WorldWideScience

Sample records for integrated health care

  1. Integrating Community Health Workers (CHWs) into Health Care Organizations.

    Science.gov (United States)

    Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam

    2017-10-01

    Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.

  2. Integrated primary health care in Australia

    Directory of Open Access Journals (Sweden)

    Gawaine Powell Davies

    2009-10-01

    Full Text Available Introduction: To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy: Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Discussion: Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

  3. Integrated primary health care in Australia.

    Science.gov (United States)

    Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna

    2009-10-14

    To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

  4. Integration: the firm and the health care sector.

    Science.gov (United States)

    Laugesen, Miriam J; France, George

    2014-07-01

    Integration in health care is a key goal of health reform in United States and England. Yet past efforts in the 1990s to better integrate the delivery system were of limited success. Building on work by Bevan and Janus on delivery integration, this article explores integration through the lens of economic theories of integration. Firms generally integrate to increase efficiency through economies of scale, to improve their market power, and resolve the transaction costs involved with multiple external suppliers. Using the United States and England as laboratories, we apply concepts of economic integration to understand why integration does or does not occur in health care, and whether expectations of integrating different kinds of providers (hospital, primary care) and health and social services are realistic. Current enthusiasm for a more integrated health care system expands the scope of integration to include social services in England, but retains the focus on health care in the United States. We find mixed applicability of economic theories of integration. Economies of scale have not played a significant role in stimulating integration in both countries. Managerial incentives for monopoly or oligopoly may be more compelling in the United States, since hospitals seek higher prices and more leverage over payers. In both countries the concept of transaction costs could explain the success of new payment and budgeting methods, since health care integration ultimately requires resolving transaction costs across different delivery organizations.

  5. An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

    Science.gov (United States)

    Dwinnells, Ronald; Misik, Lauren

    2017-10-01

    Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

  6. [Integrated health care organizations: guideline for analysis].

    Science.gov (United States)

    Vázquez Navarrete, M Luisa; Vargas Lorenzo, Ingrid; Farré Calpe, Joan; Terraza Núñez, Rebeca

    2005-01-01

    There has been a tendency recently to abandon competition and to introduce policies that promote collaboration between health providers as a means of improving the efficiency of the system and the continuity of care. A number of countries, most notably the United States, have experienced the integration of health care providers to cover the continuum of care of a defined population. Catalonia has witnessed the steady emergence of increasing numbers of integrated health organisations (IHO) but, unlike the United States, studies on health providers' integration are scarce. As part of a research project currently underway, a guide was developed to study Catalan IHOs, based on a classical literature review and the development of a theoretical framework. The guide proposes analysing the IHO's performance in relation to their final objectives of improving the efficiency and continuity of health care by an analysis of the integration type (based on key characteristics); external elements (existence of other suppliers, type of services' payment mechanisms); and internal elements (model of government, organization and management) that influence integration. Evaluation of the IHO's performance focuses on global strategies and results on coordination of care and efficiency. Two types of coordination are evaluated: information coordination and coordination of care management. Evaluation of the efficiency of the IHO refers to technical and allocative efficiency. This guide may have to be modified for use in the Catalan context.

  7. Integrated occupational health care at sea

    DEFF Research Database (Denmark)

    Jensen, Olaf Chresten

    2011-01-01

    exposures during life at sea and work place health promotion. SEAHEALTH and some of the shipping companies have already added workplace health promotion to occupational health care programs. The purpose of this article is to reinforce this trend by adding some international perspectives and by providing......Workplace Health Promotion is the combined efforts of employers, employees and society to improve the health and well-being of people at work. Integrated maritime health care can be defined as the total maritime health care function that includes the prevention of health risks from harmful...

  8. Integration of Mental Health into Primary Health Care in a rural ...

    African Journals Online (AJOL)

    Objective: Mental health has been identified as a major priority in the Ugandan Health Sector Strategic Plan. Efforts are currently underway to integrate mental health services into the Primary Health Care system. In this study, we report aspects of the integration of mental health into primary health care in one rural district in ...

  9. The Health Care Strengthening Act: The next level of integrated care in Germany.

    Science.gov (United States)

    Milstein, Ricarda; Blankart, Carl Rudolf

    2016-05-01

    The lack of integration of health-care sectors and specialist groups is widely accepted as a necessity to effectively address the most urgent challenges in modern health care systems. Germany follows a more decentralized approach that allows for many degrees of freedom. With its latest bill, the German government has introduced several measures to explicitly foster the integration of health-care services. This article presents the historic development of integrated care services and offers insights into the construction of integrated care programs in the German health-care system. The measures of integrated care within the Health Care Strengthening Act are presented and discussed in detail from the perspective of the provider, the payer, and the political arena. In addition, the effects of the new act are assessed using scenario technique based on an analysis of the effects of previously implemented health policy reforms. Germany now has a flourishing integrated care scene with many integrated care programs being able to contain costs and improve quality. Although it will be still a long journey for Germany to reach the coordination of care standards set by leading countries such as the United Kingdom, New Zealand or Switzerland, international health policy makers may deliberately and selectively adopt elements of the German approach such as the extensive freedom of contract, the strong patient-focus by allowing for very need-driven and regional solutions, or the substantial start-up funding allowing for more unproven and progressive endeavors to further improve their own health systems. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  10. A systematic review of integrated working between care homes and health care services

    Science.gov (United States)

    2011-01-01

    Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in

  11. Ethical Issues in Integrated Health Care: Implications for Social Workers.

    Science.gov (United States)

    Reamer, Frederic G

    2018-05-01

    Integrated health care has come of age. What began modestly in the 1930s has evolved into a mature model of health care that is quickly becoming the standard of care. Social workers are now employed in a wide range of comprehensive integrated health care organizations. Some of these settings were designed as integrated health care delivery systems from their beginning. Others evolved over time, some incorporating behavioral health into existing primary care centers and others incorporating primary care into existing behavioral health agencies. In all of these contexts, social workers are encountering complex, sometimes unprecedented, ethical challenges. This article identifies and discusses ethical issues facing social workers in integrated health care settings, especially related to informed consent, privacy, confidentiality, boundaries, dual relationships, and conflicts of interest. The author includes practical resources that social workers can use to develop state-of-the-art ethics policies and protocols.

  12. From parallel practice to integrative health care: a conceptual framework

    Directory of Open Access Journals (Sweden)

    O'Hara Dennis

    2004-07-01

    Full Text Available Abstract Background "Integrative health care" has become a common term to describe teams of health care providers working together to provide patient care. However this term has not been well-defined and likely means many different things to different people. The purpose of this paper is to develop a conceptual framework for describing, comparing and evaluating different forms of team-oriented health care practices that have evolved in Western health care systems. Discussion Seven different models of team-oriented health care practice are illustrated in this paper: parallel, consultative, collaborative, coordinated, multidisciplinary, interdisciplinary and integrative. Each of these models occupies a position along the proposed continuum from the non-integrative to fully integrative approach they take to patient care. The framework is developed around four key components of integrative health care practice: philosophy/values; structure, process and outcomes. Summary This framework can be used by patients and health care practitioners to determine what styles of practice meet their needs and by policy makers, healthcare managers and researchers to document the evolution of team practices over time. This framework may also facilitate exploration of the relationship between different practice models and health outcomes.

  13. Defining and measuring integrated patient care: promoting the next frontier in health care delivery.

    Science.gov (United States)

    Singer, Sara J; Burgers, Jako; Friedberg, Mark; Rosenthal, Meredith B; Leape, Lucian; Schneider, Eric

    2011-02-01

    Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and (b) its essential components, particularly when constructing measures.To address these issues, the authors propose a definition of integrated patient care that distinguishes it from integrated delivery organizations, acknowledging that integrated organizational structures and processes may fail to produce integrated patient care. The definition emphasizes patients' central role as active participants in managing their own health by including patient centeredness as a key element of integrated patient care. Measures based on the proposed definition will enable empirical assessment of the potential relationships between the integration of organizations, the integration of patient care, and patient outcomes, providing valuable guidance to health systems reformers.

  14. A decade of integration and collaboration: the development of integrated health care in Sweden 2000-2010

    Directory of Open Access Journals (Sweden)

    Bengt Ahgren

    2011-03-01

    Full Text Available Introduction: The recent history of integrated health care in Sweden is explored in this article, focusing on the first decade of the 2000s. In addition, there are some reflections about successes and setbacks in this development and challenges for the next decade.     Description of policy and practice: The first efforts to integrate health care in Sweden appeared in the beginning of the 1990s. The focus was on integration of intra-organisational processes, aiming at a more cost-effective health care provision. Partly as a reaction to the increasing economism at that time, there was also a growing interest in quality improvement. Out of this work emerged the "chains of care", integrating all health care providers involved in the care of specific patient groups. During the 2000s, many county councils have also introduced inter-organisational systems of "local health care". There has also been increasing collaboration between health professionals and other professional groups in different health and welfare services.  Discussion and conclusion: Local health care meant that the chains of care and other forms of integration and collaboration became embedded in a more integrative context. At the same time, however, policy makers have promoted free patient choice in primary health care and also mergers of hospitals and clinical departments. These policies tend to fragment the provision of health care and have an adverse effect on the development of integrated care. As a counterbalance, more efforts should be put into evaluation of integrated health care, in order to replace political convictions with evidence concerning the benefits of such health care provision.

  15. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

    Science.gov (United States)

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  16. Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care

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    Raymond Brian

    2008-10-01

    Full Text Available Abstract Background Integrated personal health records (PHRs offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable. Discussion While there is a spectrum of dominant PHR models, (standalone, tethered, integrated, the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders. Summary Integrated PHRs

  17. Knowledge integration, teamwork and performance in health care.

    Science.gov (United States)

    Körner, Mirjam; Lippenberger, Corinna; Becker, Sonja; Reichler, Lars; Müller, Christian; Zimmermann, Linda; Rundel, Manfred; Baumeister, Harald

    2016-01-01

    Knowledge integration is the process of building shared mental models. The integration of the diverse knowledge of the health professions in shared mental models is a precondition for effective teamwork and team performance. As it is known that different groups of health care professionals often tend to work in isolation, the authors compared the perceptions of knowledge integration. It can be expected that based on this isolation, knowledge integration is assessed differently. The purpose of this paper is to test these differences in the perception of knowledge integration between the professional groups and to identify to what extent knowledge integration predicts perceptions of teamwork and team performance and to determine if teamwork has a mediating effect. The study is a multi-center cross-sectional study with a descriptive-explorative design. Data were collected by means of a staff questionnaire for all health care professionals working in the rehabilitation clinics. The results showed that there are significant differences in knowledge integration within interprofessional health care teams. Furthermore, it could be shown that knowledge integration is significantly related to patient-centered teamwork as well as to team performance. Mediation analysis revealed partial mediation of the effect of knowledge integration on team performance through teamwork. PRACTICAL/IMPLICATIONS: In practice, the results of the study provide a valuable starting point for team development interventions. This is the first study that explored knowledge integration in medical rehabilitation teams and its relation to patient-centered teamwork and team performance.

  18. Promoting Mental Health Equity: The Role of Integrated Care.

    Science.gov (United States)

    Satcher, David; Rachel, Sharon A

    2017-12-01

    People suffering from mental illness experience poor physical health outcomes, including an average life expectancy of 25 years less than the rest of the population. Stigma is a frequent barrier to accessing behavioral health services. Health equity refers to the opportunity for all people to experience optimal health; the social determinants of health can enable or impede health equity. Recommendations from the U.S. government and the World Health Organization support mental health promotion while recognizing barriers that preclude health equity. The United States Preventive Services Task Force recently recommended screening all adults for depression. The Satcher Health Leadership Institute at the Morehouse School of Medicine (SHLI/MSM) is committed to developing leaders who will help to reduce health disparities as the nation moves toward health equity. The SHLI/MSM Integrated Care Leadership Program (ICLP) provides clinical and administrative healthcare professionals with knowledge and training to develop culturally-sensitive integrated care practices. Integrating behavioral health and primary care improves quality of life and lowers health system costs.

  19. Vertical integration and organizational networks in health care.

    Science.gov (United States)

    Robinson, J C; Casalino, L P

    1996-01-01

    This paper documents the growing linkages between primary care-centered medical groups and specialists and between physicians and hospitals under managed care. We evaluate the two alternative forms of organizational coordination: "vertical integration," based on unified ownership, and "virtual integration," based on contractual networks. Excess capacity and the need for investment capital are major short-term determinants of these vertical versus virtual integration decisions in health care. In the longer term, the principal determinants are economies of scale, risk-bearing ability, transaction costs, and the capacity for innovation in methods of managing care.

  20. Progress in the development of integrated mental health care in Scotland

    Directory of Open Access Journals (Sweden)

    Kevin Woods

    2002-06-01

    Full Text Available The development of integrated care through the promotion of ‘partnership working’ is a key policy objective of the Scottish Executive, the administration responsible for health services in Scotland. This paper considers the extent to which this goal is being achieved in mental health services, particularly those for people with severe and enduring mental illness. Distinguishing between the horizontal and vertical integration of services, exploratory research was conducted to assess progress towards this objective by examining how far a range of functional activities in Primary Care Trusts (PCTs and their constituent Local Health Care Co-operatives (LHCCs were themselves becoming increasingly integrated. All PCTs in Scotland were surveyed by postal questionnaire, and followed up by detailed telephone interviews. Six LHCC areas were selected for detailed case study analysis. A Reference Group was used to discuss and review emerging themes from the fieldwork. The report suggests that faster progress is being made in the horizontal integration of services between health and social care organisations than is the case for vertical integration between primary health care and specialist mental health care services; and that there are significant gaps in the extent to which functional activities within Trusts are changing to support the development of integrated care. A number of models are briefly considered, including the idea of ‘intermediate care’ that might speed the process of integration.

  1. Integrating mental health into primary health care – Uganda's ...

    African Journals Online (AJOL)

    Adele

    demographic and health indicators.1 The data showed a high growth rate in excess of 3% ... an integrated form with all other health care needs including promotive and ... In 1999 the government of Uganda (Ministry of Health) developed a ten .... The usual drug procurement system was strengthened with a special project.

  2. Integration of health care organizations: using the power strategies of horizontal and vertical integration in public and private health systems.

    Science.gov (United States)

    Thaldorf, Carey; Liberman, Aaron

    2007-01-01

    Integration in health care attempts to provide all elements in a seamless continuum of care. Pressures influencing development of system-wide integration primarily come from unsustainable cost increases in the United States over the later part of the 20th century and the early 21st century. Promoters of health care integration assume that it will lead to increased effectiveness and quality of care while concurrently increasing cost-effectiveness and possibly facilitating cost savings. The primary focus of this literature review is on the Power Strategies of Horizontal and Vertical Integration. The material presented suggests that vertical integration is most effective in markets where the partners involved are larger and dominant in the regions they serve. The research has also found that integrating health care networks had little or no significant effect on improving overall organizational efficiencies or profits. Capital investment in information technologies still is cost prohibitive and outweighs its benefits to integration efficiencies in the private sector; however, there are some indications of improvements in publicly provided health care. Further research is needed to understand the reasons the public sector has had greater success in improving effectiveness and efficiency through integration than the private sector.

  3. Integrated Care Programme—Department of Health, UK

    OpenAIRE

    Dewji, Mo; Passmore, Julie; Wardell, John

    2010-01-01

    Introduction Integration is seen as a key building block within the strategic plan for improving the health and well-being of the population of England. The Integrated Care Pilot programme is a three-year academically assessed research programme sponsored by the Department of Health, England, which aims to explore and gather evidence to support different approaches to integration. Aims With 16 pilot sites across England the objectives of the programme are based upon a Government commitment to...

  4. Defining and measuring integrated patient care: promoting the next frontier in health care delivery.

    NARCIS (Netherlands)

    Singer, S.J.; Burgers, J.S.; Friedberg, M.; Rosenthal, M.B.; Leape, L.; Schneider, E.

    2011-01-01

    Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and

  5. Project INTEGRATE - a common methodological approach to understand integrated health care in Europe

    Directory of Open Access Journals (Sweden)

    Lucinda Cash-Gibson

    2014-12-01

    Full Text Available Background: The use of case studies in health services research has proven to be an excellent methodology for gaining in-depth understanding of the organisation and delivery of health care. This is particularly relevant when looking at the complexity of integrated healthcare programmes, where multifaceted interactions occur at the different levels of care and often without a clear link between the interventions (new and/or existing and their impact on outcomes (in terms of patients health, both patient and professional satisfaction and cost-effectiveness. Still, integrated care is seen as a core strategy in the sustainability of health and care provision in most societies in Europe and beyond. More specifically, at present, there is neither clear evidence on transferable factors of integrated care success nor a method for determining how to establish these specific success factors. The drawback of case methodology in this case, however, is that the in-depth results or lessons generated are usually highly context-specific and thus brings the challenge of transferability of findings to other settings, as different health care systems and different indications are often not comparable. Project INTEGRATE, a European Commission-funded project, has been designed to overcome these problems; it looks into four chronic conditions in different European settings, under a common methodology framework (taking a mixed-methods approach to try to overcome the issue of context specificity and limited transferability. The common methodological framework described in this paper seeks to bring together the different case study findings in a way that key lessons may be derived and transferred between countries, contexts and patient-groups, where integrated care is delivered in order to provide insight into generalisability and build on existing evidence in this field.Methodology: To compare the different integrated care experiences, a mixed-methods approach has

  6. Vertical Integration Spurs American Health Care Revolution.

    Science.gov (United States)

    Phillips, Richard C.

    1986-01-01

    Under new "managed health care systems," the classical functional separation of risk taker, claims payor, and provider are vertically integrated into a common entity. This evolution should produce a competitive environment with medical care rendered to all Americans on a more cost-effective basis. (CJH)

  7. Financial incentives for disease management programmes and integrated care in German social health insurance.

    Science.gov (United States)

    Greb, Stefan; Focke, Axel; Hessel, Franz; Wasem, Jürgen

    2006-10-01

    As a result of recent health care reforms sickness funds and health care providers in German social health insurance face increased financial incentives for implementing disease management and integrated care. Sickness funds receive higher payments form the risk adjustment system if they set up certified disease management programmes and induce patients to enrol. If health care providers establish integrated care projects they are able to receive extra-budgetary funding. As a consequence, the number of certified disease management programmes and the number of integrated care contracts is increasing rapidly. However, contracts about disease management programmes between sickness funds and health care providers are highly standardized. The overall share of health care expenses spent on integrated care still is very low. Existing integrated care is mostly initiated by hospitals, is based on only one indication and is not fully integrated. However, opportunity to invest in integrated care may open up innovative processes, which generate considerable productivity gains. What is more, integrated care may serve as gateway for the introduction of more widespread selective contracting.

  8. DOH to integrate reproductive health in health care delivery.

    Science.gov (United States)

    According to a Department of Health (DOH) official speaking at the recent Reproductive Health Advocacy Forum in Zamboanga City, the concept of reproductive health (RH) is now on the way to being fully integrated into the Philippines' primary health care system. The DOH is also developing integrated information, education, and communication material for an intensified advocacy campaign on RH among target groups in communities. The forum was held to enhance the knowledge and practice of RH among health, population and development program managers, field workers, and local government units. In this new RH framework, family planning becomes just one of many concerns of the RH package of services which includes maternal and child health, sexuality education, the prevention and treatment of abortion complications, prevention of violence against women, and the treatment of reproductive tract infections. Of concern, however, the Asian economic crisis has led the Philippine government to reduce funding, jeopardizing the public sector delivery of basic services, including reproductive health care. The crisis has also forced other governments in the region to reassess their priorities and redirect their available resources into projects which are practical and sustainable.

