Health Policy最新文献

Introduction: Few integrated care studies elaborate how interventions are brought to wider scale. The SCUBY project developed interventions for scale-up of an Integrated Care Package (ICP) for two common diseases - type 2 diabetes and hypertension-, comprising evidence-based roadmaps and policy dialogues. This paper's aim is to report on the process evaluation of the ICP scale-up in Belgium. Specific objectives are: to describe the development of scale-up interventions; to assess the actual process outcomes; and to assess progress on three scale-up dimensions coverage, expansion and institutionalisation.

Methods: A case study design, with data collection including project diaries, stakeholder surveys and interviews. 11 Key informant interviews were held with five research team members and six external people. Tools were developed to visualise progress for coverage, institutionalisation and expansion.

Results: The roadmap included three themes: primary care practice organization, data and monitoring, and healthcare financing. 99 policy dialogues of varying size and type were held. Stakeholders rated all themes relevant. For scale-up outcomes, progress was most on the institutionalization axis.

Discussion: Scale-up of ICP demands a collaborative, networking approach to build trust and buy-in. Protagonists need to strike a balance between relevance and feasibility of scale-up strategies, being aware of context elasticity. A roadmap can be a living document serving change teams in communication, planning and monitoring, while allowing intervention plasticity.

Background: New models of care that integrate health and social care provision around the patient require a supportive infrastructure, including interorganizational arrangements and information systems. While public policies have been designed to facilitate visions of integrated care, these often neglect the implementation of effective and efficient delivery mechanisms.

Method: This study examines a decade of attempts to move from fragmented health and care delivery to integrated care at scale in NHS England by developing and implementing a support infrastructure. We undertook a longitudinal qualitative investigation -encompassing interviews and documentary analysis- of the implementation of interorganizational and digital interoperability infrastructures intended to support integrated care policies.

Findings: Our findings underscore the long-term symbiotic relationship between institutional interorganizational frameworks and the construction of interoperability infrastructures, emphasizing how they mutually reinforce each other to support their ongoing evolution. Iterative, flexible, and experimental approaches to implementation provide opportunities to adapt to local realities while learning in the making.

Conclusion: This study underlines the importance of adaptable, locally-informed implementation strategies in supporting the vision of integrated care, and the need to understand such development as a long-term, ongoing process of construction and learning.

Background: The rising complexity of the population's needs has made health and social care integration a priority for the future. Despite the presence of supporting policies and funding, the number of successful experiences that endure over time is limited.

Objective: This work aims to investigate how health and social care integration occur and identify factors facilitating its endurance.

Methods: We conducted a multiple case study on four long-lasting health and social care integration cases in Italy, where a new policy for enhancing integration was introduced. 20 senior managers employed in the four cases were interviewed and 33 official documents and websites were collected. The interviews' transcripts and documents were coded using an abductive approach.

Results: The modalities of health and social care integration can vary according to the level of integration, type of network governance, and level of customization. There is no one predominant solution as the modalities depend on the specific context. To support policy-makers and health and social care providers in designing and implementing a sustainable health and social care integration in their contexts, this study provides six possible macro factors that clarify the priorities for integration.

Conclusions: This paper clarifies the modalities of integration and provides macro factors for enduring health and social care integration over time, providing avenues for future supporting policies.