International Journal of Integrated Care最新文献

Introduction: Following hospitalization, older adults with complex health and social care needs are often deemed to need an "alternate level of care" (ALC) where care needs are misaligned with resources. Coordinated networks can implement integrated care programs for this group in home settings. Understanding the experiences of providers, caregivers, and patients will inform ongoing implementation efforts.

Methods: A qualitative case study was undertaken of North York Community Access to Resources Enabling Support (NYCARES), a novel integrated care program implemented during the COVID-19 pandemic. Data collection consisted of semi-structured interviews, document analysis, and observational field notes; data were thematically analyzed.

Results: Thirty-six providers, caregivers, and patients were interviewed. Three themes were developed: 1) NYCARES as a lifeline; 2) Experiences tempered by expectations and connection; and 3) The role of integrated care.

Discussion: The NYCARES program was seen as valuable, but implementation posed challenges for each participant group due to varying expectations and perceived degree of connection between patients, families, and providers.

Conclusions: The local coordinated network successfully implemented the NYCARES program for ALC patients despite challenges in stakeholder connections. Similar programs should formally support caregivers and forefront multidirectional communication, particularly between providers in different implementation roles.

Introduction: The healthcare response to the COVID-19 pandemic in long term care facilities (LTCF), constitutes one of the challenges faced by governments and institutions worldwide. Our aim was to analyze the facilitators and barriers of this response, for the future integrated care model in these facilities.

Methods: From a retrospective observational study, we present the experience and lessons learned of the implementation of an integrated response at the meso level in LTCF for older people and for people with physical and mental conditions in the North Metropolitan area of Barcelona, in Catalonia, during the COVID-19 pandemic.

Results: We analyzed the care provided to 13,369 institutionalized people. The major facilitating points were: the adaptation of proactive care teams, the creation of a tool to improve communication with institutions, and the management of epidemiological data for planning collaboration between different actors. Main barriers were not including users and family members views in the response adaptation, and the lack of LTCF resources to respond to changing needs.

Conclusions: Increasing proactivity and adapting interventions based on updated information were key to minimize infections and mortality. Improving the communication and the collaboration between actors, and people involvement in the response planning, need to be considered for the future.

Introduction: Families experiencing adversity often have complex needs and face barriers to accessing health and social care. This study evaluated the acceptability, feasibility and preliminary effectiveness of a Wellbeing Coordination (WBC) program to improve access to services. The program combined care navigation and social prescribing within an integrated health and social care Child and Family Hub.

Methods: Mixed-methods design, with data collected through surveys and interviews from: 1) caregivers who participated in the WBC program (n = 11) and those who did not (n = 18), and 2) practitioners working in the Hub (n = 21).

Results: Caregivers and practitioners found the WBC program acceptable and mostly feasible, demonstrating the potential to alleviate caregivers' loneliness and enhance their health, connection to the community, and knowledge and confidence in supporting child and family health and wellbeing.

Discussion: Future WBC program enhancements could include a robust communication strategy to ensure what the program offers is clearly understood by practitioners and caregivers, establishing organisational structures to provide adequate support for the wellbeing coordinator and adopting flexible eligibility criteria.

Conclusion: The WBC program appears acceptable and feasible. Future research should establish program effectiveness with larger and more diverse caregiver samples.

Introduction: Value-based healthcare is a current global trend in health and policy where digital technologies can play an important role to measure what matters to the people. The digitalisation of value-based healthcare is only possible if the care team and people trust in this new concept and the tools provided. In this framework, a participatory co-desing approach was implemented to identify the core elements of an innovative value-based, integrated health and social care delivery model supported by ICT solutions: the VALUECARE model for older people with comorbidities.

Description: The main guiding principles for care delivery have been obtained by means of a literature review. Qualitative data was collected from 369 participants using focus groups and interviews in 6 European countries (Croatia, Ireland, Portugal, Italy, Spain & The Netherlands). The eHealth Enhanced Chronic Care Model was used as a heuristic tool to integrate the participants' discourses.

Discussion: The VALUECARE model fits with the features for the integrated care practice facilitating the transformation of care delivery addressing the needs of the growing old population and the rapidly development of technologies.

Conclusion: VALUECARE model highlights best practice value-based, integrated care delivery through the application of a set of 6 guiding principles across 7 different core elements.

This thesis explored the issue of coordination in the Belgian mental health sector, focusing on "network coordinators" introduced through public policies setting up local networks to counter fragmentation. Using a qualitative and ethnographic methodology, the author examined the work of these new professionals from four perspectives: instruments, practices, knowledge and experience. Describing the contours of a promising but unachievable mandate, this thesis explained the disillusionment that they experience. Finally, it took a critical look at these coordination initiatives by showing the rareness of the "successful coordinator" and highlighting the limits of the network model as it is currently conceived.

Introduction: Integrated care is crucial in delivering coherent and coordinated support to families with multiple and complex problems. Reorienting care organisations towards integrated care is a complex organisational change process. It requires both structural and behavioural adjustments. To learn about effective practice, it is useful to study implementation between contexts.