  9. Managing the physics of the economics of integrated health care.

    Science.gov (United States)

    Zismer, Daniel K; Werner, Mark J

    2012-01-01

    The physics metaphor, as applied to the economics (and financial performance) of the integrated health system, seems appropriate when considered together with the nine principles of management framework provided. The nature of the integrated design enhances leaders' management potential as they consider organizational operations and strategy in the markets ahead. One question begged by this argument for the integrated design is the durability, efficiency and ultimate long-term survivability of the more "traditional" community health care delivery models, which, by design, are fragmented, internally competitive and less capital efficient. They also cannot exploit the leverage of teams, optimal access management or the pursuit of revenues made available in many forms. For those who wish to move from the traditional to the more integrated community health system designs (especially those who have not yet started the journey), the path requires: * Sufficient balance sheet capacity to fund the integration process-especially as the model requires physician practice acquisitions and electronic health record implementations * A well-prepared board13, 14 * A functional, durable and sustainable physician services enterprise design * A redesigned organizational and governance structure * Favorable internal financial incentives alignment design * Effective accountable physician leadership * Awareness that the system is not solely a funding strategy for acquired physicians, rather a fully -.. committed clinical and business model, one in which patient-centered integrated care is the core service (and not acute care hospital-based services) A willingness to create and exploit the implied and inherent potential of an integrated design and unified brand Last, it's important to remember that an integrated health system is a tool that creates a "new potential" (a physics metaphor reference, one last time). The design doesn't operate itself. Application of the management principles

  10. Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings

    Science.gov (United States)

    Bridges, Ana J.; Andrews, Arthur R.; Villalobos, Bianca T.; Pastrana, Freddie A.; Cavell, Timothy A.; Gomez, Debbie

    2014-01-01

    Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen’s d values > .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos. PMID:25309845

  11. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

    Directory of Open Access Journals (Sweden)

    Nuria Toro Polanco

    2015-06-01

    Full Text Available Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions.Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii overall impact of integration through several indicators based on the Triple Aim Framework.Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure.Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

  12. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

    Directory of Open Access Journals (Sweden)

    Nuria Toro Polanco

    2015-06-01

    Full Text Available Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions. Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii overall impact of integration through several indicators based on the Triple Aim Framework. Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure. Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

  13. Studying integrated health care systems with a structurationist approach

    Science.gov (United States)

    Demers, Louis; Arseneault, Stéphane; Couturier, Yves

    2010-01-01

    Introduction To implement an integrated health care system is not an easy task and to ensure its sustainability is yet more difficult. Aim Discuss how a structurationist approach can shed light on the stakes of these processes and guide the managers of such endeavours. Theory and method Structuration theory [1] has been used by numerous authors to cast new light on complex organizational phenomena. One of the central tenets of this theory is that social systems, such as integrated health care systems, are recurrent social practices across time-space and are characterized by structural properties which simultaneously constrain and enable the constitutive social actors who reproduce and transform the system through their practices. We will illustrate our theoretical standpoint with empirical material gathered during the study of an integrated health care system for the frail elderly in Quebec, Canada. This system has been implemented in 1997 and is still working well in 2010. Results and conclusion To implement an integrated health care system that is both effective and sustainable, its managers must shrewdly allow for the existing system and progressively introduce changes in the way managers and practitioners at work in the system view their role and act on a daily basis.

  14. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

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    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

  15. Co-Leadership - A Management Solution for Integrated Health and Social Care.

    Science.gov (United States)

    Klinga, Charlotte; Hansson, Johan; Hasson, Henna; Sachs, Magna Andreen

    2016-05-23

    Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers - each manager representing one of the two principal organizations in integrated health and social care services - was explored. To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care. Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care. Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability.

  16. Organizing integrated health-care services to meet older people's needs.

    Science.gov (United States)

    Araujo de Carvalho, Islene; Epping-Jordan, JoAnne; Pot, Anne Margriet; Kelley, Edward; Toro, Nuria; Thiyagarajan, Jotheeswaran A; Beard, John R

    2017-11-01

    In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people's physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services. Existing organizational structures do not have to merge; rather, a wide array of service providers must work together in a more coordinated fashion. The evidence suggests that integrated health and social care for older people contributes to better health outcomes at a cost equivalent to usual care, thereby giving a better return on investment than more familiar ways of working. Moreover, older people can participate in, and contribute to, society for longer. Integration at the level of clinical care is especially important: older people should undergo comprehensive assessments with the goal of optimizing functional ability and care plans should be shared among all providers. At the health system level, integrated care requires: (i) supportive policy, plans and regulatory frameworks; (ii) workforce development; (iii) investment in information and communication technologies; and (iv) the use of pooled budgets, bundled payments and contractual incentives. However, action can be taken at all levels of health care from front-line providers through to senior leaders - everyone has a role to play.

  17. Integrating Biopsychosocial Intervention Research in a Changing Health Care Landscape

    Science.gov (United States)

    Ell, Kathleen; Oh, Hyunsung; Wu, Shinyi

    2016-01-01

    Objective: Safety net care systems are experiencing unprecedented change from the "Affordable Care Act," Patient-Centered Medical Home (PCMH) uptake, health information technology application, and growing of mental health care integration within primary care. This article provides a review of previous and current efforts in which social…

  18. Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness.

    Science.gov (United States)

    Parsell, Cameron; Ten Have, Charlotte; Denton, Michelle; Walter, Zoe

    2017-04-07

    Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access. Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically. Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented. Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare. What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services. What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in

  19. Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

    Science.gov (United States)

    Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal

    Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

  20. Administrative Challenges to the Integration of Oral Health With Primary Care

    Science.gov (United States)

    Maxey, Hannah L.; Randolph, Courtney; Gano, Laura; Kochhar, Komal

    2017-01-01

    Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce. PMID:27218701

  1. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park

    2014-03-01

    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased. Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

  2. Preparing the Workforce for Behavioral Health and Primary Care Integration.

    Science.gov (United States)

    Hall, Jennifer; Cohen, Deborah J; Davis, Melinda; Gunn, Rose; Blount, Alexander; Pollack, David A; Miller, William L; Smith, Corey; Valentine, Nancy; Miller, Benjamin F

    2015-01-01

    To identify how organizations prepare clinicians to work together to integrate behavioral health and primary care. Observational cross-case comparison study of 19 U.S. practices, 11 participating in Advancing Care Together, and 8 from the Integration Workforce Study. Practices varied in size, ownership, geographic location, and experience delivering integrated care. Multidisciplinary teams collected data (field notes from direct practice observations, semistructured interviews, and online diaries as reported by practice leaders) and then analyzed the data using a grounded theory approach. Organizations had difficulty finding clinicians possessing the skills and experience necessary for working in an integrated practice. Practices newer to integration underestimated the time and resources needed to train and organizationally socialize (onboard) new clinicians. Through trial and error, practices learned that clinicians needed relevant training to work effectively as integrated care teams. Training efforts exclusively targeting behavioral health clinicians (BHCs) and new employees were incomplete if primary care clinicians (PCCs) and others in the practice also lacked experience working with BHCs and delivering integrated care. Organizations' methods for addressing employees' need for additional preparation included hiring a consultant to provide training, sending employees to external training programs, hosting residency or practicum training programs, or creating their own internal training program. Onboarding new employees through the development of training manuals; extensive shadowing processes; and protecting time for ongoing education, mentoring, and support opportunities for new and established clinicians and staff were featured in these internal training programs. Insufficient training capacity and practical experience opportunities continue to be major barriers to supplying the workforce needed for effective behavioral health and primary care integration

  3. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

    Science.gov (United States)

    Goodwin, N

    2001-01-01

    This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

  4. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2001-03-01

    Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

  5. The integrated project: a promising promotional strategy for primary health care.

    Science.gov (United States)

    Daniel, C; Mora, B

    1985-10-01

    The integrated project using parasite control and nutrition as entry points for family planning practice has shown considerable success in promoting health consciousness among health workers and project beneficiaries. This progress is evident in the Family Planning, Parasite Control and Nutrition (FAPPCAN) areas. The project has also mobilized technical and financial support from the local government as well as from private and civic organizations. The need for integration is underscored by the following considerations: parasite control has proved to be effective for preventive health care; the integrated project uses indigenous community health workers to accomplish its objectives; the primary health care (PHC) movement depends primarily on voluntary community participation and the integrated project has shown that it can elicit this participation. The major health problems in the Philippines are: a prevalence of communicable and other infectious diseases; poor evironmental sanitation; malnutrition; and a rapid population growth rate. The integrated program utilizes the existing village health workers in identifying problems related to family planning, parasite control and nutrition and integrates these activities into the health delivery system; educates family members on how to detect health and health-related problems; works out linkages with government agencies and the local primary health care committee in defining the scope of health-related problems; mobilizes community members to initiate their own projects; gets the commitment of village officials and committe members. The integrated project operates within the PHC. A health van with a built-in video playback system provides educational and logistical support to the village worker. The primary detection and treatment of health problems are part of the village health workers' responsibilities. Research determines the project's capability to reactivate the village primary health care committees and sustain

  6. Health system challenges to integration of mental health delivery in primary care in Kenya--perspectives of primary care health workers.

    Science.gov (United States)

    Jenkins, Rachel; Othieno, Caleb; Okeyo, Stephen; Aruwa, Julyan; Kingora, James; Jenkins, Ben

    2013-09-30

    Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness. Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training). These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other

  7. Changes in Quality of Health Care Delivery after Vertical Integration.

    Science.gov (United States)

    Carlin, Caroline S; Dowd, Bryan; Feldman, Roger

    2015-08-01

    To fill an empirical gap in the literature by examining changes in quality of care measures occurring when multispecialty clinic systems were acquired by hospital-owned, vertically integrated health care delivery systems in the Twin Cities area. Administrative data for health plan enrollees attributed to treatment and control clinic systems, merged with U.S. Census data. We compared changes in quality measures for health plan enrollees in the acquired clinics to enrollees in nine control groups using a differences-in-differences model. Our dataset spans 2 years prior to and 4 years after the acquisitions. We estimated probit models with errors clustered within enrollees. Data were assembled by the health plan's informatics team. Vertical integration is associated with increased rates of colorectal and cervical cancer screening and more appropriate emergency department use. The probability of ambulatory care-sensitive admissions increased when the acquisition caused disruption in admitting patterns. Moving a clinic system into a vertically integrated delivery system resulted in limited increases in quality of care indicators. Caution is warranted when the acquisition causes disruption in referral patterns. © Health Research and Educational Trust.

  8. Integrated (one-stop shop) youth health care: best available evidence and future directions.

    Science.gov (United States)

    Hetrick, Sarah E; Bailey, Alan P; Smith, Kirsten E; Malla, Ashok; Mathias, Steve; Singh, Swaran P; O'Reilly, Aileen; Verma, Swapna K; Benoit, Laelia; Fleming, Theresa M; Moro, Marie Rose; Rickwood, Debra J; Duffy, Joseph; Eriksen, Trissel; Illback, Robert; Fisher, Caroline A; McGorry, Patrick D

    2017-11-20

    Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.

  9. Integral Health Care As A Guiding Axis Of Medical Training: Case Studies

    Directory of Open Access Journals (Sweden)

    Alcides Viana de Lima Neto

    2017-04-01

    Full Text Available Objective: The aim is to report the experiences during the practical experiences in the territory assigned to a basic health unit provided by the module of Integral Health Care I. Methods: Case studies resulting from a process of critical reflections about practical experiences by medical students in a basic health unit from August to December 2015. Results: Through the module of Integral Health Care I, students were allowed to recognize the assigned area of a family health team, as well as to develop the territorialization process and to classify the demographic, epidemiological, socioeconomic and environmental profile in that place; in addition to perform other activities as a singular therapeutic project and intervention project. Conclusion: The activities developed motivated the students to be able to apply the concepts of family and community medicine in primary health care, in addition to bringing them closer to the reality of this work process. Descriptors: Integral Health Care; Family Health Strategy; Physician-Patient Relationship; Basic Health Unit.

  10. Integrative Health and Healing as the New Health Care Paradigm for the Military.

    Science.gov (United States)

    Petri, Richard P

    2015-10-01

    Background: The field of integrative health and healing (IH 2 ) is emerging out of the dark recesses of "voodoo" stereotypes and into the light as a new and much needed health care paradigm. It is a philosophy of health and healing that seeks to place patients as the preeminent players in health management, disease prevention, and injury recovery. There is an emphasis of patient responsibility, which includes a holistic approach that merges allopathic with complementary medicine. Objective: The aim of this article is to explore the historical origins of integrative medicine and investigate the future role of the IH 2 paradigm. Methods: This article reviews current available data and information regarding complementary and alternative medicine utilized in civilian and military populations as the basis for a new paradigm for a system of care-a system that empowers patients. Conclusions: The current U.S. health care system is reactive and disease-based, with a focus on reductionism. This system is not serving us well. IH 2 is a new model of cost-effective patient-centered health care.

  11. Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model.

    Science.gov (United States)

    van Rensburg, André Janse; Fourie, Pieter

    2016-01-01

    Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource

  12. Preparing Social Work Students for Integrated Health Care: Results from a National Study

    Science.gov (United States)

    Held, Mary Lehman; Mallory, Kim Crane; Cummings, Sherry

    2017-01-01

    Integrated health care serves a vital role in addressing interrelated physical and behavioral health conditions, but social work graduates often lack sufficient training to work on integrated teams. We surveyed 94 deans of master's of social work programs to assess the current and planned integrated health care curricula and the aptitude of…

  13. Defining Remoteness from Health Care: Integrated Research on Accessing Emergency Maternal Care in Indonesia

    Directory of Open Access Journals (Sweden)

    Bronwyn A Myers

    2015-07-01

    Full Text Available The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering emergency obstetric care (EmOC and population distribution were modelled for a district in eastern Indonesia. As an index of remoteness, the proportion of the population more than two hours estimated travel time from EmOC was calculated. For the best case scenario (transport by ambulance in the dry season, modelling estimated more than 10,000 fertile aged women were more than two hours from EmOC. Maternal mortality ratios were positively correlated with the remoteness index, however there was considerable variation around this relationship. In a companion study, ethnographic research in a subdistrict with relatively good access to health care and high maternal mortality identified factors influencing access to EmOC, including some that had not been incorporated into the travel time model. Ethnographic research provided information about actual travel involved in requesting and reaching EmOC. Modeled travel time could be improved by incorporating time to deliver request for care. Further integration of social and spatial methods and the development of more dynamic travel time models are needed to develop programs and policies to address these multiple factors to improve maternal health outcomes.

  14. Co-Leadership – A Management Solution for Integrated Health and Social Care

    Directory of Open Access Journals (Sweden)

    Charlotte Klinga

    2016-05-01

    Full Text Available Introduction: Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers – each manager representing one of the two principal organizations in integrated health and social care services – was explored. Aim: To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care. Method: Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. Results: Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care.  Conclusion and discussion: Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability.

  15. Working toward financial sustainability of integrated behavioral health services in a public health care system.

    Science.gov (United States)

    Monson, Samantha Pelican; Sheldon, J Christopher; Ivey, Laurie C; Kinman, Carissa R; Beacham, Abbie O

    2012-06-01

    The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

  16. Integrated specialty service readiness in health reform: connections in haemophilia comprehensive care.

    Science.gov (United States)

    Pritchard, A M; Page, D

    2008-05-01

    The World Health Organization (WHO) has identified primary healthcare reform as a global priority whereby innovative practice changes are directed at improving health. This transformation to health reform in haemophilia service requires clarification of comprehensive care to reflect the WHO definition of health and key elements of primary healthcare reform. While comprehensive care supports effective healthcare delivery, comprehensive care must also be regarded beyond immediate patient management to reflect the broader system purpose in the care continuum with institutions, community agencies and government. Furthermore, health reform may be facilitated through integrated service delivery (ISD). ISD in specialty haemophilia care has the potential to reduce repetition of assessments, enhance care plan communication between providers and families, provide 24-h access to care, improve information availability regarding care quality and outcomes, consolidate access for multiple healthcare encounters and facilitate family self-efficacy and autonomy [1]. Three core aspects of ISD have been distinguished: clinical integration, information management and technology and vertical integration in local communities [2]. Selected examples taken from Canadian haemophilia comprehensive care illustrate how practice innovations are bridged with a broader system level approach and may support initiatives in other contexts. These innovations are thought to indicate readiness regarding ISD. Reflecting on the existing capacity of haemophilia comprehensive care teams will assist providers to connect and direct their existing strengths towards ISD and health reform.

  17. [The hospital perspective: disease management and integrated health care].

    Science.gov (United States)

    Schrappe, Matthias

    2003-06-01

    Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.

  18. Home birth integration into the health care systems of eleven international jurisdictions.

    Science.gov (United States)

    Comeau, Amanda; Hutton, Eileen K; Simioni, Julia; Anvari, Ella; Bowen, Megan; Kruegar, Samantha; Darling, Elizabeth K

    2018-02-13

    The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta-analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer-reviewed, non-peer-reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences. © 2018 Wiley Periodicals, Inc.

  19. Integrating Compassionate, Collaborative Care (the "Triple C") Into Health Professional Education to Advance the Triple Aim of Health Care.

    Science.gov (United States)

    Lown, Beth A; McIntosh, Sharrie; Gaines, Martha E; McGuinn, Kathy; Hatem, David S

    2016-03-01

    Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care.

  20. Unraveling care integration: Assessing its dimensions and antecedents in the Italian Health System.

    Science.gov (United States)

    Calciolari, Stefano; Ilinca, Stefania

    2016-01-01

    In recent decades, consensus has grown on the need to organize health systems around the concept of care integration to better confront the challenges associated with demographic trends and financial sustainability. However, care integration remains an imprecise umbrella term in both the academic and policy arenas. In addition, little substantive knowledge exists on the success factors for integration initiatives. We propose a composite measure of care integration and a conceptual framework suggesting its relationships with three types of antecedents: contextual, cultural, and organizational factors. Our framework was tested using data from the Italian National Health System (NHS). We administered an ad-hoc questionnaire to all Italian local health units (LHUs), with a 60.4% response rate, and used structural equation modeling to assess the relationships between the relevant latent constructs. The results validated our measure of care integration and supported the hypothesized relationships. In particular, integration was found to be fostered by results-oriented institutional settings, a professional culture conducive to inclusiveness and shared goals, and organizational arrangements promoting clear expectations among providers. Thus, integration improves care and mediates the effects of specific operating means on care enhancement. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract

    Directory of Open Access Journals (Sweden)

    H. Hildebrandt

    2010-06-01

    Full Text Available Introduction: Integrated care solutions need supportive financial incentives. In this paper we describe the financial architecture and operative details of the integrated pilot Gesundes Kinzigtal.Description of integrated care case: Located in Southwest Germany, Gesundes Kinzigtal is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH in coope­ration with the physicians' network in the region (MQNK, a German health care management company with a background in medical sociology and health economics (OptiMedis AG and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg.Discussion and (preliminary conclusion: The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a sub­stantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach. This approach is based on the assumption that a more effective trans-sector organisation of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in  morbidity, and in particular to a reduced incidence and prevalence of chronic diseases. This, in turn, is to lead to a comparative reduction in health care cost. Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether - and to what extent - cost reduction may be attributed to a real population health gain.

  2. Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract

    Directory of Open Access Journals (Sweden)

    H. Hildebrandt

    2010-06-01

    Full Text Available Introduction: Integrated care solutions need supportive financial incentives. In this paper we describe the financial architecture and operative details of the integrated pilot 'Gesundes Kinzigtal'. Description of integrated care case: Located in Southwest Germany, 'Gesundes Kinzigtal' is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH in coope­ration with the physicians' network in the region (MQNK, a German health care management company with a background in medical sociology and health economics (OptiMedis AG and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg. Discussion and (preliminary conclusion: The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a sub­stantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach. This approach is based on the assumption that a more effective trans-sector organisation of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in  morbidity, and in particular to a reduced incidence and prevalence of chronic diseases. This, in turn, is to lead to a comparative reduction in health care cost. Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether - and to what extent - cost reduction may be attributed to a real population health gain.

  3. Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept.

