthma with the PC-IC approach. Systematically selected questionnaires were administered to eligible patients at baseline and at 6 months, and comprehensibility of the questionnaires was assessed. We defined a composite outcome by comparing different scenarios for combining the questionnaire scores.

Results: The method for thoroughly designing an evaluation study for a complex healthcare intervention consisted of several steps. First, the measurement instruments for the feasibility study were chosen after a structured literature search, consulting experts, checking the questionnaires for comprehensibility by patients, and a consensus meeting with the project team. Next, the questionnaires were applied in the study target population for a period of 6 months. The results were then analysed to explore the distribution and size of these outcomes. Subsequently we assessed the most appropriate outcomes, which led to the creation of a composite outcome in our example. The final step was performing a sample size calculation based on the results of the feasibility study.

Conclusions: Using the described method, we conducted a feasibility study to prepare the evaluation of a complex intervention in Dutch general practice. Our paper is useful for other researchers preparing evaluation studies on complex interventions.