Description: This mixed methods case study provides a comparison over time of five regional teams simultaneously implementing an integrated care delivery mode. Group interviews identified whether and how different elements in the change approach helped or hindered the change progress.

Discussion: We describe and discuss how the teams were guided and supported in learning to make the behavioural switches associated with their new integrated mode of operation.

Conclusion: Our support-interventions appeared to be largely successful in fostering four pre-defined integrated care behaviours. This research took place during the Covid-19 pandemic, which was challenging but also brought unexpected benefits.

Introduction: Integrated care poses a significant challenge for healthcare policies in Japan as evaluation of hospital discharge services is limited. This study aimed to elucidate the effects of discharge services for elderly acute-care patients on preventing rehospitalisation.

Methods: A retrospective cohort study was conducted using national health data from Kita Ward, Tokyo. Survival analysis was performed with a Cox proportional hazards model, with readmission hazard ratios (HRs) as the primary endpoint. Subgroup analysis examined interactions between each discharge service category (dummy variable) and readmission.

Results: The study encompassed 6,681 subjects. The Cox model adjusted for age, gender, and complications revealed increased readmission events in the discharge service group (HR = 2.92, 95% CI 2.60-3.27). Subgroup analysis by age and length of hospital stay identified a preventive effect in the 85-year-old group (HR = 0.68, 95% CI 0.49-0.93) and 15-21-day length of stay group (HR = 0.73, 95% CI 0.53-1.01), suggesting that discharge services may inadvertently lower barriers to readmission due to healthcare system influences.

Conclusion: While discharge services may elevate readmission demand, they appear to have a preventive effect for individuals aged 85 and over or with an average length of stay of 15-21 days.

Introduction: Addressing challenges due to demographic changes and the quest for improved value in healthcare requires an extended integrated approach to care that fosters collaboration between all stakeholders, especially within collaboration supporting cognitively impaired patients. The aim is to review existing studies on interventions to improve communication and collaboration between such patients, their caregivers and healthcare staff.

Methods: Following PRISMA guidelines, we systematically searched electronic databases Medline (OVID), CINAHL (Ebsco), and Web of Science (Clarivate) for peer-reviewed literature [2010-2020] focusing on intervention studies. Papers were excluded if not assessing the impact of interventions or only presenting a study protocol.

Results: Twelve studies explored diverse approaches to social support, all with the aim of improving communication and collaboration among stakeholders, and identified three intervention types: supporting empowerment, promoting collaborative disease management, and coping, and enhancing communication and relationships.

Discussion: The interventions employed various approaches and assessed a range of outcomes, demonstrating the benefits of enhancing communication and collaboration among stakeholders. Yet only a few studies included the full triad of partners in care.

Conclusion: There is still much to be done to achieve the extended integration of care services and support that will benefit from patient and caregiver involvement.

Introduction: While the World Health Organization (WHO) advocates organizing maternity care and preventive child healthcare (PCHC) as people-centred, integrated healthcare services, globally these services are often established separately, causing discontinuity of care. Our aim is to synthesize the evidence concerning what impacts parents' experience of continuity of care, and how to promote it.

Methods: Qualitative systematic review. Embase, Medline, Web of Science, Cochrane, CINAHL and Google Scholar were searched for studies on parents' perspectives on integrated care. Helpful practices and issues regarding continuity of care were identified.

Results: We found that parents valued easily accessible, tailored, family-centred care that is a display of interprofessional collaboration and is geared towards supporting and empowering parents.

Discussion: Study strengths are its qualitative nature, allowing for in-depth patient views and experiences, and the multidisciplinary research team, which ensured a multidimensional view of the issue.

Conclusion: Ideally, (a) parents enter the postnatal period well-prepared, and well-informed about self-care, PCHC and possible postnatal carepathways, (b) number of caretransfers is limited, (c) by overlapping maternity care and PCHC, parents are provided with an opportunity to maintain meaningful relationships with their care providers, and (d) information is consistent, family-centred, and tailored.

Introduction: Multimorbid patients have been growing, leading to an exponential increase in healthcare costs and patterns of resource utilization. Despite the heightened interest toward integrated care programs as a response to the complex need of multimorbid patients, economic evaluations of these programs remain scarce. This work investigated the economic evaluations of service interventions targeting multimorbid patients, to identify the characteristics of these programs and the methods applied to their evaluation.

Methods: We conducted a scoping review of papers published between 2010 and 2021 on PubMed, Science Direct, EconLit and Web Of Science. The search strategy was built around three keyword blocks: service interventions, multimorbidity, economic evaluations. We selected economic evaluations of service interventions delivered through multiple care settings and targeting patients with 2+ chronic conditions.

Results: Twenty-five articles were included. Interventions were categorized as organizational-type versus patient-oriented. The selected studies often targeted patients with one chronic disease, associated with a mental disorder, like depression or anxiety. Included studies were mostly cost-utility analyses conducted with the healthcare perspective.

Discussions and conclusions: This work confirmed that economic evaluations of service interventions for multimorbid patients are limited in number. This could suggest that decision-making regarding the delivery of healthcare services for multimorbid patients may not always be based on a solid evidence base. More economic analyses are needed to inform evidence-based coverage decision-making.