    Science.gov (United States)

    Choi, Bryan Y; Blumberg, Charles; Williams, Kenneth

    2016-03-01

    Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  4. Bridging the gap: a virtual health record for integrated home care

    Directory of Open Access Journals (Sweden)

    Maria Hägglund

    2007-06-01

    Full Text Available Introduction: The coexistence of different information systems that are unable to communicate is a persistent problem in healthcare and in integrated home care in particular. Theory and methods: Physically federated integration is used for design of the underlying technical architecture to implement a mobile virtual health record for integrated home care. A user centered system development approach is followed during design and development of the system. Results: A technical platform based on a service-oriented approach where database functionality and services are separated has been developed. This guarantees flexibility with regard to changed functional demands and allows third party systems to interact with the platform in a standardized way. A physically federated integration enables point-of-care documentation, integrated presentation of information from different feeder systems, and offline access to data on handheld devices. Feeder systems deliver information in XML-files that are mapped against an ideal XML schema, published as an interface for integration with the information broker, and inserted into the mediator database. Conclusions: A seamless flow of information between both different care professionals involved in integrated home care and patients and relatives is provided through mobile information access and interaction with different feeder systems using the virtual health record.

  5. Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals.

    Science.gov (United States)

    Cohen, Deborah J; Davis, Melinda; Balasubramanian, Bijal A; Gunn, Rose; Hall, Jennifer; deGruy, Frank V; Peek, C J; Green, Larry A; Stange, Kurt C; Pallares, Carla; Levy, Sheldon; Pollack, David; Miller, Benjamin F

    2015-01-01

    This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions. This was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States. Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior. Primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems. Organizations can create integrated care environments that support these collaborations and health professions training programs should equip clinicians to execute all 3Cs routinely in practice

  6. QUANTITATIVE СHARACTERISTICS OF COMPLEMENTARY INTEGRATED HEALTH CARE SYSTEM AND INTEGRATED MEDICATION MANAGEMENT INFORMATION SYSTEM

    Directory of Open Access Journals (Sweden)

    L. Yu. Babintseva

    2015-05-01

    i mportant elements of state regulation of the pharmaceutical sector health. For the first time creation of two information systems: integrated medication management infor mation system and integrated health care system in an integrated medical infor mation area, operating based on th e principle of complementarity was justified. Global and technological coefficients of these systems’ functioning were introduced.

  7. Shangri-La and the integration of mental health care in Australia

    Directory of Open Access Journals (Sweden)

    Sebastian Rosenberg

    2017-07-01

    Full Text Available We wanted the best, but it turned out like always. (Viktor Chernomyrdin1 According to literary legend, Shangri-La is an idyllic and harmonious place. Mental health is aspiring to its own Shangri-La in the shape of better integrated care. But do current reforms make integrated practice more or less likely? And what can be done to increase the chances of success? The aim of this article is to review the current state of mental health reforms in Australia now under way across Primary Health Networks, the National Disability Insurance Scheme, psychosocial support services and elsewhere. What are these changes and what are the implications for the future of integrated mental health care? Is Shangri-La just over the horizon, or have we embarked instead on a fool’s errand?

  8. Shangri-La and the integration of mental health care in Australia.

    Science.gov (United States)

    Rosenberg, Sebastian

    2017-07-26

    We wanted the best, but it turned out like always. Victor Chernomydrin) 1 According to literary legend, Shangri-La is an idyllic and harmonious place. Mental health is aspiring to its own Shangri-La in the shape of better integrated care. But do current reforms make integrated practice more or less likely? And what can be done to increase the chances of success? The aim of this article is to review the current state of mental health reforms in Australia now under way across Primary Health Networks, the National Disability Insurance Scheme, psychosocial support services and elsewhere. What are these changes and what are the implications for the future of integrated mental health care? Is Shangri-La just over the horizon, or have we embarked instead on a fool's errand?

  9. Integrating mental health services into primary HIV care for women: the Whole Life project.

    OpenAIRE

    Dodds, Sally; Nuehring, Elane M.; Blaney, Nancy T.; Blakley, Theresa; Lizzotte, Jean-Marie; Lopez, Myriam; Potter, JoNell E.; O'Sullivan, Mary J.

    2004-01-01

    The high rate of mental health problems in HIV-infected women jeopardizes the health of this vulnerable population, and constitutes a mandate for integrating mental health services into HIV primary care. The Whole Life project-a collaboration of the departments of Psychiatry and Obstetrics/Gynecology at the University of Miami School of Medicine-successfully integrated mental health services into primary HIV care for women. This article describes the conceptual framework of the integration, i...

  10. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

    Directory of Open Access Journals (Sweden)

    Christos Lionis

    2009-07-01

    Full Text Available Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

  11. Participative mental health consumer research for improving physical health care: An integrative review.

    Science.gov (United States)

    Happell, Brenda; Ewart, Stephanie B; Platania-Phung, Chris; Stanton, Robert

    2016-10-01

    People with mental illness have a significantly lower life expectancy and higher rates of chronic physical illnesses than the general population. Health care system reform to improve access and quality is greatly needed to address this inequity. The inclusion of consumers of mental health services as co-investigators in research is likely to enhance service reform. In light of this, the current paper reviews mental health consumer focussed research conducted to date, addressing the neglect of physical health in mental health care and initiatives with the aim of improving physical health care. The international literature on physical healthcare in the context of mental health services was searched for articles, including mental health consumers in research roles, via Medline, CINAHL and Google Scholar, in October 2015. Four studies where mental health consumers participated as researchers were identified. Three studies involved qualitative research on barriers and facilitators to physical health care access, and a fourth study on developing technologies for more effective communication between GPs and patients. This review found that participatory mental health consumer research in physical health care reform has only become visible in the academic literature in 2015. Heightened consideration of mental health consumer participation in research is required by health care providers and researchers. Mental health nurses can provide leadership in increasing mental health consumer research on integrated care directed towards reducing the health gap between people with and without mental illness. © 2016 Australian College of Mental Health Nurses Inc.

  12. Nursing competency standards in primary health care: an integrative review.

    Science.gov (United States)

    Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

    2016-05-01

    This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice. Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting. Integrative review. A comprehensive search of relevant electronic databases using keywords (e.g. 'competencies', 'competen*' and 'primary health care', 'general practice' and 'nurs*') was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000. Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment. Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers. Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content

  13. Community-Based Rehabilitation in Bangladesh, Health Components Need to be Integrated with Primary Health Care

    Directory of Open Access Journals (Sweden)

    Md Shahidur Rahman

    2018-01-01

    Full Text Available Community-based rehabilitation (CBR is defined as a strategy within general community development for the rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities. The role of CBR is to work closely with the health sector to ensure that the needs of people with disabilities and their family members are addressed in the areas of health promotion, prevention, medical care, rehabilitation and assistive devices. CBR also needs to work with individuals and their families to facilitate their access to health services and to work with other sectors to ensure that all aspects of health are addressed. Health components of CBR as per WHO guidelines are grossly neglected in Bangladesh. Some government and non-government organizations are working independently, but health components are inadequately addressed. We observed that primary health care, if integrated with medical rehabilitation of disabled, will better address the need and help bring disabled into mainstream of development. Health care providers at grass root level need to be trained in CBR activities which can be arranged centrally with health ministry, social welfare ministry and rehabilitation specialists. In this review we have tried to reveal the health components of CBR in global and Bangladesh context and importance of integrating health components of CBR with primary health care.

  14. Integrated care information technology.

    Science.gov (United States)

    Rowe, Ian; Brimacombe, Phil

    2003-02-21

    Counties Manukau District Health Board (CMDHB) uses information technology (IT) to drive its Integrated Care strategy. IT enables the sharing of relevant health information between care providers. This information sharing is critical to closing the gaps between fragmented areas of the health system. The tragic case of James Whakaruru demonstrates how people have been falling through those gaps. The starting point of the Integrated Care strategic initiative was the transmission of electronic discharges and referral status messages from CMDHB's secondary provider, South Auckland Health (SAH), to GPs in the district. Successful pilots of a Well Child system and a diabetes disease management system embracing primary and secondary providers followed this. The improved information flowing from hospital to GPs now enables GPs to provide better management for their patients. The Well Child system pilot helped improve reported immunization rates in a high health need area from 40% to 90%. The diabetes system pilot helped reduce the proportion of patients with HbA1c rang:9 from 47% to 16%. IT has been implemented as an integral component of an overall Integrated Care strategic initiative. Within this context, Integrated Care IT has helped to achieve significant improvements in care outcomes, broken down barriers between health system silos, and contributed to the establishment of a system of care continuum that is better for patients.

  15. Children’s Environmental Health Faculty Champions Initiative: A Successful Model for Integrating Environmental Health into Pediatric Health Care

    Science.gov (United States)

    Rogers, Bonnie; McCurdy, Leyla Erk; Slavin, Katie; Grubb, Kimberly; Roberts, James R.

    2009-01-01

    Background Pediatric medical and nursing education lack the environmental health content needed to properly prepare health care professionals to prevent, recognize, manage, and treat environmental exposure–related diseases. The need for improvements in health care professionals’ environmental health knowledge has been expressed by leading institutions. However, few studies have evaluated the effectiveness of programs that incorporate pediatric environmental health (PEH) into curricula and practice. Objective We evaluated the effectiveness of the National Environmental Education Foundation’s (NEEF) Children’s Environmental Health Faculty Champions Initiative, which is designed to build environmental health capacity among pediatric health care professionals. Methods Twenty-eight pediatric health care professionals participated in a train-the-trainer workshop, in which they were educated to train other health care professionals in PEH and integrate identified PEH competencies into medical and nursing practice and curricula. We evaluated the program using a workshop evaluation tool, action plan, pre- and posttests, baseline and progress assessments, and telephone interviews. Results During the 12 months following the workshop, the faculty champions’ average pretest score of 52% was significantly elevated (p < 0.0001) to 65.5% on the first posttest and to 71.5% on the second posttest, showing an increase and retention of environmental health knowledge. Faculty champions trained 1,559 health care professionals in PEH, exceeding the goal of 280 health care professionals trained. Ninety percent of faculty champions reported that PEH had been integrated into the curricula at their institution. Conclusion The initiative was highly effective in achieving its goal of building environmental health capacity among health care professionals. The faculty champions model is a successful method and can be replicated in other arenas. PMID:19478972

  16. Organisational Culture Matters for System Integration in Health Care

    Science.gov (United States)

    Munir, Samina K.; Kay, Stephen

    2003-01-01

    This paper illustrates the importance of organisational culture for Clinical Information Systems (CIS) integration. The study is based on data collected in intensive care units in the UK and Denmark. Data were collected using qualitative methods, i.e., observations, interviews and shadowing of health care providers, together with a questionnaire at each site. The data are analysed to extract salient variables for CIS integration, and it is shown that these variables can be separated into two categories that describe the ‘Actual Usefulness’ of the system and the ‘Organisational Culture’. This model is then extended to show that CIS integration directly affects the work processes of the organisation, forming an iterative process of change as a CIS is introduced and integrated. PMID:14728220

  17. The integration of behavioral health interventions in children's health care: services, science, and suggestions.

    Science.gov (United States)

    Kolko, David J; Perrin, Ellen

    2014-01-01

    Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

  18. Integrated Care and Connected Health Approaches Leveraging Personalised Health through Big Data Analytics.

    Science.gov (United States)

    Maglaveras, Nicos; Kilintzis, Vassilis; Koutkias, Vassilis; Chouvarda, Ioanna

    2016-01-01

    Integrated care and connected health are two fast evolving concepts that have the potential to leverage personalised health. From the one side, the restructuring of care models and implementation of new systems and integrated care programs providing coaching and advanced intervention possibilities, enable medical decision support and personalized healthcare services. From the other side, the connected health ecosystem builds the means to follow and support citizens via personal health systems in their everyday activities and, thus, give rise to an unprecedented wealth of data. These approaches are leading to the deluge of complex data, as well as in new types of interactions with and among users of the healthcare ecosystem. The main challenges refer to the data layer, the information layer, and the output of information processing and analytics. In all the above mentioned layers, the primary concern is the quality both in data and information, thus, increasing the need for filtering mechanisms. Especially in the data layer, the big biodata management and analytics ecosystem is evolving, telemonitoring is a step forward for data quality leverage, with numerous challenges still left to address, partly due to the large number of micro-nano sensors and technologies available today, as well as the heterogeneity in the users' background and data sources. This leads to new R&D pathways as it concerns biomedical information processing and management, as well as to the design of new intelligent decision support systems (DSS) and interventions for patients. In this paper, we illustrate these issues through exemplar research targeting chronic patients, illustrating the current status and trends in PHS within the integrated care and connected care world.

  19. Review of behavioral health integration in primary care at Baylor Scott and White Healthcare, Central Region

    OpenAIRE

    Jolly, John B.; Fluet, Norman R.; Reis, Michael D.; Stern, Charles H.; Thompson, Alexander W.; Jolly, Gillian A.

    2016-01-01

    The integration of behavioral health services in primary care has been referred to in many ways, but ultimately refers to common structures and processes. Behavioral health is integrated into primary care because it increases the effectiveness and efficiency of providing care and reduces costs in the care of primary care patients. Reimbursement is one factor, if not the main factor, that determines the level of integration that can be achieved. The federal health reform agenda supports change...

  20. Review of behavioral health integration in primary care at Baylor Scott and White Healthcare, Central Region.

    Science.gov (United States)

    Jolly, John B; Fluet, Norman R; Reis, Michael D; Stern, Charles H; Thompson, Alexander W; Jolly, Gillian A

    2016-04-01

    The integration of behavioral health services in primary care has been referred to in many ways, but ultimately refers to common structures and processes. Behavioral health is integrated into primary care because it increases the effectiveness and efficiency of providing care and reduces costs in the care of primary care patients. Reimbursement is one factor, if not the main factor, that determines the level of integration that can be achieved. The federal health reform agenda supports changes that will eventually permit behavioral health to be fully integrated and will allow the health of the population to be the primary target of intervention. In an effort to develop more integrated services at Baylor Scott and White Healthcare, models of integration are reviewed and the advantages and disadvantages of each model are discussed. Recommendations to increase integration include adopting a disease management model with care management, planned guideline-based stepped care, follow-up, and treatment monitoring. Population-based interventions can be completed at the pace of the development of alternative reimbursement methods. The program should be based upon patient-centered medical home standards, and research is needed throughout the program development process.

  1. [Social constructionism in primary health care: an integrative review].

    Science.gov (United States)

    Cadoná, Eliane; Scarparo, Helena

    2015-09-01

    This study sets out to analyze scientific articles in order to investigate how researchers in the area of Social Constructionism define "health" in Primary Health Care. An integrative review of the literature was conducted along with a decision to concentrate on those works with narrative experiences and research studies. The database researched was the Brazilian Virtual Health Library, with experiences in the scope of Primary Health Care. The effectiveness of this step resulted in 12 articles. Data were analyzed and discussed based on the perspectives of social constructionism, which generated two central themes. They were: citizenship exercises - promoting health in collective spaces; health practices - overcoming the dichotomies and absolute truths. This study revealed the relevance of the notion of shared responsibility on meanings of health contained in the texts analyzed. The researchers claim that it is possible to expand health practices into collective action to facilitate ongoing dialogue between health users and workers. However, the dominance of biomedical discourse is criticized by the researchers, because that paradigm still promotes practices of care focused on illness.

  2. Owned vertical integration and health care: promise and performance.

    Science.gov (United States)

    Walston, S L; Kimberly, J R; Burns, L R

    1996-01-01

    This article examines the alleged benefits and actual outcomes of vertical integration in the health sector and compares them to those observed in other sectors of the economy. This article concludes that the organizational models on which these arrangements are based may be poorly adapted to the current environment in health care.

  3. Designing Clinical Space for the Delivery of Integrated Behavioral Health and Primary Care.

    Science.gov (United States)

    Gunn, Rose; Davis, Melinda M; Hall, Jennifer; Heintzman, John; Muench, John; Smeds, Brianna; Miller, Benjamin F; Miller, William L; Gilchrist, Emma; Brown Levey, Shandra; Brown, Jacqueline; Wise Romero, Pam; Cohen, Deborah J

    2015-01-01

    This study sought to describe features of the physical space in which practices integrating primary care and behavioral health care work and to identify the arrangements that enable integration of care. We conducted an observational study of 19 diverse practices located across the United States. Practice-level data included field notes from 2-4-day site visits, transcripts from semistructured interviews with clinicians and clinical staff, online implementation diary posts, and facility photographs. A multidisciplinary team used a 4-stage, systematic approach to analyze data and identify how physical layout enabled the work of integrated care teams. Two dominant spatial layouts emerged across practices: type-1 layouts were characterized by having primary care clinicians (PCCs) and behavioral health clinicians (BHCs) located in separate work areas, and type-2 layouts had BHCs and PCCs sharing work space. We describe these layouts and the influence they have on situational awareness, interprofessional "bumpability," and opportunities for on-the-fly communication. We observed BHCs and PCCs engaging in more face-to-face methods for coordinating integrated care for patients in type 2 layouts (41.5% of observed encounters vs 11.7%; P < .05). We show that practices needed to strike a balance between professional proximity and private work areas to accomplish job tasks. Private workspace was needed for focused work, to see patients, and for consults between clinicians and clinical staff. We describe the ways practices modified and built new space and provide 2 recommended layouts for practices integrating care based on study findings. Physical layout and positioning of professionals' workspace is an important consideration in practices implementing integrated care. Clinicians, researchers, and health-care administrators are encouraged to consider the role of professional proximity and private working space when creating new facilities or redesigning existing space to foster

  4. An integrated health care standard for the management and prevention of obesity in The Netherlands

    NARCIS (Netherlands)

    Seidell, J.C.; Halberstadt, J.; Noordam, H.; Niemer, S.I.J.

    2012-01-01

    The Partnership Overweight Netherlands (PON) is a collaboration between 18 partners, which are national organizations of health care providers, health insurance companies and patient organizations. The PON published an integrated health care standard for obesity in November 2010.The integrated

  5. Operational integration in primary health care: patient encounters and workflows.

    Science.gov (United States)

    Sifaki-Pistolla, Dimitra; Chatzea, Vasiliki-Eirini; Markaki, Adelais; Kritikos, Kyriakos; Petelos, Elena; Lionis, Christos

    2017-11-29

    Despite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration. The study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review. Overall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows. Existing patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web

  6. Collaboratively reframing mental health for integration of HIV care in Ethiopia.

    Science.gov (United States)

    Wissow, Lawrence S; Tegegn, Teketel; Asheber, Kassahun; McNabb, Marion; Weldegebreal, Teklu; Jerene, Degu; Ruff, Andrea

    2015-07-01

    Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient-provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists' settings and clinical goals. An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method

  7. Integrated versus fragmented implementation of complex innovations in acute health care

    Science.gov (United States)

    Woiceshyn, Jaana; Blades, Kenneth; Pendharkar, Sachin R.

    2017-01-01

    Background: Increased demand and escalating costs necessitate innovation in health care. The challenge is to implement complex innovations—those that require coordinated use across the adopting organization to have the intended benefits. Purpose: We wanted to understand why and how two of five similar hospitals associated with the same health care authority made more progress with implementing a complex inpatient discharge innovation whereas the other three experienced more difficulties in doing so. Methodology: We conducted a qualitative comparative case study of the implementation process at five comparable urban hospitals adopting the same inpatient discharge innovation mandated by their health care authority. We analyzed documents and conducted 39 interviews of the health care authority and hospital executives and frontline managers across the five sites over a 1-year period while the implementation was ongoing. Findings: In two and a half years, two of the participating hospitals had made significant progress with implementing the innovation and had begun to realize benefits; they exemplified an integrated implementation mode. Three sites had made minimal progress, following a fragmented implementation mode. In the former mode, a semiautonomous health care organization developed a clear overall purpose and chose one umbrella initiative to implement it. The integrative initiative subsumed the rest and guided resource allocation and the practices of hospital executives, frontline managers, and staff who had bought into it. In contrast, in the fragmented implementation mode, the health care authority had several overlapping, competing innovations that overwhelmed the sites and impeded their implementation. Practice Implications: Implementing a complex innovation across hospital sites required (a) early prioritization of one initiative as integrative, (b) the commitment of additional (traded off or new) human resources, (c) deliberate upfront planning and

  8. Development and initial feasibility of an organizational measure of behavioral health integration in medical care settings.

    Science.gov (United States)

    McGovern, Mark P; Urada, Darren; Lambert-Harris, Chantal; Sullivan, Steven T; Mazade, Noel A

    2012-12-01

    In the advent of health care reform, models are sought to integrate behavioral health and routine medical care services. Historically, the behavioral health specialty has not itself been integrated, but instead bifurcated by substance use and mental health across treatment systems, care providers and even research. With the present opportunity to transform the health care delivery system, it is incumbent upon policymakers, researchers and clinicians to avoid repeating this historical error, and provide integrated behavioral health services in medical contexts. An organizational measure designed to assess this capacity is described: the Dual Diagnosis Capability in Health Care Settings (DDCHCS). The DDCHCS was used to assess a sample of federally-qualified health centers (N=13) on the degree of behavioral health integration. The measure was found to be feasible and sensitive to detecting variation in integrated behavioral health services capacity. Three of the 13 agencies were dual diagnosis capable, with significant variation in DDCHCS dimensions measuring staffing, treatment practices and program milieu. In general, mental health services were more integrated than substance use. Future research should consider a revised version of the measure, a larger and more representative sample, and linking organizational capacity with patient outcomes. Copyright © 2012. Published by Elsevier Inc.

  9. Integrated health care in Russia: to be or not to be?

    Directory of Open Access Journals (Sweden)

    Mikko A. Vienonen

    2001-03-01

    Full Text Available The purpose of this paper is to look at what has happened in Russia during the last ten years in the health care sector from the point of view of integrated care. This country, when it still was the leading subject of the Soviet Union, hosted in 1978 the Alma Ata Conference on Primary Health Care, which in many countries gave a strong boost on the development of multidisciplinary, community based care in a gate-keeper position. In Soviet Russia, PHC became marginalised and identical to poor level of care in remote areas of the country where people had very little choice and did not want to use it. Has the situation changed, and is Russia in practice addressing the problems created by the lack of integration, vertical treatment structures and over specialisation? In addition to the data sources that are referred to in the text, this paper is based on “gray literature” available in project reports and governmental documents, and on the personal experiences of the authors, who have worked for long periods of time in the Russian Federation as international experts dealing with health sector reforms and health policy formulation.

  10. Occupational Health Services Integrated in Primary Health Care in Iran.

    Science.gov (United States)

    Rafiei, Masoud; Ezzatian, Reza; Farshad, Asghar; Sokooti, Maryam; Tabibi, Ramin; Colosio, Claudio

    2015-01-01

    A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health

  11. Eradicating Barriers to Mental Health Care Through Integrated Service Models: Contemporary Perspectives for Psychiatric-Mental Health Nurses.

    Science.gov (United States)

    Ellis, Horace; Alexander, Vinette

    2016-06-01

    There has been renewed, global interest in developing new and transformative models of facilitating access to high-quality, cost-effective, and individually-centered health care for severe mentally-ill (SMI) persons of diverse racial/ethnic, cultural and socioeconomic backgrounds. However, in our present-day health-service delivery systems, scholars have identified layers of barriers to widespread dispersal of well-needed mental health care both nationally and internationally. It is crucial that contemporary models directed at eradicating barriers to mental health services are interdisciplinary in context, design, scope, sequence, and best-practice standards. Contextually, nurses are well-positioned to influence the incorporation and integration of new concepts into operationally interdisciplinary, evidence-based care models with measurable outcomes. The aim of this concept paper is to use the available evidence to contextually explicate how the blended roles of psychiatric mental health (PMH) nursing can be influential in eradicating barriers to care and services for SMI persons through the integrated principles of collaboration, integration and service expansion across health, socioeconomic, and community systems. A large body of literature proposes that any best-practice standards aimed at eliminating barriers to the health care needs of SMI persons require systematic, well-coordinated interdisciplinary partnerships through evidence-based, high-quality, person-centered, and outcome-driven processes. Transforming the conceptual models of collaboration, integration and service expansion could be revolutionary in how care and services are coordinated and dispersed to populations across disadvantaged communities. Building on their longstanding commitment to individual and community care approaches, and their pivotal roles in research, education, leadership, practice, and legislative processes; PMH nurses are well-positioned to be both influential and instrumental in

  12. Health care providers' perceived barriers to and need for the implementation of a national integrated health care standard on childhood obesity in the Netherlands - a mixed methods approach.

    Science.gov (United States)

    Schalkwijk, Annemarie A H; Nijpels, Giel; Bot, Sandra D M; Elders, Petra J M

    2016-03-08

    In 2010, a national integrated health care standard for (childhood) obesity was published and disseminated in the Netherlands. The aim of this study is to gain insight into the needs of health care providers and the barriers they face in terms of implementing this integrated health care standard. A mixed-methods approach was applied using focus groups, semi-structured, face-to-face interviews and an e-mail-based internet survey. The study's participants included: general practitioners (GPs) (focus groups); health care providers in different professions (face-to-face interviews) and health care providers, including GPs; youth health care workers; pediatricians; dieticians; psychologists and physiotherapists (survey). First, the transcripts from the focus groups were analyzed thematically. The themes identified in this process were then used to analyze the interviews. The results of the analysis of the qualitative data were used to construct the statements used in the e-mail-based internet survey. Responses to items were measured on a 5-point Likert scale and were categorized into three outcomes: 'agree' or 'important' (response categories 1 and 2), 'disagree' or 'not important'. Twenty-seven of the GPs that were invited (51 %) participated in four focus groups. Seven of the nine health care professionals that were invited (78 %) participated in the interviews and 222 questionnaires (17 %) were returned and included in the analysis. The following key barriers were identified with regard to the implementation of the integrated health care standard: reluctance to raise the subject; perceived lack of motivation and knowledge on the part of the parents; previous negative experiences with lifestyle programs; financial constraints and the lack of a structured multidisciplinary approach. The main needs identified were: increased knowledge and awareness on the part of both health care providers and parents/children; a social map of effective intervention; structural

  13. Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care.

    Science.gov (United States)

    Miller, Benjamin F; Ross, Kaile M; Davis, Melinda M; Melek, Stephen P; Kathol, Roger; Gordon, Patrick

    2017-01-01

    The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. Developing integrated health and social care services for older persons in Europe.

    Science.gov (United States)

    Leichsenring, Kai

    2004-01-01

    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. 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. 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. 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. 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

  15. Instruments to assess integrated care

    DEFF Research Database (Denmark)

    Lyngsø, Anne Marie; Godtfredsen, Nina Skavlan; Høst, Dorte

    2014-01-01

    INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how to mea...... was prevalent. It is uncertain whether development of a single 'all-inclusive' model for assessing integrated care is desirable. We emphasise the continuing need for validated instruments embedded in theoretical contexts.......INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how...... to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified. METHODS: An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected...

  16. Governance of health care networks: Assessment of the health care integrating councils in the context of the health sector reform in Chile.

    Directory of Open Access Journals (Sweden)

    Osvaldo Artaza-Barrios

    2013-11-01

    Full Text Available Objective. This paper aims at assessing the contribution of Chile’s Health Care Integrating Councils (CIRA, Spanish acronym to strengthening governance in health. Materials and methods. A literature review on the official documents related to the process of creation and development of CIRA was carried out; an ad hoc questionnaire was applied to all 29 health services of the country; finally, 35 semi-structure in-depth interviews were carried on a sample of six CIRA. Results. The CIRAs have become a tool for functional integration and a valuable space for dialogue, cooperation and learning for all of the actors of the Chilean public health network. Conclusions. In this study, we conclude that there is room for improvements of CIRA’s role regarding governance of the health care network as long as CIRA is authorized to deal with strategic topics, such as investment in infrastructure, technology and human resources, and budgeting.

  17. Collaboration process for integrated social and health care strategy implementation

    Directory of Open Access Journals (Sweden)

    Jukka Korpela

    2012-05-01

    Full Text Available Objective:  To present collaboration process for creating a roadmap for the implementation of a strategy for integrated health and social care. The developed collaboration process includes multiple phases and uses electronic group decision support system technology (GDSS.Method: A case study done in the South Karelia District of Social and Health Services in Finland during 2010 - 2011. An expert panel of 13 participants was used in the planning process of the strategy implementation. The participants were interviewed and observed during the case study.Results: As a practical result, a roadmap for integrated health and social care strategy implementation has been developed. The strategic roadmap includes detailed plans of several projects which are needed for successful integration strategy implementation. As an academic result, a collaboration process to create such a roadmap has been developed.Conclusions: The collaboration process and technology seem to suit the planning process well. The participants of the meetings were satisfied with the collaboration process and the GDSS technology. The strategic roadmap was accepted by the participants, which indicates satisfaction with the developed process.

  18. Collaboration process for integrated social and health care strategy implementation.

    Science.gov (United States)

    Korpela, Jukka; Elfvengren, Kalle; Kaarna, Tanja; Tepponen, Merja; Tuominen, Markku

    2012-01-01

    To present a collaboration process for creating a roadmap for the implementation of a strategy for integrated health and social care. The developed collaboration process includes multiple phases and uses electronic group decision support system technology (GDSS). A case study done in the South Karelia District of Social and Health Services in Finland during 2010-2011. An expert panel of 13 participants was used in the planning process of the strategy implementation. The participants were interviewed and observed during the case study. As a practical result, a roadmap for integrated health and social care strategy implementation has been developed. The strategic roadmap includes detailed plans of several projects which are needed for successful integration strategy implementation. As an academic result, a collaboration process to create such a roadmap has been developed. The collaboration process and technology seem to suit the planning process well. The participants of the meetings were satisfied with the collaboration process and the GDSS technology. The strategic roadmap was accepted by the participants, which indicates satisfaction with the developed process.

  19. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

    NARCIS (Netherlands)

    Valentijn, P.P.; Schepman, S.M.; Opheij, W.; Bruijnzeels, M.A.

    2013-01-01

    Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to

  20. [Declared dead? Recommendations regarding integrated care from the perspective of German statutory health insurance].

    Science.gov (United States)

    Amelung, Volker; Wolf, S; Ozegowski, S; Eble, S; Hildebrandt, H; Knieps, F; Lägel, R; Schlenker, R-U; Sjuts, R

    2015-04-01

    The traditional separation of health care into sectors in Germany causes communication problems that hinder continuous, patient-oriented care. This is most evident in the transition from inpatient to outpatient care. That said, there are also breaks in the flow of information, a lack of supply, or even incorrect information flowing within same-sector care. The transition from a division of functions into sectors to a patient-oriented process represents a change in the paradigm of health care that can only be successfully completed with considerable effort. Germany's statutory health insurance (SHI) funds play a key role here, as they are the contracting parties as well as the financiers of integrated care, and are strategically located at the center of the development process.The objective of this article is to explore how Germany's SHI funds view integrated care, what they regard as being the drivers of and barriers to transitioning to such a system, and what recommendations they can provide with regard to the further development of integrated care. For this purpose semi-structured interviews with board members and those responsible for implementing integrated care into the operations of ten SHI funds representing more than half of Germany's SHI-insured population were conducted. According to the interviewees, a better framework for integrated care urgently needs to be developed and rendered more receptive to innovation.Only in this way will the widespread stagnation of the past several years be overcome. The deregulation of § 140a-d SGB V and the establishment of a uniform basis for new forms of care in terms of a new innovation clause are among the central recommendations of this article. The German federal government's innovation fund was met with great hope, but also implied risks. Nonetheless, the new law designed to strengthen health care overall generated high expectations.

  1. Review of The Behavioral Health Specialist in Primary Care: Skills for Integrated Practice.

    Science.gov (United States)

    Harsh, Jennifer

    2016-03-01

    Reviews the book, The Behavioral Health Specialist in Primary Care: Skills for Integrated Practice edited by Mary Ann Burg and Oliver Oyama (see record 2015-46891-000). The editors and the chapter authors of this useful book provide insight into the skills and knowledge needed to do integrated behavioral health in primary care. The most beneficial part of the book is the layout of the chapters, and the authors do a great job of articulating the clinical components of care. Behavioral health and medical providers in practice or in training could greatly benefit from reading this book. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  2. Developing a tool for mapping adult mental health care provision in Europe: the REMAST research protocol and its contribution to better integrated care

    Directory of Open Access Journals (Sweden)

    Luis Salvador-Carulla

    2015-12-01

    Full Text Available Introduction: Mental health care is a critical area to better understand integrated care and to pilot the different components of the integrated care model. However, there is an urgent need for better tools to compare and understand the context of integrated mental health care in Europe.Method: The REMAST tool (REFINEMENT MApping Services Tool combines a series of standardised health service research instruments and geographical information systems (GIS to develop local atlases of mental health care from the perspective of horizontal and vertical integrated care. It contains five main sections: (a Population Data; (b the Verona Socio-economic Status (SES Index; (c the Mental Health System Checklist; (d the Mental Health Services Inventory using the DESDE-LTC instrument; and (e Geographical Data.Expected results: The REMAST tool facilitates context analysis in mental health by providing the comparative rates of mental health service provision according to the availability of main types of care; care placement capacity; workforce capacity; and geographical accessibility to services in the local areas in eight study areas in Austria, England, Finland, France, Italy, Norway, Romania and Spain.Discussion: The outcomes of this project will facilitate cooperative work and knowledge transfer on mental health care to the different agencies involved in mental health planning and provision. This project would improve the information to users and society on the available resources for mental health care and system thinking at the local level by the different stakeholders. The techniques used in this project and the knowledge generated could eventually be transferred to the mapping of other fields of integrated care.

  3. Evaluation of health care delivery integration: the case of the Russian Federation.

    Science.gov (United States)

    Sheiman, Igor; Shevski, Vladimir

    2014-04-01

    Fragmentation in organization and discontinuities in the provision of medical care are problems in all health systems, whether it is the mixed public-private one in the USA, national health services in the UK, or insurance based one in Western Europe and Russia. In all of these countries a major challenge is to strengthen integration in order to enhance efficiency and health outcomes. This article assesses issues related to fragmentation and integration in conceptual terms and argues that key attributes of integration are teamwork, coordination and continuity of care. It then presents a summary of service integration problems in Russia and the results of a large survey of physicians concerning the attributes of integration. It is argued that characteristics of the national service delivery model don't ensure integration. The Semashko model is not an equivalent to the integrated model. Big organizational forms of service provision, like polyclinics and integrated hospital-polyclinics, don't have higher scores of integration indicators than smaller ones. Proposals to improve integration in Russia are presented with the focus on the regular evaluation of integration/fragmentation, regulation of integration activities, enhancing the role of PHC providers, economic incentives. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Health Care and Family and Consumer Sciences Education: An Integrative Approach.

    Science.gov (United States)

    Montgomery, Ruth; Rider, Mary Ellen

    2001-01-01

    Uses ecological systems theory as a foundation for integrating health care and its public policy issues into family and consumer sciences classrooms. Offers teachers alternative perspectives on consumer behavior changes and needs in heath care systems and policies. Contains 24 references. (JOW)

  5. The monopolistic integrated model and health care reform: the Swedish experience.

    Science.gov (United States)

    Anell, A

    1996-07-01

    This article reviews recent reforms geared to creating internal markets in the Swedish health-care sector. The main purpose is to describe driving forces behind reforms, and to analyse the limitations of reforms oriented towards internal markets within a monopolistic integrated health-care model. The principal part of the article is devoted to a discussion of incentives within Swedish county councils, and of how these incentives have influenced reforms in the direction of more choices for consumers and a separation between purchasers and providers. It is argued that the current incentives, in combination with criticism against county council activities in the early 1990's, account for the present inconsistencies as regards reforms. Furthermore, the article maintains that a weak form of separation between purchasers and providers will lead to distorted incentives, restricting innovative behaviour and structural change. In conclusion, the process of reforming the Swedish monopolistic integrated health-care model in the direction of some form of internal market is said to rest on shaky ground.

  6. Integration of the primary health care approach into a community nursing science curriculum.

    Science.gov (United States)

    Vilakazi, S S; Chabeli, M M; Roos, S D

    2000-12-01

    The purpose of this article is to explore and describe guidelines for integration of the primary health care approach into a Community Nursing Science Curriculum in a Nursing College in Gauteng. A qualitative, exploratory, descriptive and contextual research design was utilized. The focus group interviews were conducted with community nurses and nurse educators as respondents. Data were analysed by a qualitative descriptive method of analysis as described in Creswell (1994: 155). Respondents in both groups held similar perceptions regarding integration of primary health care approach into a Community Nursing Science Curriculum. Five categories, which are in line with the curriculum cycle, were identified as follows: situation analysis, selection and organisation of objectives/goals, content, teaching methods and evaluation. Guidelines and recommendations for the integration of the primary health care approach into a Community Nursing Science Curriculum were described.

  7. Integration of the primary health care approach into a community nursing science curriculum

    Directory of Open Access Journals (Sweden)

    SS Vilakazi

    2000-09-01

    Full Text Available The purpose of this article is to explore and describe guidelines for integration of the primary health care approach into a Community Nursing Science Curriculum in a Nursing College in Gauteng. A qualitative, exploratory, descriptive and contextual research design was utilized. The focus group interviews were conducted with community nurses and nurse educators as respondents. Data were analysed by a qualitative descriptive method of analysis as described in Creswell (1994:155. Respondents in both groups held similar perceptions regarding integration of primary health care approach into a Community Nursing Science Curriculum. Five categories, which are in line with the curriculum cycle, were identified as follows: situation analysis, selection and organisation of objectives/ goals, content, teaching methods and evaluation. Guidelines and recommendations for the integration of the primary health care approach into a Community Nursing Science Curriculum were described.

  8. From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care.

    Science.gov (United States)

    Harnagea, Hermina; Lamothe, Lise; Couturier, Yves; Esfandiari, Shahrokh; Voyer, René; Charbonneau, Anne; Emami, Elham

    2018-02-15

    Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training non-dental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector.

  9. Developing integrated health and social care services for older persons in Europe

    Directory of Open Access Journals (Sweden)

    Kai Leichsenring

    2004-09-01

    Full Text Available 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

  10. Community mental health nurses’ experience of decentralised and integrated psychiatric-mental health care services in the Southern mental health region of Botswana (part 1

    Directory of Open Access Journals (Sweden)

    M.K. Maphorisa

    2002-09-01

    Full Text Available Since the inception of the decentralisation and integration of psychiatric mental health care services into the general health care delivery system in Botswana, there has never been a study to investigate what community mental health nurses are experiencing due to the policy. Many of these nurses have been leaving the scantily staffed mental health care services in increasing numbers to join other sectors of health or elsewhere since the beginning of the implementation of the policy. During the research study, phenomenological in-depth interviews were conducted with three groups of 12 community mental health nurses altogether. An open central question was posed to each group followed by probing questions to explore and describe these nurses’ experience of the decentralisation and integration of psychiatric-mental health care services. After the data was analysed, related literature was incorporated and guidelines for advanced psychiatric nurses were formulated and described to assist these nurses to cope with the decentralisation and integration of psychiatric-mental health care services. The guidelines were set up for the management of the community mental health nurses who are experiencing obstacles in the quest for mental health which also interfere with their capabilities as mental health care providers.

  11. Connected health and integrated care: Toward new models for chronic disease management.

    Science.gov (United States)

    Chouvarda, Ioanna G; Goulis, Dimitrios G; Lambrinoudaki, Irene; Maglaveras, Nicos

    2015-09-01

    The increasingly aging population in Europe and worldwide brings up the need for the restructuring of healthcare. Technological advancements in electronic health can be a driving force for new health management models, especially in chronic care. In a patient-centered e-health management model, communication and coordination between patient, healthcare professionals in primary care and hospitals can be facilitated, and medical decisions can be made timely and easily communicated. Bringing the right information to the right person at the right time is what connected health aims at, and this may set the basis for the investigation and deployment of the integrated care models. In this framework, an overview of the main technological axes and challenges around connected health technologies in chronic disease management are presented and discussed. A central concept is personal health system for the patient/citizen and three main application areas are identified. The connected health ecosystem is making progress, already shows benefits in (a) new biosensors, (b) data management, (c) data analytics, integration and feedback. Examples are illustrated in each case, while open issues and challenges for further research and development are pinpointed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

    Science.gov (United States)

    Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

    2012-04-01

    This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

  13. Integration of antenatal care services with health programmes in low– and middle– income countries: systematic review

    Directory of Open Access Journals (Sweden)

    Thyra E de Jongh

    2016-06-01

    Full Text Available Antenatal care (ANC presents a potentially valuable platform for integrated delivery of additional health services for pregnant women–services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low– and middle–income countries (LMICs. However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs.

  14. [National Policy of Humanization and education of health care professionals: integrative review].

    Science.gov (United States)

    Barbosa, Guilherme Correa; Meneguim, Silmara; Lima, Silvana Andréa Molina; Moreno, Vania

    2013-01-01

    The National Policy of Humanization aims at innovations in health production, management and care with emphasis on permanent education for workers in the Unified Public Health System and training of university students in the health care field. This study aimed to know, through an integrative review of the literature, the scientific production about the National Policy of Humanization and education of health care professionals, from 2002 to 2010. Ten articles were analyzed in thematic strand through three axes: humanization and users caring, humanization and the work process, humanization and training. The articles point to the need to overcome the biological conception, valuing cultural aspects of users. The work process is marked by the devaluation of workers and by users deprived of their rights. The training of health professionals is grounded in health services where the prevailing standards are practices that hinder innovative attitudes.

  15. Interprofessional collaboration and integration as experienced by social workers in health care.

    Science.gov (United States)

    Glaser, Brooklyn; Suter, Esther

    2016-01-01

    Interprofessional collaboration in health care is gaining popularity. This secondary analysis focuses on social workers' experiences on interprofessional teams. The data revealed that social workers perceived overall collaboration as positive. However, concerns were made apparent regarding not having the opportunity to work to full scope and a lack of understanding of social work ideology from other professionals. Both factors seem to impede integration of and collaboration with social workers on health care teams. This study confirms the need to encourage and support health care providers to more fully understand the foundation, role, and efficacy of social work on interprofessional teams.

  16. Revisiting Organisational Learning in Integrated Care.

    Science.gov (United States)

    Nuño-Solinís, Roberto

    2017-08-11

    Progress in health care integration is largely linked to changes in processes and ways of doing. These changes have knowledge management and learning implications. For this reason, the use of the concept of organisational learning is explored in the field of integrated care. There are very limited contributions that have connected the fields of organisational learning and care integration in a systematic way, both at the theoretical and empirical level. For this reason, hybridization of both perspectives still provides opportunities for understanding care integration initiatives from a research perspective as well as potential applications in health care management and planning.

  17. Should nurses be leaders of integrated health care?

    Science.gov (United States)

    Thomas, Paul; While, Alison

    2007-09-01

    To examine the role of nurses within integrated health care. Healthcare planners are overly concerned with the treatment of diseases and insufficiently focused on social cohesion vertical rather than horizontal integration of healthcare effort. These domains need to be better connected, to avoid medicalization of social problems and socialisation of medical problems. Published literature, related to theories of whole system integration. *When conceptualizing whole system integration it helps to consider research insights to be snapshots of more complex stories-in-evolution, and change to be the result of ongoing community dance where multiple players adapt their steps to each other. *One image that helps to conceptualize integration is that of a railway network. Railway tracks and multiple journeys are equally needed; each requiring a different approach for success. *Traditional nursing values make nurses more attuned to the issues of combined vertical and horizontal integration than medical colleagues. Nurses should lead integration at the interface between horizontal and vertical activities. Nursing managers and universities should support the development of nurses as leaders of whole system integration, in partnership with local healthcare organizations.

  18. Integrated employee assistance program/managed behavioral health care benefits: relationship with access and client characteristics.

    Science.gov (United States)

    Levy Merrick, Elizabeth S; Hodgkin, Dominic; Horgan, Constance M; Hiatt, Deirdre; McCann, Bernard; Azzone, Vanessa; Zolotusky, Galina; Ritter, Grant; Reif, Sharon; McGuire, Thomas G

    2009-11-01

    This study examined service user characteristics and determinants of access for enrollees in integrated EAP/behavioral health versus standard managed behavioral health care plans. A national managed behavioral health care organization's claims data from 2004 were used. Integrated plan service users were more likely to be employees rather than dependents, and to be diagnosed with adjustment disorder. Logistic regression analyses found greater likelihood in integrated plans of accessing behavioral health services (OR 1.20, CI 1.17-1.24), and substance abuse services specifically (OR 1.23, CI 1.06-1.43). Results are consistent with the concept that EAP benefits may increase access and address problems earlier.

  19. Integrated care: theory to practice.

    Science.gov (United States)

    Stokes, Jonathan; Checkland, Kath; Kristensen, Søren Rud

    2016-10-01

    'Integrated care' is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team case management is frequently the primary focus of integrated care when implemented internationally. We examine the practical application of integrated care in the NHS in England to exemplify the prevalence of the case management focus. We look at the evidence for effectiveness of multi-disciplinary team case management, for the focus on high-risk groups and for integrated care more generally. We suggest realistic expectations of what integration of care alone can achieve and additional research questions. © The Author(s) 2016.

  20. Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review.

    Science.gov (United States)

    de Jongh, Thyra E; Gurol-Urganci, Ipek; Allen, Elizabeth; Zhu, Nina Jiayue; Atun, Rifat

    2016-06-01

    Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women-services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs. Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non-integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle-Ottawa Scale, depending on the study design. Due to high heterogeneity no meta-analysis could be conducted. Results are presented narratively. 12 studies were included in the review. Limited evidence, with moderate- to high-risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services. The reported evidence is largely based on non-randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC.

  1. Improving Outcomes through Transformational Health and Social Care Integration - The Scottish Experience.

    Science.gov (United States)

    Hendry, Anne; Taylor, Alison; Mercer, Stewart; Knight, Peter

    2016-01-01

    The Scottish Parliament recently passed legislation on integrating healthcare and social care to improve the quality and outcomes of care and support for people with multiple and complex needs across Scotland. This ambitious legislation provides a national framework to accelerate progress in person-centred and integrated care and support for the growing number of people who have multiple physical and mental health conditions and complex needs. Additional investment and improvement capacity is helping to commission support and services that are designed and delivered with people in local communities and in partnership with housing, community, voluntary and independent sectors.

  2. The process of care in integrative health care settings - a qualitative study of US practices.

    Science.gov (United States)

    Grant, Suzanne J; Bensoussan, Alan

    2014-10-23

    There is a lack of research on the organisational operations of integrative healthcare (IHC) practices. IHC is a therapeutic strategy integrating conventional and complementary medicine in a shared context to administer individualized treatment. To better understand the process of care in IHC - the way in which patients are triaged and treatment plans are constructed, interviews were conducted with integrative health care leaders and practitioners in the US. Semi-structured interviews were conducted with a pragmatic group of fourteen leaders and practitioners from nine different IHC settings. All interviews were conducted face-to-face with the exception of one phone interview. Questions focussed on understanding the "process of care" in an integrative healthcare setting. Deductive categories were formed from the aims of the study, focusing on: organisational structure, processes of care (subcategories: patient intake, treatment and charting, use of guidelines or protocols), prevalent diseases or conditions treated, and the role of research in the organisation. The similarities and differences of the ITH entities emerged from this process. On an organisational level, conventional and CM services and therapies were co-located in all nine settings. For patients, this means there is more opportunity for 'seamless care'. Shared information systems enabled easy communication using internal messaging or email systems, and shared patient intake information. But beyond this infrastructure alignment for integrative health care was less supported. There were no use of protocols or guidelines within any centre, no patient monitoring mechanism beyond that which occurred within one-on-one appointments. Joint planning for a patient treatment was typically ad hoc through informal mechanisms. Additional duties typically come at a direct financial cost to fee-for-service practitioners. In contrast, service delivery and the process of care within hospital inpatient services followed

  3. The Norrtaelje model: a unique model for integrated health and social care in Sweden.

    Science.gov (United States)

    Bäck, Monica Andersson; Calltorp, Johan

    2015-01-01

    Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This "top-down" approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.

  4. Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices

    Directory of Open Access Journals (Sweden)

    Bart Verhees

    2017-12-01

    Full Text Available Point-of-care testing (POCT—laboratory tests performed with new mobile devices and online technologies outside of the central laboratory—is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP’s network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre.

  5. Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices.

    Science.gov (United States)

    Verhees, Bart; van Kuijk, Kees; Simonse, Lianne

    2017-12-21

    Point-of-care testing (POCT)-laboratory tests performed with new mobile devices and online technologies outside of the central laboratory-is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP's network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre.

  6. Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices.

    Science.gov (United States)

    Neprash, Hannah T; Chernew, Michael E; Hicks, Andrew L; Gibson, Teresa; McWilliams, J Michael

    2015-12-01

    Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. To assess the association between recent increases in physician-hospital integration and changes in spending and prices for outpatient and inpatient services. Using regression analysis, we estimated the relationship between changes in physician-hospital integration from January 1, 2008, through December 31, 2012, in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending. Adjustments were made for patient, plan, and market characteristics, including physician, hospital, and insurer market concentration. The study population included a cohort of 7,391,335 nonelderly enrollees in preferred-provider organizations or point-of-service plans included in the Truven Health MarketScan Commercial Database during the study period. Data were analyzed from December 1, 2013, through July 13, 2015. Physician-hospital integration, measured using Medicare claims data as the share of physicians in an MSA who bill for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. Annual inpatient and outpatient spending per enrollee and associated use of health care services, with utilization measured by price-standardized spending (the sum of annual service counts multiplied by the national mean of allowed charges for the service). Among the 240 MSAs, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs (interquartile range, 0.8-5.2 percentage points). For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean

  7. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

    Science.gov (United States)

    Valentijn, Pim P; Schepman, Sanneke M; Opheij, Wilfrid; Bruijnzeels, Marc A

    2013-01-01

    Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.

  8. Integrating Religion and Spirituality into Mental Health Care, Psychiatry and Psychotherapy

    OpenAIRE

    René Hefti

    2011-01-01

    Integrating spirituality into mental health care, psychiatry and psychotherapy is still controversial, albeit a growing body of evidence is showing beneficial effects and a real need for such integration. In this review, past and recent research as well as evidence from the integrative concept of a Swiss clinic is summarized. Religious coping is highly prevalent among patients with psychiatric disorders. Surveys indicate that 70–80% use religious or spiritual beliefs and activities to cope wi...

  9. [The Community Care as a model of social and health integration at the local level].

    Science.gov (United States)

    Ridolfi, Luciana

    2013-01-01

    The article develops a hypothesis for improving primary care services through health care solutions that can exceed the models in use (essentially hierarchical and based on tasks) in favor of new relational, multi-sectoral and network approaches that could privilege the integration of social and health services at the regional and district level (Community care). A qualitative methodological approach which analyzes the role of social networks in Community care, some national and international experiences of primary care models and the evaluation of the different role given to primary care both in the hierarchical-pyramidal approach and in the horizontal one (network approach). Some Italian regions are experimenting effective organizational models of care such as Primary Care Teams, Primary Care Units, Regional teams, Departments of Primary Care, Houses of Health ... At international level, it should be mentioned the Chronic Care Model (CCM), recently identified by WHO as a reference model, and adopted by the Tuscany Region (Italy). People-centered health care projects need shared interventions by competent and functional multiprofessional teams: the best outcome for the patient depends on the good interaction between individuals. It's necessary that relationships between members of the group are based on interdependence, integration and consistency to avoid risks of group illusion.

  10. A governance model for integrated primary/secondary care for the health-reforming first world - results of a systematic review.

    Science.gov (United States)

    Nicholson, Caroline; Jackson, Claire; Marley, John

    2013-12-20

    Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006-2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006-2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement - using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. All examples of successful primary/secondary care integration reported in the literature have focused on a combination

  11. The Importance Of Integrating Narrative Into Health Care Decision Making.

    Science.gov (United States)

    Dohan, Daniel; Garrett, Sarah B; Rendle, Katharine A; Halley, Meghan; Abramson, Corey

    2016-04-01

    When making health care decisions, patients and consumers use data but also gather stories from family and friends. When advising patients, clinicians consult the medical evidence but also use professional judgment. These stories and judgments, as well as other forms of narrative, shape decision making but remain poorly understood. Furthermore, qualitative research methods to examine narrative are rarely included in health science research. We illustrate how narratives shape decision making and explain why it is difficult but necessary to integrate qualitative research on narrative into the health sciences. We draw on social-scientific insights on rigorous qualitative research and our ongoing studies of decision making by patients with cancer, and we describe new tools and approaches that link qualitative research findings with the predominantly quantitative health science scholarship. Finally, we highlight the benefits of more fully integrating qualitative research and narrative analysis into the medical evidence base and into evidence-based medical practice. Project HOPE—The People-to-People Health Foundation, Inc.

  12. An integrative discourse perspective on positive leadership in public health care.

    Science.gov (United States)

    Pietiläinen, Ville; Salmi, Ilkka

    2017-02-06

    Purpose This study aims to take a discursive view on positive leadership (PL). A positive approach has gained momentum in recent years as appropriate leadership practices are implemented in organizations. Despite the turn toward discursive approaches in organization studies, there is insufficient evidence supporting PL as a socially constructed experience. Design/methodology/approach The present study addresses an integrative discourse perspective for capturing the PL concept as a social process within the public health-care context. Findings Four meanings of PL are highlighted: role-taking, servicing, balancing and deciphering. Research limitations/implications The meanings shift the emphasis of certain PL definitions to a contextual interpretation. For scholars, the perspective demonstrates a multidimensional process approach in the desired organizational context as a counterbalance to one unanimously agreed-upon PL definition. Practical implications For leaders, an integrative discourse perspective offers tools for comprehending PL as a process: how to identify, negotiate and reconcile various PL meanings. Originality/value An integrative discourse perspective provides a novel perspective capturing the PL concept within the public health-care field.

  13. Integration for coexistence? Implementation of intercultural health care policy in Ghana from the perspective of service users and providers.

    Science.gov (United States)

    Gyasi, Razak Mohammed; Poku, Adjoa Afriyie; Boateng, Simon; Amoah, Padmore Adusei; Mumin, Alhassan Abdul; Obodai, Jacob; Agyemang-Duah, Williams

    2017-01-01

    In spite of the World Health Organization's recommendations over the past decades, Ghana features pluralistic rather than truly integrated medical system. Policies about the integration of complementary medicine into the national health care delivery system need to account for individual-level involvement and cultural acceptability of care rendered by health care providers. Studies in Ghana, however, have glossed over the standpoint of the persons of the illness episode about the intercultural health care policy framework. This paper explores the health care users, and providers' experiences and attitudes towards the implementation of intercultural health care policy in Ghana. In-depth interviews, augmented with informal conversations, were conducted with 16 health service users, 7 traditional healers and 6 health professionals in the Sekyere South District and Kumasi Metropolis in the Ashanti Region of Ghana. Data were thematically analysed and presented based on the a posteriori inductive reduction approach. Findings reveal a widespread positive attitude to, and support for integrative medical care in Ghana. However, inter-provider communication in a form of cross-referrals and collaborative mechanisms between healers and health professionals seldom occurs and remains unofficially sanctioned. Traditional healers and health care professionals are skeptical about intercultural health care policy mainly due to inadequate political commitment for provider education. The medical practitioners have limited opportunity to undergo training for integrative medical practice. We also find a serious mistrust between the practitioners due to the "diversity of healing approaches and techniques." Weak institutional support, lack of training to meet standards of practice, poor registration and regulatory measures as well as negative perception of the integrative medical policy inhibit its implementation in Ghana. In order to advance any useful intercultural health care policy in

  14. Systematic Review of Integrative Health Care Research: Randomized Control Trials, Clinical Controlled Trials, and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Raheleh Khorsan

    2011-01-01

    Full Text Available A systematic review was conducted to assess the level of evidence for integrative health care research. We searched PubMed, Allied and Complementary Medicine (AMED, BIOSIS Previews, EMBASE, the entire Cochrane Library, MANTIS, Social SciSearch, SciSearch Cited Ref Sci, PsychInfo, CINAHL, and NCCAM grantee publications listings, from database inception to May 2009, as well as searches of the “gray literature.” Available studies published in English language were included. Three independent reviewers rated each article and assessed the methodological quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN 50. Our search yielded 11,891 total citations but 6 clinical studies, including 4 randomized, met our inclusion criteria. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. The methodological quality of the included studies was assessed independently using quality checklists of the SIGN 50. Only a small number of RCTs and CCTs with a limited number of patients and lack of adequate control groups assessing integrative health care research are available. These studies provide limited evidence of effective integrative health care on some modalities. However, integrative health care regimen appears to be generally safe.

  15. Proposals for enhanced health risk assessment and stratification in an integrated care scenario

    NARCIS (Netherlands)

    Duenas-Espin, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Carles Contel, Joan; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M. H.; Lluch-Ariet, Magi; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastia; Schonenberg, Helen; Stoerk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep

    2016-01-01

    Objectives: Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies

  16. Proposals for enhanced health risk assessment and stratification in an integrated care scenario

    NARCIS (Netherlands)

    Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep

    2016-01-01

    OBJECTIVES: Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies

  17. Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison

    Directory of Open Access Journals (Sweden)

    Dukers-Muijrers Nicole HTM

    2012-12-01

    Full Text Available Abstract Background Hospital HIV care and public sexual health care (a Sexual Health Care Centre services were integrated to provide sexual health counselling and sexually transmitted infections (STIs testing and treatment (sexual health care to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. Methods The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254, and quality rating. Results Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals. Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. Conclusions The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.

  18. Chronic and integrated care in Catalonia

    Science.gov (United States)

    Contel, Juan Carlos; Ledesma, Albert; Blay, Carles; Mestre, Assumpció González; Cabezas, Carmen; Puigdollers, Montse; Zara, Corine; Amil, Paloma; Sarquella, Ester; Constante, Carles

    2015-01-01

    Introduction The Chronicity Prevention and Care Programme set up by the Health Plan for Catalonia 2011–2015 has been an outstanding and excellent opportunity to create a new integrated care model in Catalonia. People with chronic conditions require major changes and transformation within the current health and social system. The new and gradual context of ageing, increase in the number of chronic diseases and the current fragmented system requires this transformation to be implemented. Method The Chronicity Prevention and Care Programme aims to implement actions which drive the current system towards a new scenario where organisations and professionals must work collaboratively. New tools should facilitate this new context- or work-like integrated health information systems, an integrative financing and commissioning scheme and provide a new approach to virtual care by substituting traditional face-to-face care with transfer and shared responsibilities between patients, citizens and health care professionals. Results It has been observed some impact reducing the rate of emergency admissions and readmission related to chronic conditions and better outcome related to better chronic disease control. Some initiative like the Catalan Expert Patient Program has obtained good results and an appropriate service utilization. Discussion The implementation of a Chronic Care Program show good results but it is expected that the new integrated health and social care agenda could provoke a real change and transformation. Some of the results related to better health outcomes and a decrease in avoidable hospital admissions related to chronic conditions confirm we are on the right track to make our health and social system more sustainable for the decades to come. PMID:26150763

  19. Chronic and integrated care in Catalonia

    Directory of Open Access Journals (Sweden)

    Juan Carlos Contel

    2015-06-01

    Full Text Available Introduction: The Chronicity Prevention and Care Programme set up by the Health Plan for Catalonia 2011–2015 has been an outstanding and excellent opportunity to create a new integrated care model in Catalonia. People with chronic conditions require major changes and transformation within the current health and social system. The new and gradual context of ageing, increase in the number of chronic diseases and the current fragmented system requires this transformation to be implemented. Method: The Chronicity Prevention and Care Programme aims to implement actions which drive the current system towards a new scenario where organisations and professionals must work collaboratively. New tools should facilitate this new context- or work-like integrated health information systems, an integrative financing and commissioning scheme and provide a new approach to virtual care by substituting traditional face-to-face care with transfer and shared responsibilities between patients, citizens and health care professionals. Results: It has been observed some impact reducing the rate of emergency admissions and readmission related to chronic conditions and better outcome related to better chronic disease control. Some initiative like the Catalan Expert Patient Program has obtained good results and an appropriate service utilization. Discussion: The implementation of a Chronic Care Program show good results but it is expected that the new integrated health and social care agenda could provoke a real change and transformation. Some of the results related to better health outcomes and a decrease in avoidable hospital admissions related to chronic conditions confirm we are on the right track to make our health and social system more sustainable for the decades to come.

  20. Technology integration performance assessment using lean principles in health care.

    Science.gov (United States)

    Rico, Florentino; Yalcin, Ali; Eikman, Edward A

    2015-01-01

    This study assesses the impact of an automated infusion system (AIS) integration at a positron emission tomography (PET) center based on "lean thinking" principles. The authors propose a systematic measurement system that evaluates improvement in terms of the "8 wastes." This adaptation to the health care context consisted of performance measurement before and after integration of AIS in terms of time, utilization of resources, amount of materials wasted/saved, system variability, distances traveled, and worker strain. The authors' observations indicate that AIS stands to be very effective in a busy PET department, such as the one in Moffitt Cancer Center, owing to its accuracy, pace, and reliability, especially after the necessary adjustments are made to reduce or eliminate the source of errors. This integration must be accompanied by a process reengineering exercise to realize the full potential of AIS in reducing waste and improving patient care and worker satisfaction. © The Author(s) 2014.

  1. A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review

    Science.gov (United States)

    2013-01-01

    Background Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. Methods A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006–2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006–2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Results Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement – using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. Conclusions All examples of successful primary/secondary care integration reported in

  2. Translating the Elements of Health Governance for Integrated Care from Theory to Practice: A Case Study Approach.

    Science.gov (United States)

    Nicholson, Caroline; Hepworth, Julie; Burridge, Letitia; Marley, John; Jackson, Claire

    2018-01-31

    Against a paucity of evidence, a model describing elements of health governance best suited to achieving integrated care internationally was developed. The aim of this study was to explore how health meso-level organisations used, or planned to use, the governance elements. A case study design was used to offer two contrasting contexts of health governance. Semi-structured interviews were conducted with participants who held senior governance roles. Data were thematically analysed to identify if the elements of health governance were being used, or intended to be in the future. While all participants agreed that the ten elements were essential to developing future integrated care, most were not used. Three major themes were identified: (1) organisational versus system focus, (2) leadership and culture, and, (3) community (dis)engagement. Several barriers and enablers to the use of the elements were identified and would require addressing in order to make evidence-based changes. Despite a clear international policy direction in support of integrated care this study identified a number of significant barriers to its implementation. The study reconfirmed that a focus on all ten elements of health governance is essential to achieve integrated care.

  3. Health care consumers’ perspectives on pharmacist integration into private general practitioner clinics in Malaysia: a qualitative study

    Directory of Open Access Journals (Sweden)

    Saw PS

    2015-03-01

    Full Text Available Pui San Saw,1 Lisa M Nissen,2,3 Christopher Freeman,2,4 Pei Se Wong,3 Vivienne Mak5 1School of Postgraduate Studies and Research, International Medical University, Kuala Lumpur, Malaysia; 2School of Clinical Sciences, Queensland University Technology, Brisbane, QLD, Australia; 3School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia; 4School of Pharmacy, University of Queensland, St Lucia, QLD, Australia; 5School of Pharmacy, Monash University Malaysia, Selangor, Malaysia Background: Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists’ involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers’ views on the integration of pharmacists within private GP clinics in Malaysia.Methods: A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10. Results: A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1 pharmacists’ role viewed mainly as supplying medications, 2 readiness to accept pharmacists in private GP clinics, 3 willingness to pay for pharmacy services, and 4 concerns about GPs’ resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy

  4. Barriers and facilitators to the integration of mental health services into primary health care: a systematic review protocol.

    Science.gov (United States)

    Wakida, Edith K; Akena, Dickens; Okello, Elialilia S; Kinengyere, Alison; Kamoga, Ronald; Mindra, Arnold; Obua, Celestino; Talib, Zohray M

    2017-08-25

    Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works. This review will use the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework approach to identify experiences of mental health integration into PHC; the findings will be reported using the "Best fit" framework synthesis. PubMed, EMBASE, PsycINFO, and Cochrane Central Register of Controlled trials (CENTRAL) will be searched including other sources like the WHO website and OpenGrey database. Assessment of bias and quality will be done at study level using two separate tools to check for the quality of evidence presented. Data synthesis will take on two synergistic approaches (qualitative and quantitative studies). Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. The findings will be useful to a wide array of stakeholders involved in the implementation of the mental health integration into PHC. The SPIDER framework has been chosen for this review because of its suitable application to qualitative and mixed methods research and will be used as a guide when selecting articles for inclusion. Data extracted will be synthesized using the "Best fit" framework because it has been used before and proved its suitability in producing new conceptual models for explaining decision-making and possible behaviors. Synthesizing evidence from countries across the globe

  5. An analysis of integrated health care for Internet Use Disorders in adolescents and adults.

    Science.gov (United States)

    Lindenberg, Katajun; Szász-Janocha, Carolin; Schoenmaekers, Sophie; Wehrmann, Ulrich; Vonderlin, Eva

    2017-12-01

    Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients' compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization.

  6. Barriers and facilitators in the integration of oral health into primary care: a scoping review.

    Science.gov (United States)

    Harnagea, Hermina; Couturier, Yves; Shrivastava, Richa; Girard, Felix; Lamothe, Lise; Bedos, Christophe Pierre; Emami, Elham

    2017-09-25

    This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care. Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results. From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients' oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity. This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Oral Health Care Delivery Within the Accountable Care Organization.

    Science.gov (United States)

    Blue, Christine; Riggs, Sheila

    2016-06-01

    The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

  8. Integrating cost information with health management support system: an enhanced methodology to assess health care quality drivers.

    Science.gov (United States)

    Kohli, R; Tan, J K; Piontek, F A; Ziege, D E; Groot, H

    1999-08-01

    Changes in health care delivery, reimbursement schemes, and organizational structure have required health organizations to manage the costs of providing patient care while maintaining high levels of clinical and patient satisfaction outcomes. Today, cost information, clinical outcomes, and patient satisfaction results must become more fully integrated if strategic competitiveness and benefits are to be realized in health management decision making, especially in multi-entity organizational settings. Unfortunately, traditional administrative and financial systems are not well equipped to cater to such information needs. This article presents a framework for the acquisition, generation, analysis, and reporting of cost information with clinical outcomes and patient satisfaction in the context of evolving health management and decision-support system technology. More specifically, the article focuses on an enhanced costing methodology for determining and producing improved, integrated cost-outcomes information. Implementation issues and areas for future research in cost-information management and decision-support domains are also discussed.

  9. General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model.

    Science.gov (United States)

    Schulte, Timothy J; Isley, Elayne; Link, Nancy; Shealy, Craig N; Winfrey, LaPearl Logan

    2004-10-01

    The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace. Copyright 2004 Wiley Periodicals, Inc.

  10. Mental health service users' experiences of mental health care: an integrative literature review.

    Science.gov (United States)

    Newman, D; O'Reilly, P; Lee, S H; Kennedy, C

    2015-04-01

    A number of studies have highlighted issues around the relationship between service users and providers. The recovery model is predominant in mental health as is the recognition of the importance of person-centred practice. The authors completed an in-depth search of the literature to answer the question: What are service users' experiences of the mental health service? Three key themes emerged: acknowledging a mental health problem and seeking help; building relationships through participation in care; and working towards continuity of care. The review adds to the current body of knowledge by providing greater detail into the importance of relationships between service users and providers and how these may impact on the delivery of care in the mental health service. The overarching theme that emerged was the importance of the relationship between the service user and provider as a basis for interaction and support. This review has specific implications for mental health nursing. Despite the recognition made in policy documents for change, issues with stigma, poor attitudes and communication persist. There is a need for a fundamental shift in the provider-service user relationship to facilitate true service-user engagement in their care. The aim of this integrative literature review was to identify mental health service users' experiences of services. The rationale for this review was based on the growing emphasis and requirements for health services to deliver care and support, which recognizes the preferences of individuals. Contemporary models of mental health care strive to promote inclusion and empowerment. This review seeks to add to our current understanding of how service users experience care and support in order to determine to what extent the principles of contemporary models of mental health care are embedded in practice. A robust search of Web of Science, the Cochrane Database, Science Direct, EBSCO host (Academic Search Complete, MEDLINE, CINAHL Plus

  11. Integrating Quality Improvement and Continuing Professional Development: A Model From the Mental Health Care System.

    Science.gov (United States)

    Sockalingam, Sanjeev; Tehrani, Hedieh; Lin, Elizabeth; Lieff, Susan; Harris, Ilene; Soklaridis, Sophie

    2016-04-01

    To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. In 2013-2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants' perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantly at the individual and hospital levels. Four themes related to the relationship between QI and CPD were identified: challenges with QI training, adoption of QI into the mental health care system, implementation of QI in CPD, and practice improvement outcomes. Despite participants describing QI and CPD as mutually beneficial, they expressed uncertainty about the appropriateness of aligning these domains within a mental health care context because of the identified challenges. This study identified challenges with aligning QI and CPD in psychiatry and yielded a framework to inform future integration efforts. Further research is needed to determine the generalizability of this framework to other specialties and health care professions.

  12. Developing compassionate leadership in health care: an integrative review

    Directory of Open Access Journals (Sweden)

    de Zulueta PC

    2015-12-01

    Full Text Available Paquita C de Zulueta Department of Primary Care and Public Health, Imperial College London, UK Abstract: Compassionate health care is universally valued as a social and moral good to be upheld and sustained. Leadership is considered pivotal for enabling the development and preservation of compassionate health care organizations. Strategies for developing compassionate health care leadership in the complex, fast-moving world of today will require a paradigm shift from the prevalent dehumanizing model of the organization as machine to one of the organizations as a living complex adaptive system. It will also require the abandonment of individualistic, heroic models of leadership to one of shared, distributive, and adaptive leadership. “Command and control” leadership, accompanied by stifling regulation, rigid prescriptions, coercive punishments, and/or extrinsic rewards, infuses fear into the system with consequent disempowerment and disunity within the workforce, and the attrition of innovation and compassion. It must be eschewed. Instead, leadership should be developed throughout the organization with collective holistic learning strategies combined with high levels of staff support and engagement. Culture and leadership are interdependent and synergistic; their codevelopment needs to be grounded in a sophisticated, scientifically based account of human nature held within a coherent philosophical framework reflected by modern organizational and leadership theories. Developing leadership for compassionate care requires acknowledging and making provision for the difficulties and challenges of working in an anxiety-laden context. This means providing appropriate training and well-being programs, sustaining high levels of trust and mutually supportive interpersonal connections, and fostering the sharing of knowledge, skills, and workload across silos. It requires enabling people to experiment without fear of reprisal, to reflect on their work

  13. BURNOUT SYNDROME IN NURSES OF PRIMARY HEALTH CARE: AN INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    Magno Conceição das Merces

    2015-04-01

    Full Text Available Background and Objective: Burnout Syndrome (BS also known as burnout is described as a phenomenon composed of feelings of failure and exhaustion, caused by excessive wear and energy resources, mediated by practice and work stress. In this sense, the nurse Primary Health Care (PHC is not exempted in the development of the syndrome in question, since it is a profession that develops their work activities through direct contact with patients and families, making workloads too much which can depreciate the quality of care. This study becomes relevant because it will contribute to the PHC nurses have deeper knowledge of the BS, and few studies at this level of health care. He stood as guiding question: What is the prevalence of BS nurses in the PHC based in Brazilian literature from 2000 to 2014? And as objective to determine the prevalence of BS nurses in the PHC. Content: This is an integrative literature review. To that end, we conducted survey of manuscripts published from 2000 to 2014, using as descriptors, in combination: nurse; burnout and primary care in the Virtual Health Library (VHL. Conclusion: It is not yet possible to know the prevalence of BS nurses in the PHC due to lack of studies in the area. KEYWORDS: Nurse. Burnout, Professional. Primary Health Care.

  14. Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

    Directory of Open Access Journals (Sweden)

    Kornhaber R

    2016-10-01

    Full Text Available Rachel Kornhaber,1 Kenneth Walsh,1,2 Jed Duff,1,3 Kim Walker1,3 1School of Health Sciences, Faculty of Health, University of Tasmania, Alexandria, NSW, 2Tasmanian Health Services – Southern Region, Hobart, TAS, 3St Vincent’s Private Hospital, Sydney, NSW, Australia Abstract: Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician–patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients’ experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships. Keywords: health, acute care, therapeutic interpersonal relationships, relational care integrative review 

  15. Integrated care: a Danish perspective

    DEFF Research Database (Denmark)

    Rudkjøbing, Andreas; Olejaz, Maria; Birk, Hans Okkels

    2012-01-01

    that it generally provides high quality services and patient satisfaction with primary care and hospital services is high. Nevertheless, despite a raft of policies aimed at integrating health services, the Danish system still suffers from a lack of coordination of care. Although Denmark’s health information systems...

  16. Integration and Task Allocation: Evidence from Patient Care.

    Science.gov (United States)

    David, Guy; Rawley, Evan; Polsky, Daniel

    2013-01-01

    Using the universe of patient transitions from inpatient hospital care to skilled nursing facilities and home health care in 2005, we show how integration eliminates task misallocation problems between organizations. We find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower-cost organizations by discharging patients earlier (and in poorer health) and increasing post-hospitalization service intensity. While integration facilitates a shift in the allocation of tasks and resources, health outcomes either improved or were unaffected by integration on average. The evidence suggests that integration solves coordination problems that arise in market exchange through improvements in the allocation of tasks across care settings.

  17. Integration and Task Allocation: Evidence from Patient Care*

    Science.gov (United States)

    David, Guy; Rawley, Evan; Polsky, Daniel

    2013-01-01

    Using the universe of patient transitions from inpatient hospital care to skilled nursing facilities and home health care in 2005, we show how integration eliminates task misallocation problems between organizations. We find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower-cost organizations by discharging patients earlier (and in poorer health) and increasing post-hospitalization service intensity. While integration facilitates a shift in the allocation of tasks and resources, health outcomes either improved or were unaffected by integration on average. The evidence suggests that integration solves coordination problems that arise in market exchange through improvements in the allocation of tasks across care settings. PMID:24415893

  18. Measuring integrated care.

    Science.gov (United States)

    Strandberg-Larsen, Martin

    2011-02-01

    The positive outcomes of coordination of healthcare services are to an increasing extent becoming clear. However the complexity of the field is an inhibiting factor for vigorously designed trial studies. Conceptual clarity and a consistent theoretical frame-work are thus needed. While researchers respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine the associations between specific organizational factors and clinical integration within each system. The literature was systematically searched to identify methods for measurement of integrated healthcare delivery. A national cross-sectional survey was conducted among major professional stake-holders at five different levels of the Danish healthcare system. The survey data were used to allow for analysis of the level of integration achieved. Data from the survey were

  19. An integrated health and social care organisation in Sweden: creation and structure of a unique local public health and social care system.

    Science.gov (United States)

    Øvretveit, John; Hansson, Johan; Brommels, Mats

    2010-10-01

    Research and citizens have noted failures in coordinating health and social services and professionals, and the need to address this issue to realize benefits from increasing specialisation. Different methods have been proposed and one has been structural integration of separate services within one organisation. This paper reports an empirical longitudinal study of the development of an integrated health and social care organisation in Sweden combining service provision, purchasing and political governance for a defined population. The study found a combination of influences contributed to the development of this new organisation. The initial structural macro-integration facilitated, but did not of itself result in better clinical care coordination. Other actions were needed to modify the specialised systems and cultures which the organisation inherited. The study design was not able to establish with any degree of certainty whether better patient and cost outcomes resulted, but it did find structural and process changes which make improved outcomes likely. The study concludes that coordinated actions at different levels and of different types were needed to achieve care coordination for patients and that a phased approach was necessary where management capacity and outside expertise are limited. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  20. A Framework for Integrating Environmental and Occupational Health and Primary Care in a Postdisaster Context.

    Science.gov (United States)

    Kirkland, Katherine; Sherman, Mya; Covert, Hannah; Barlet, Grace; Lichtveld, Maureen

    Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels. This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health. The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues. The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories. This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.

  1. Collaborative Care in Schools: Enhancing Integration and Impact in Youth Mental Health

    Science.gov (United States)

    Lyon, Aaron R.; Whitaker, Kelly; French, William P.; Richardson, Laura P.; Wasse, Jessica Knaster; McCauley, Elizabeth

    2016-01-01

    Collaborative Care is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality, and lowering healthcare expenditures. A large body of evidence supports the effectiveness of Collaborative Care models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analog for the accessibility that primary care offers to adults. Collaborative Care aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of Collaborative Care models in schools. Based on the existing evidence for Collaborative Care models, the current paper (1) provides a rationale for the adaptation of Collaborative Care models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary Collaborative Care model for use in schools; and (3) describes avenues for research surrounding school-based Collaborative Care, including the currently funded Accessible, Collaborative Care for Effective School-based Services (ACCESS) project. PMID:28392832

  2. An Innovative Model of Integrated Behavioral Health: School Psychologists in Pediatric Primary Care Settings

    Science.gov (United States)

    Adams, Carolyn D.; Hinojosa, Sara; Armstrong, Kathleen; Takagishi, Jennifer; Dabrow, Sharon

    2016-01-01

    This article discusses an innovative example of integrated care in which doctoral level school psychology interns and residents worked alongside pediatric residents and pediatricians in the primary care settings to jointly provide services to patients. School psychologists specializing in pediatric health are uniquely trained to recognize and…

  3. Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access.

    Science.gov (United States)

    Vickers, Kristin S; Ridgeway, Jennifer L; Hathaway, Julie C; Egginton, Jason S; Kaderlik, Angela B; Katzelnick, David J

    2013-01-01

    This evaluation assessed the opinions and experiences of primary care providers and their support staff before and after implementation of expanded on-site mental health services and related system changes in a primary care clinic. Individual semistructured interviews, which contained a combination of open-ended questions and rating scales, were used to elicit opinions about mental health services before on-site system and resource changes occurred and repeated following changes that were intended to improve access to on-site mental health care. In the first set of interviews, prior to expanding mental health services, primary care providers and support staff were generally dissatisfied with the availability and scheduling of on-site mental health care. Patients were often referred outside the primary care clinic for mental health treatment, to the detriment of communication and coordinated care. Follow-up interviews conducted after expansion of mental health services, scheduling refinements and other system changes revealed improved provider satisfaction in treatment access and coordination of care. Providers appreciated immediate and on-site social worker availability to triage mental health needs and help access care, and on-site treatment was viewed as important for remaining informed about patient care the primary care providers are not delivering directly. Expanding integrated mental health services resulted in increased staff and provider satisfaction. Our evaluation identified key components of satisfaction, including on-site collaboration and assistance triaging patient needs. The sustainability of integrated models of care requires additional study. © 2013.

  4. Integrative medicine and patient-centered care.

    Science.gov (United States)

    Maizes, Victoria; Rakel, David; Niemiec, Catherine

    2009-01-01

    Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies

  5. Design of a terminal solution for integration of in-home health care devices and services towards the Internet-of-Things

    Science.gov (United States)

    Pang, Zhibo; Zheng, Lirong; Tian, Junzhe; Kao-Walter, Sharon; Dubrova, Elena; Chen, Qiang

    2015-01-01

    In-home health care services based on the Internet-of-Things are promising to resolve the challenges caused by the ageing of population. But the existing research is rather scattered and shows lack of interoperability. In this article, a business-technology co-design methodology is proposed for cross-boundary integration of in-home health care devices and services. In this framework, three key elements of a solution (business model, device and service integration architecture and information system integration architecture) are organically integrated and aligned. In particular, a cooperative Health-IoT ecosystem is formulated, and information systems of all stakeholders are integrated in a cooperative health cloud as well as extended to patients' home through the in-home health care station (IHHS). Design principles of the IHHS includes the reuse of 3C platform, certification of the Health Extension, interoperability and extendibility, convenient and trusted software distribution, standardised and secured electrical health care record handling, effective service composition and efficient data fusion. These principles are applied to the design of an IHHS solution called iMedBox. Detailed device and service integration architecture and hardware and software architecture are presented and verified by an implemented prototype. The quantitative performance analysis and field trials have confirmed the feasibility of the proposed design methodology and solution.

  6. Payment and economic evaluation of integrated care

    Directory of Open Access Journals (Sweden)

    Apostolos Tsiachristas

    2015-04-01

    Full Text Available Chronic diseases have an increasingly negative impact on (1 population health by increasing morbidity and mortality, (2 society by increasing health inequalities and burden to informal caregivers, and (3 economy by requiring enormous financial resources and jeopardising macro-economic development (e.g. consumption, capital accumulation, labour productivity and labour supply. Integrated care is the most promising concept in redesigning care to tackle the increasing threat of chronic diseases. Several European countries have experimented with models for integrating care, most frequently in the form of disease management programmes. These models were often supported by payment schemes to provide financial incentives to health care providers for implementing integrated care. This thesis aimed to investigate these payment schemes and assess their impact, explore the variability in costs of disease management programmes, and determine the costs and effects of disease management programmes.

  7. Perceived Educational Needs of the Integrated Care Psychiatric Consultant.

    Science.gov (United States)

    Ratzliff, Anna; Norfleet, Kathryn; Chan, Ya-Fen; Raney, Lori; Unützer, Jurgen

    2015-08-01

    With the increased implementation of models that integrate behavioral health with other medical care, there is a need for a workforce of integrated care providers, including psychiatrists, who are trained to deliver mental health care in new ways and meet the needs of a primary care population. However, little is known about the educational needs of psychiatrists in practice delivering integrated care to inform the development of integrated care training experiences. The educational needs of the integrated care team were assessed by surveying psychiatric consultants who work in integrated care. A convenience sample of 52 psychiatrists working in integrated care responded to the survey. The majority of the topics included in the survey were considered educational priorities (>50% of the psychiatrists rated them as essential) for the psychiatric consultant role. Psychiatrists' perspectives on educational priorities for behavioral health providers (BHPs) and primary care providers (PCPs) were also identified. Almost all psychiatrists reported that they provide educational support for PCPs and BHPs (for PCP 92%; for BHP 96%). The information provided in this report suggests likely educational needs of the integrated care psychiatric consultant and provides insight into the learning needs of other integrated care team members. Defining clear priorities related to the three roles of the integrated care psychiatric consultant (clinical consultant, clinical educator, and clinical team leader) will be helpful to inform residency training programs to prepare psychiatrists for work in this emerging field of psychiatry.

  8. Developing compassionate leadership in health care: an integrative review.

    Science.gov (United States)

    de Zulueta, Paquita C

    2016-01-01

    Compassionate health care is universally valued as a social and moral good to be upheld and sustained. Leadership is considered pivotal for enabling the development and preservation of compassionate health care organizations. Strategies for developing compassionate health care leadership in the complex, fast-moving world of today will require a paradigm shift from the prevalent dehumanizing model of the organization as machine to one of the organizations as a living complex adaptive system. It will also require the abandonment of individualistic, heroic models of leadership to one of shared, distributive, and adaptive leadership. "Command and control" leadership, accompanied by stifling regulation, rigid prescriptions, coercive punishments, and/or extrinsic rewards, infuses fear into the system with consequent disempowerment and disunity within the workforce, and the attrition of innovation and compassion. It must be eschewed. Instead, leadership should be developed throughout the organization with collective holistic learning strategies combined with high levels of staff support and engagement. Culture and leadership are interdependent and synergistic; their codevelopment needs to be grounded in a sophisticated, scientifically based account of human nature held within a coherent philosophical framework reflected by modern organizational and leadership theories. Developing leadership for compassionate care requires acknowledging and making provision for the difficulties and challenges of working in an anxiety-laden context. This means providing appropriate training and well-being programs, sustaining high levels of trust and mutually supportive interpersonal connections, and fostering the sharing of knowledge, skills, and workload across silos. It requires enabling people to experiment without fear of reprisal, to reflect on their work, and to view errors as opportunities for learning and improvement. Tasks and relational care need to be integrated into a coherent

  9. Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa.

    Science.gov (United States)

    Mathibe, Maphuthego D; Hendricks, Stephen J H; Bergh, Anne-Marie

    2015-10-02

    Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Workload, staff development and support for integration affected clinicians' performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

  10. Ten years integrated care for mental disorders in the Netherlands

    Directory of Open Access Journals (Sweden)

    Christina M van der Feltz-Cornelis

    2011-03-01

    Full Text Available Background and problem statement: Integrated care for mental disorders aims to encompass forms of collaboration between different health care settings for the treatment of mental disorders. To this end, it requires integration at several levels, i.e. integration of psychiatry in medicine, of the psychiatric discourse in the medical discourse; of localization of mental health care and general health care facilities; and of reimbursement systems.   Description of policy practice: Steps have been taken in the last decade to meet these requirements, enabling psychiatry to move on towards integrated treatment of mental disorder as such, by development of a collaborative care model that includes structural psychiatric consultation that was found to be applicable and effective in several Dutch health care settings. This collaborative care model is a feasible and effective model for integrated care in several health care settings. The Bio Psycho Social System has been developed as a feasible instrument for assessment in integrated care as well. Discussion: The discipline of Psychiatry has moved from anti-psychiatry in the last century, towards an emancipated medical discipline. This enabled big advances towards integrated care for mental disorder, in collaboration with other medical disciplines, in the last decade. Conclusion: Now is the time to further expand this concept of care towards other mental disorders, and towards integrated care for medical and mental co-morbidity. Integrated care for mental disorder should be readily available to the patient, according to his/her preference, taking somatic co-morbidity into account, and with a focus on rehabilitation of the patient in his or her social roles.

  11. Ten years integrated care for mental disorders in the Netherlands

    Directory of Open Access Journals (Sweden)

    Christina M van der Feltz-Cornelis

    2011-03-01

    Full Text Available Background and problem statement: Integrated care for mental disorders aims to encompass forms of collaboration between different health care settings for the treatment of mental disorders. To this end, it requires integration at several levels, i.e. integration of psychiatry in medicine, of the psychiatric discourse in the medical discourse; of localization of mental health care and general health care facilities; and of reimbursement systems.  Description of policy practice: Steps have been taken in the last decade to meet these requirements, enabling psychiatry to move on towards integrated treatment of mental disorder as such, by development of a collaborative care model that includes structural psychiatric consultation that was found to be applicable and effective in several Dutch health care settings. This collaborative care model is a feasible and effective model for integrated care in several health care settings. The Bio Psycho Social System has been developed as a feasible instrument for assessment in integrated care as well.Discussion: The discipline of Psychiatry has moved from anti-psychiatry in the last century, towards an emancipated medical discipline. This enabled big advances towards integrated care for mental disorder, in collaboration with other medical disciplines, in the last decade.Conclusion: Now is the time to further expand this concept of care towards other mental disorders, and towards integrated care for medical and mental co-morbidity. Integrated care for mental disorder should be readily available to the patient, according to his/her preference, taking somatic co-morbidity into account, and with a focus on rehabilitation of the patient in his or her social roles.

  12. Developing standards for an integrated approach to workplace facilitation for interprofessional teams in health and social care contexts: a Delphi study.

    Science.gov (United States)

    Martin, Anne; Manley, Kim

    2018-01-01

    Integration of health and social care forms part of health and social care policy in many countries worldwide in response to changing health and social care needs. The World Health Organization's appeal for systems to manage the global epidemiologic transition advocates for provision of care that crosses boundaries between primary, community, hospital, and social care. However, the focus on structural and process changes has not yielded the full benefit of expected advances in care delivery. Facilitating practice in the workplace is a widely recognised cornerstone for developments in the delivery of health and social care as collaborative and inclusive relationships enable frontline staff to develop effective workplace cultures that influence whether transformational change is achieved and maintained. Workplace facilitation embraces a number of different purposes which may not independently lead to better quality of care or improved patient outcomes. Holistic workplace facilitation of learning, development, and improvement supports the integration remit across health and social care systems and avoids duplication of effort and waste of valuable resources. To date, no standards to guide the quality and effectiveness of integrated facilitation have been published. This study aimed to identify key elements constitute standards for an integrated approach to facilitating work-based learning, development, improvement, inquiry, knowledge translation, and innovation in health and social care contexts using a three rounds Delphi survey of facilitation experts from 10 countries. Consensus about priority elements was determined in the final round, following an iteration process that involved modifications to validate content. The findings helped to identify key qualities and skills facilitators need to support interprofessional teams to flourish and optimise performance. Further research could evaluate the impact of skilled integrated facilitation on health and social care

  13. Electronic health records and disease registries to support integrated care in a health neighbourhood: an ontology-based methodology.

    Science.gov (United States)

    Liaw, Siaw-Teng; Taggart, Jane; Yu, Hairong; Rahimi, Alireza

    2014-01-01

    Disease registries derived from Electronic Health Records (EHRs) are widely used for chronic disease management (CDM). However, unlike national registries which are specialised data collections, they are usually specific to an EHR or organization such as a medical home. We approached registries from the perspective of integrated care in a health neighbourhood, considering data quality issues such as semantic interoperability (consistency), accuracy, completeness and duplication. Our proposition is that a realist ontological approach is required to systematically and accurately identify patients in an EHR or data repository of EHRs, assess intrinsic data quality and fitness for use by members of the multidisciplinary integrated care team. We report on this approach as applied to routinely collected data in an electronic practice based research network in Australia.

  14. Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care

    OpenAIRE

    Rajkumar, Rajasekaran; Sriman Narayana Iyengar, Nallani Chackravatula

    2013-01-01

    Objectives The existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventati...

  15. Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention.

    Science.gov (United States)

    Quinn, Margaret M; Henneberger, Paul K; Braun, Barbara; Delclos, George L; Fagan, Kathleen; Huang, Vanthida; Knaack, Jennifer L S; Kusek, Linda; Lee, Soo-Jeong; Le Moual, Nicole; Maher, Kathryn A E; McCrone, Susan H; Mitchell, Amber Hogan; Pechter, Elise; Rosenman, Kenneth; Sehulster, Lynne; Stephens, Alicia C; Wilburn, Susan; Zock, Jan-Paul

    2015-05-01

    The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel. The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice. An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives. A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  16. Client satisfaction with reproductive health-care quality: integrating business approaches to modeling and measurement.

    Science.gov (United States)

    Alden, Dana L; Do, Mai Hoa; Bhawuk, Dharm

    2004-12-01

    Health-care managers are increasingly interested in client perceptions of clinic service quality and satisfaction. While tremendous progress has occurred, additional perspectives on the conceptualization, modeling and measurement of these constructs may further assist health-care managers seeking to provide high-quality care. To that end, this study draws on theories from business and health to develop an integrated model featuring antecedents to and consequences of reproductive health-care client satisfaction. In addition to developing a new model, this study contributes by testing how well Western-based theories of client satisfaction hold in a developing, Asian country. Applied to urban, reproductive health clinic users in Hanoi, Vietnam, test results suggest that hypothesized antecedents such as pre-visit expectations, perceived clinic performance and how much performance exceeds expectations impact client satisfaction. However, the relative importance of these predictors appears to vary depending on a client's level of service-related experience. Finally, higher levels of client satisfaction are positively related to future clinic use intentions. This study demonstrates the value of: (1) incorporating theoretical perspectives from multiple disciplines to model processes underlying health-care satisfaction and (2) field testing those models before implementation. It also furthers research designed to provide health-care managers with actionable measures of the complex processes related to their clients' satisfaction.

  17. Integrated working between residential care homes and primary care: a survey of care homes in England

    Directory of Open Access Journals (Sweden)

    Gage Heather

    2012-11-01

    Full Text Available Abstract Background Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. Methods A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621 in England in 2009. Responses were analysed using quantitative and qualitative methods. Results The survey achieved an overall response rate of 15.8%. Most care homes (78.7% worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs had visited the care homes in the last six months (SD 5.11, median 14; a mean of .39 (SD.163 professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60% managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low

  18. Ten years of integrated care for the older in France

    Directory of Open Access Journals (Sweden)

    Dominique Somme

    2011-12-01

    Full Text Available Background: This paper analyzes progress made toward the integration of the French health care system for the older and chronically ill population. Policies: Over the last ten years, the French health care system has been principally influenced by two competing linkage models that failed to integrate social and health care services: local information and coordination centers, governed by the social field, and the gerontological health networks governed by the health field. In response to this fragmentation, Homes for the Integration and Autonomy for Alzheimer patients (MAIAs is currently being implemented at experimental sites in the French national Alzheimer plan, using an evidence-based model of integrated care. In addition, the state's reforms recently created regional health agencies (ARSs by merging seven strategic institutions to manage the overall delivery of care. Conclusion: The French health care system is moving from a linkage-based model to a more integrated care system. We draw some early lessons from these changes, including the importance of national leadership and governance and a change management strategy that uses both top-down and bottom-up approaches to implement these reforms.

  19. EHR-based disease registries to support integrated care in a health neighbourhood: an ontology-based methodology.

    Science.gov (United States)

    Liaw, Siaw-Teng; Taggart, Jane; Yu, Hairong

    2014-01-01

    Disease registries derived from Electronic Health Records (EHRs) are widely used for chronic disease management. We approached registries from the perspective of integrated care in a health neighbourhood, considering data quality issues such as semantic interoperability (consistency), accuracy, completeness and duplication. Our proposition is that a realist ontological approach is required to accurately identify patients in an EHR or data repository, assess data quality and fitness for use by the multidisciplinary integrated care team. We report on this approach with routinely collected data in a practice based research network in Australia.

  20. Provider and Staff Perceptions and Experiences Implementing Behavioral Health Integration in Six Low-Income Health Care Organizations.

    Science.gov (United States)

    Farb, Heather; Sacca, Katie; Variano, Margaret; Gentry, Lisa; Relle, Meagan; Bertrand, Jane

    2018-01-01

    Behavioral health integration (BHI) is a proven, effective practice for addressing the joint behavioral health and medical health needs of vulnerable populations. As part of the New Orleans Charitable Health Fund (NOCHF) program, this study addressed a gap in literature to better understand factors that impact the implementation of BHI by analyzing perceptions and practices among staff at integrating organizations. Using a mixed-method design, quantitative results from the Levels of Integration Measure (LIM), a survey tool for assessing staff perceptions of BHI in primary care settings (n=86), were analyzed alongside qualitative results from in-depth interviews with staff (n=27). Findings highlighted the roles of strong leadership, training, and process changes on staff collaboration, relationships, and commitment to BHI. This study demonstrates the usefulness of the LIM in conjunction with in-depth interviews as an assessment tool for understanding perceptions and organizational readiness for BHI implementation.

  1. Integrated care: wellness-oriented peer approaches: a key ingredient for integrated care.

    Science.gov (United States)

    Swarbrick, Margaret A

    2013-08-01

    People with lived experience of mental illness have become leaders of an influential movement to help the mental health system embrace the notion of whole health and wellness in the areas of advocacy, policy, and care delivery. Wellness-oriented peer approaches delivered by peer-support whole-health specialists and wellness coaches can play an important role in integrated care models. This column examines the wellness definitions and peer models and some specific benefits and tensions between the peer-oriented wellness approach and the medical model. These models can work in unison to improve health and wellness among people with mental and substance use disorders.

  2. Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa

    Directory of Open Access Journals (Sweden)

    Maphuthego D. Mathibe

    2015-10-01

    Full Text Available Background: Primary Health Care (PHC clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. Objective: This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. Method: An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Results: Workload, staff development and support for integration affected clinicians’ performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Conclusion: Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

  3. Integrated care: a comprehensive bibliometric analysis and literature review

    Directory of Open Access Journals (Sweden)

    Xiaowei Sun

    2014-06-01

    Full Text Available Introduction: Integrated care could not only fix up fragmented health care but also improve the continuity of care and the quality of life. Despite the volume and variety of publications, little is known about how ‘integrated care’ has developed. There is a need for a systematic bibliometric analysis on studying the important features of the integrated care literature.Aim: To investigate the growth pattern, core journals and jurisdictions and identify the key research domains of integrated care.Methods: We searched Medline/PubMed using the search strategy ‘(delivery of health care, integrated [MeSH Terms] OR integrated care [Title/Abstract]’ without time and language limits. Second, we extracted the publishing year, journals, jurisdictions and keywords of the retrieved articles. Finally, descriptive statistical analysis by the Bibliographic Item Co-occurrence Matrix Builder and hierarchical clustering by SPSS were used.Results: As many as 9090 articles were retrieved. Results included: (1 the cumulative numbers of the publications on integrated care rose perpendicularly after 1993; (2 all documents were recorded by 1646 kinds of journals. There were 28 core journals; (3 the USA is the predominant publishing country; and (4 there are six key domains including: the definition/models of integrated care, interdisciplinary patient care team, disease management for chronically ill patients, types of health care organizations and policy, information system integration and legislation/jurisprudence.Discussion and conclusion: Integrated care literature has been most evident in developed countries. International Journal of Integrated Care is highly recommended in this research area. The bibliometric analysis and identification of publication hotspots provides researchers and practitioners with core target journals, as well as an overview of the field for further research in integrated care.

  4. Integration of midwives into the Quebec health care system. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.

    Science.gov (United States)

    Collin, J; Blais, R; White, D; Demers, A; Desbiens, F

    2000-01-01

    This paper reports on one aspect of the evaluation of the midwifery pilot projects in Quebec: the identification of the professional and organizational factors, as well as the mode of integrating midwives into the maternity care system, that would promote the best outcomes and the autonomy of midwives. The research strategy involved a multiple-case study, in which each midwifery pilot project represented a case. Based on a qualitative approach, the study employed various sources of data: individual interviews and focus groups with key informants, site observations and analyses of written documents. Results show that midwives were poorly integrated into the health care system during the evaluation. Four main reasons were identified: lack of knowledge about the practice of midwifery on the part of other health care providers; deficiencies in the legal and organizational structure of the pilot projects; competition over professional territories; and gaps between the midwives' and other providers' professional cultures. Recommendations are provided to facilitate the integration of midwives into the health care system.

  5. Integrating mental health into primary care: a global perspective

    National Research Council Canada - National Science Library

    Funk, Michelle

    2008-01-01

    ... for mental disorders is enormous 4. Primary care for mental health enhances access 5. Primary care for mental health promotes respect of human rights 6. Primary care for mental health is affordab...

  6. Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur

    Directory of Open Access Journals (Sweden)

    Yasuda Silvia

    2009-07-01

    Full Text Available Abstract Background There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. Methods A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Results Most patients were diagnosed with epilepsy (47% and psychosis (31% and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1–10.2 to 7.1 (95%CI 5.9–8.2 p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6–7.0 p Conclusion The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.

  7. Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur.

    Science.gov (United States)

    Souza, Renato; Yasuda, Silvia; Cristofani, Susanna

    2009-07-21

    There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Most patients were diagnosed with epilepsy (47%) and psychosis (31%) and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1-10.2) to 7.1 (95%CI 5.9-8.2) p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6-7.0) p < 0.0001. The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.

  8. The 7 Habits of Highly Effective Implementation of eHealth Enabled Integrated Care

    NARCIS (Netherlands)

    Keijser, Wouter Alexander; Penterman, L; van Montfort, Augustinus P.W.P.; Smits, Jacco Gerardus Wilhelmus Leonardus; Wilderom, Celeste P.M.

    2017-01-01

    Introduction: ‘E-health enabled integrated care’ (eHEIC) has high potential to improve quality of care, widen access and increase efficiency. Experts and scholars increasingly report about difficulties of sustainable eHEIC implementation. These reports indicate in particular ‘human factors’ often

  9. A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care.

    Science.gov (United States)

    Flys, Tamara; González, Rosalba; Sued, Omar; Suarez Conejero, Juana; Kestler, Edgar; Sosa, Nestor; McKenzie-White, Jane; Monzón, Irma Irene; Torres, Carmen-Rosa; Page, Kathleen

    2012-01-01

    Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. Of 258 initially active participants, 225 (225/258=87.2%) successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85%) attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (pstructure, and effectiveness in improving their HIV-related knowledge and skills. This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills acquired through the process, and could continue working within their underserved communities while participating in the online component and then implement interventions that successfully converted theoretical knowledge to action to improve integration of HIV care into primary care.

  10. Toward population management in an integrated care model.

    Science.gov (United States)

    Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

    2013-01-01

    Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. © 2013 S. Karger AG, Basel.

  11. Mobile integrated health to reduce post-discharge acute care visits: A pilot study.

    Science.gov (United States)

    Siddle, Jennica; Pang, Peter S; Weaver, Christopher; Weinstein, Elizabeth; O'Donnell, Daniel; Arkins, Thomas P; Miramonti, Charles

    2018-05-01

    Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. This was a retrospective cohort analysis of a quality improvement pilot of patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90days before MIH intervention to 90days after. Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre-MIH to 26 post-MIH (83% reduction, p=0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p=0.98; observation stays 95 to 106, p=0.30) Primary care visits increased 15% (p=0.11). In this pilot before/after study, MIH significantly reduces acute care hospitalizations. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. [Economic aspects of integrated care].

    Science.gov (United States)

    Lange, A; Braun, S; Greiner, W

    2012-05-01

    For more than 10 years integrated care has been an inherent part of the German healthcare system. The aims of selective contracts are to minimize interface problems between outpatient and inpatient sectors, generalist und specialist care as well as to intensify competition. Despite repeated efforts by the legislator, comprehensive integrated healthcare is still limited to a few flagship projects. This is mainly due to low incentives on the part of both suppliers and customers. Therefore, this article focuses on the economic aspects of integrated care. From a theoretical perspective, integrated care improves efficiency in the healthcare sector by reducing interface problems and asymmetric information as well as by intensifying competition. In practice, however, there are a number of obstacles to implementation. Particularly noteworthy are the financial difficulties in addition to problems regarding sectoral budgeting and the long-term nature of investments. However, the political environment and thus the financial arrangements within the statutory health insurance seem to be more important for further development of integrated care in Germany than the financing issues.

  13. Developing compassionate leadership in health care: an integrative review

    OpenAIRE

    de Zulueta, Paquita

    2015-01-01

    Paquita C de Zulueta Department of Primary Care and Public Health, Imperial College London, UK Abstract: Compassionate health care is universally valued as a social and moral good to be upheld and sustained. Leadership is considered pivotal for enabling the development and preservation of compassionate health care organizations. Strategies for developing compassionate health care leadership in the complex, fast-moving world of today will require a paradigm shift from the prevalent dehumanizi...

  14. Early Childhood Behavioral Health Integration in Pediatric Primary Care: Serving Refugee Families in the Healthy Steps Program

    Science.gov (United States)

    Buchholz, Melissa; Fischer, Collette; Margolis, Kate L.; Talmi, Ayelet

    2016-01-01

    Primary care settings are optimal environments for providing comprehensive, family-centered care to young children and their families. Primary care clinics with integrated behavioral health clinicians (BHCs) are well-positioned to build trust and create access to care for marginalized and underserved populations. Refugees from around the world are…

  15. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study.

    Science.gov (United States)

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, Bert

    2015-08-21

    Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients' insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Dutch integrated diabetes care is still a

  16. Digital Technologies Supporting Person-Centered Integrated Care - A Perspective.

    Science.gov (United States)

    Øvretveit, John

    2017-09-25

    Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning "digitalisation" of services that gives a glimpse of the potential of digital technology and systems for building coordinated and individualized integrated care. Yet the promise has been greater than the benefits, and progress has been slow compared to other industries. This paper describes for non-technical readers how information technology was used to support integrated care schemes in six EU services, and suggests practical ways forward to use the new opportunities to build person-centered integrated care.

  17. The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review.

    Science.gov (United States)

    Hazen, Ankie C M; de Bont, Antoinette A; Boelman, Lia; Zwart, Dorien L M; de Gier, Johan J; de Wit, Niek J; Bouvy, Marcel L

    2018-03-01

    A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispensing pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. In this literature review we searched two electronic databases and the reference list of published literature reviews for studies about clinical pharmacy services performed by non-dispensing pharmacists physically co-located in primary care practice. We assessed the degree of integration via key dimensions of integration based on the conceptual framework of Walshe and Smith. We included English language studies of any design that had a control group or baseline comparison published from 1966 to June 2016. Descriptive statistics were used to correlate the degree of integration to health outcomes. The analysis was stratified for disease-specific and patient-centered clinical pharmacy services. Eighty-nine health outcomes in 60 comparative studies contributed to the analysis. The accumulated evidence from these studies shows no impact of the degree of integration of non-dispensing pharmacists on health outcomes. For disease specific clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 75%, 63% and 59%. For patient-centered clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 55%, 57% and 70%. Full integration adds value to patient-centered clinical pharmacy services, but not to disease-specific clinical pharmacy services. To obtain maximum benefits

  18. Managed care, vertical integration strategies and hospital performance.

    Science.gov (United States)

    Wang, B B; Wan, T T; Clement, J; Begun, J

    2001-09-01

    The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance. The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically. Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized. Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.

  19. Educating Social Workers for Practice in Integrated Health Care: A Model Implemented in a Graduate Social Work Program

    Science.gov (United States)

    Mattison, Debra; Weaver, Addie; Zebrack, Brad; Fischer, Dan; Dubin, Leslie

    2017-01-01

    This article introduces a curricular innovation, the Integrated Health Scholars Program (IHSP), developed to prepare master's-level social work students for practice in integrated health care settings, and presents preliminary findings related to students' self-reported program competencies and perceptions. IHSP, implemented in a…

  20. Integrating rheumatology care in the community: can shared care work?

    Science.gov (United States)

    Lim, Anita Yn; Tan, Chuen Seng; Low, Bernadette Pl; Lau, Tang Ching; Tan, Tze Lee; Goh, Lee Gan; Teng, Gim Gee

    2015-01-01

    Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, "right siting" aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits. Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow. About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients) and private family physicians independently predicted successful shared care, defined as one cycle of alternating care. Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care. Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  1. Where's the LGBT in integrated care research? A systematic review.

    Science.gov (United States)

    Hughes, Rachel L; Damin, Catherine; Heiden-Rootes, Katie

    2017-09-01

    Lesbian, gay, bisexual, and transgender (LGBT) individuals experience more negative health outcomes compared with their heterosexual peers. The health disparities are often related to family and social rejection of the LGBT individuals. Integrated care, and Medical Family Therapy in particular, may aid in addressing the systemic nature of the negative health outcomes. To better understand the current state of the integrated care literature on addressing the health needs of LGBT individuals, a systematic review of the research literature was conducted from January 2000 to January 2016 for articles including integrated health care interventions for LGBT populations. Independent reviewers coded identified articles. Only 8 research articles met criteria for inclusion out of the 2,553 initially identified articles in the search. Results indicated a lack of integrated care research on health care and health needs of LGBT individuals, and none of the articles addressed the use of family or systemic-level interventions. Implications for future research and the need for better education training are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  2. Integrated and interprofessional care

    Directory of Open Access Journals (Sweden)

    Hugh Barr

    2012-07-01

    Full Text Available No wonder two movements described in such similar terms are so often confused. One strives to knit services together, the other to cultivate collaborative practice amongst their workers.  Dedicated though both of them are to the improvement of health and social care, integrated care falters without engaging the workforce actively as partners in change whilst interprofessional care falters without organisational support. Neither stands alone. Each depends on the other.

  3. Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project.

    Science.gov (United States)

    Mayberry, L J; Affonso, D D; Shibuya, J; Clemmens, D

    1999-06-01

    Determining the elements of culturally competent health care is an important goal for nurses. This goal is particularly integral in efforts to design better preventive health care strategies for pregnant and postpartum women from multiple cultural and ethnic backgrounds. Learning about the values, beliefs, and customs surrounding health among the targeted groups is essential, but integrating this knowledge into the actual health care services delivery system is more difficult. The success of a prenatal and postpartum program developed for native Hawaiian, Filipino, and Japanese women in Hawaii has been attributed to the attention on training, direct care giving, and program monitoring participation by local cultural and ethnic healers and neighborhood leaders living in the community, with coordination by public health nurses. This article profiles central design elements with examples of specific interventions used in the Malama Na Wahine or Caring for Pregnant Women program to illustrate a unique approach to the delivery of culturally competent care.

  4. Integrated health care delivery system conducts ad agency search as part of its brand-launching effort.

    Science.gov (United States)

    Lewicki, G

    1999-01-01

    PennState Geisinger Health System, Hershey, Pa., conducted an extensive ad agency search after its inception in 1997. The integrated health care delivery system needed to introduce its brand to an audience that was confused by the wide array of available health care options. BVK/McDonald, Milwaukee, the agency selected, has created a branding campaign that revolves around the tag-line "The power of health." PennState Geisinger will tabulate the results of BVK/McDonald's multi-million dollar campaign in 2000; at that time it will know whether its selection committee chose wisely.

  5. Integrating the 3Ds—Social Determinants, Health Disparities, and Health-Care Workforce Diversity

    Science.gov (United States)

    Pierre, Geraldine

    2014-01-01

    The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce. PMID:24385659

  6. Integrating the 3Ds--social determinants, health disparities, and health-care workforce diversity.

    Science.gov (United States)

    LaVeist, Thomas A; Pierre, Geraldine

    2014-01-01

    The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce.

  7. Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

    Directory of Open Access Journals (Sweden)

    Lacreisha Ejike-King

    2014-04-01

    Full Text Available Despite steadily declining incarceration rates overall, racial and ethnic minorities, namely African Americans, Latinos, and American Indians and Alaska Natives, continue to be disproportionately represented in the justice system. Ex-offenders commonly reenter communities with pressing health conditions but encounter obstacles to accessing care and remaining in care. The lack of health insurance coverage and medical treatment emerge as the some of the most reported reentry health needs and may contribute to observed health disparities. Linking ex-offenders to care and services upon release increases the likelihood that they will remain in care and practice successful disease management. The Affordable Care Act (ACA offers opportunities to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism. Coordinated efforts to link ex-offenders with these newly available opportunities may result in a trajectory for positive health and overall well-being as they reintegrate into society.

  8. Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care.

    Science.gov (United States)

    Klinga, Charlotte; Hasson, Henna; Andreen Sachs, Magna; Hansson, Johan

    2018-06-04

    Change initiatives face many challenges, and only a few lead to long-term sustainability. One area in which the challenge of achieving long-term sustainability is particularly noticeable is integrated health and social care. Service integration is crucial for a wide range of patients including people with complex mental health and social care needs. However, previous research has focused on the initiation, resistance and implementation of change, while longitudinal studies remain sparse. The objective of this study was therefore to gain insight into the dynamics of sustainable changes in integrated health and social care through an analysis of local actions that were triggered by a national policy. A retrospective and qualitative case-study research design was used, and data from the model organisation's steering-committee minutes covering 1995-2015 were gathered and analysed. The analysis generated a narrative case description, which was mirrored to the key elements of the Dynamic Sustainability Framework (DSF). The development of inter-sectoral cooperation was characterized by a participatory approach in which a shared structure was created to support cooperation and on-going quality improvement and learning based on the needs of the service user. A key management principle was cooperation, not only on all organisational levels, but also with service users, stakeholder associations and other partner organisations. It was shown that all these parts were interrelated and collectively contributed to the creation of a structure and a culture which supported the development of a dynamic sustainable health and social care. This study provides valuable insights into the dynamics of organizational sustainability and understanding of key managerial actions taken to establish, develop and support integration of health and social care for people with complex mental health needs. The service user involvement and regular reviews of service users' needs were essential in order

  9. Integration of Latino/a cultural values into palliative health care: a culture centered model.

    Science.gov (United States)

    Adames, Hector Y; Chavez-Dueñas, Nayeli Y; Fuentes, Milton A; Salas, Silvia P; Perez-Chavez, Jessica G

    2014-04-01

    Culture helps us grapple with, understand, and navigate the dying process. Although often overlooked, cultural values play a critical and influential role in palliative care. The purpose of the present study was two-fold: one, to review whether Latino/a cultural values have been integrated into the palliative care literature for Latinos/as; two, identify publications that provide recommendations on how palliative care providers can integrate Latino/a cultural values into the end-of-life care. A comprehensive systematic review on the area of Latino/a cultural values in palliative care was conducted via an electronic literature search of publications between 1930-2013. Five articles were identified for reviewing, discussing, or mentioning Latino/a cultural values and palliative care. Only one article specifically addressed Latino/a cultural values in palliative care. The four remaining articles discuss or mention cultural values; however, the cultural values were not the main focus of each article's thesis. The results of the current study highlight the lack of literature specifically addressing the importance of integrating Latino/a cultural values into the delivery of palliative care. As a result, this article introduces the Culture-Centered Palliative Care Model (CCPC). The article defines five key traditional Latino/a cultural values (i.e., familismo, personalismo, respeto, confianza, and dignidad), discusses the influence of each value on palliative health care, and ends with practical recommendations for service providers. Special attention is given to the stages of acculturation and ethnic identity.

  10. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use.

    Science.gov (United States)

    Bartels, Stephen J; Coakley, Eugenie H; Zubritsky, Cynthia; Ware, James H; Miles, Keith M; Areán, Patricia A; Chen, Hongtu; Oslin, David W; Llorente, Maria D; Costantino, Giuseppe; Quijano, Louise; McIntyre, Jack S; Linkins, Karen W; Oxman, Thomas E; Maxwell, James; Levkoff, Sue E

    2004-08-01

    The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

  11. The Gold Coast Integrated Care Model

    Directory of Open Access Journals (Sweden)

    Martin Connor

    2016-07-01

    Full Text Available This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve the capacity of specialist outpatients, and decrease planned and unplanned admission rates. Central to the model is a shared care record which is maintained and accessed by staff in the Coordination Centre. We provide a process map outlining the care protocols from initial assessment to care of the patient presenting for emergency care. The model is being evaluated over a pilot three year proof of concept phase to determine economic and process perspectives. If found to be cost-effective, acceptable to patients and professionals and as good as or better than usual care in terms of outcomes, the strategic intent is to scale the programme beyond the local health service.

  12. Shared mental models of integrated care: aligning multiple stakeholder perspectives.

    Science.gov (United States)

    Evans, Jenna M; Baker, G Ross

    2012-01-01

    Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter-organizational and inter-professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration. The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration-task, system-role, and integration-belief. The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory-based framework of psychological factors that may influence inter-organizational and inter-professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care. MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care. Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.

  13. Optimizing Health Care Environmental Hygiene.

    Science.gov (United States)

    Carling, Philip C

    2016-09-01

    This article presents a review and perspectives on aspects of optimizing health care environmental hygiene. The topics covered include the epidemiology of environmental surface contamination, a discussion of cleaning health care patient area surfaces, an overview of disinfecting health care surfaces, an overview of challenges in monitoring cleaning versus cleanliness, a description of an integrated approach to environmental hygiene and hand hygiene as interrelated disciplines, and an overview of the research opportunities and challenges related to health care environmental hygiene. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Integration of community health workers into health systems in developing countries: Opportunities and challenges

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    Collins Otieno Asweto

    2016-02-01

    Full Text Available Background: Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health workers (CHWs. It is imperative that health care systems focus on improving access to quality continuous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness. Objective: To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries. Methods: Six databases were examined for quantitative, qualitative, and mixed-methods studies that included the integration of CHWs, their motivation and supervision, and CHW policy making and implementation in developing countries. Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs. Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized. Results: CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health. Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings. Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work, as well as financial and nonfinancial incentives, motivation, collaborative and supportive supervision, and a manageable workload. Conclusions: For sustainable integration of CHWs into health care systems, high-performing health systems with sound governance, adequate financing, well-organized service delivery, and adequate supplies and equipment are essential. Similarly, competent communities could contribute to better CHW performance through sound

  15. Integrating rheumatology care in the community: can shared care work?

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    Anita YN Lim

    2015-08-01

    Full Text Available Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits. Methods: Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow. Results: About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients and private family physicians independently predicted successful shared care, defined as one cycle of alternating care. Discussion: Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care. Conclusions: Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  16. Integrating rheumatology care in the community: can shared care work?

    Directory of Open Access Journals (Sweden)

    Anita YN Lim

    2015-08-01

    Full Text Available Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits.Methods: Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow.Results: About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients and private family physicians independently predicted successful shared care, defined as one cycle of alternating care.Discussion: Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care.Conclusions: Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  17. Outcome mapping for health system integration

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    Tsasis P

    2013-03-01

    Full Text Available Peter Tsasis,1 Jenna M Evans,2 David Forrest,3 Richard Keith Jones4 1School of Health Policy and Management, Faculty of Health, York University, Toronto, Canada; 2Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada; 3Global Vision Consulting Ltd, Victoria, Canada; 4R Keith Jones and Associates, Victoria, Canada Abstract: Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. Keywords: integrated care, integrated delivery systems, complex adaptive systems, social capital

  18. Improving Health Care Management in Primary Care for Homeless People: A Literature Review

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    Abcaya, Julien; Ștefan, Diana-Elena; Calvet-Montredon, Céline; Gentile, Stéphanie

    2018-01-01

    Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. PMID:29439403

  19. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care.

    Science.gov (United States)

    Freeman, Rachel; Luyirika, Emmanuel Bk; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation's public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation.

  20. Leading Integrated Health and Social Care Systems: Perspectives from Research and Practice.

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    Evans, Jenna M; Daub, Stacey; Goldhar, Jodeme; Wojtak, Anne; Purbhoo, Dipti

    2016-01-01

    As the research evidence on integrated care has evolved over the past two decades, so too has the critical role leaders have for the implementation, effectiveness and sustainability of integrated care. This paper explores what it means to be an effective leader of integrated care initiatives by drawing from the experiences of a leadership team in implementing an award-winning integrated care program in Toronto, Canada. Lessons learned are described and assessed against existing theory and research to identify which skills and behaviours facilitate effective leadership of integrated care initiatives.

  1. Informing mental health policies and services in the EMR: cost-effective deployment of human resources to deliver integrated community-based care.

    Science.gov (United States)

    Ivbijaro, G; Patel, V; Chisholm, D; Goldberg, D; Khoja, T A M; Edwards, T M; Enum, Y; Kolkiewic, L A

    2015-09-28

    For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 & the ongoing move towards universal health coverage, all health & social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective & with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice & community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations & civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation & discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries.

  2. Integration of priority population, health and nutrition interventions into health systems: systematic review

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    Adeyi Olusoji

    2011-10-01

    Full Text Available Abstract Background Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. Methods Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction and secondary (improved population coverage, access to health services, efficiency, and quality using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. Results Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. Conclusions Targeted priority population health interventions we identified led to improved health

  3. Integration of priority population, health and nutrition interventions into health systems: systematic review.

    Science.gov (United States)

    Atun, Rifat; de Jongh, Thyra E; Secci, Federica V; Ohiri, Kelechi; Adeyi, Olusoji; Car, Josip

    2011-10-10

    Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction) and secondary (improved population coverage, access to health services, efficiency, and quality) using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. Targeted priority population health interventions we identified led to improved health outcomes, quality of care, patient satisfaction and access to care

  4. Managing externally financed projects: the Integrated Primary Health Care Project in Bolivia.

    Science.gov (United States)

    Homedes, N

    2001-12-01

    Bolivia is one of the poorest countries in Latin America. Health indicators are very poor, communicable diseases are prevalent and, coupled with malnutrition, remain the major killers of children under 5 years old. The Integrated Primary Health Care Project (PROISS) was a US$39 million project executed by the Ministry of Health (MOH), 50% financed by the World Bank and aimed at improving primary health care in the four largest Bolivian municipalities. The implementation of the project started in 1990 and ended in 1997. During implementation it went through three distinct phases: Phase 1 (1990-94) was a period characterized by conflict and confusion; Phase 2 (1995-mid-1996) documented major improvements in coverage and service quality; and Phase 3 (mid-1996-97) witnessed the decline of the project. This paper explores the factors that contributed to the success and the decline of the project, draws lessons for project managers and international agencies involved in the definition and implementation of social sector projects, and discusses the unlikelihood that externally financed projects can have a sustainable impact on the development of the health sector of recipient countries.

  5. Integrating Religion and Spirituality into Mental Health Care, Psychiatry and Psychotherapy

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    René Hefti

    2011-11-01

    Full Text Available Integrating spirituality into mental health care, psychiatry and psychotherapy is still controversial, albeit a growing body of evidence is showing beneficial effects and a real need for such integration. In this review, past and recent research as well as evidence from the integrative concept of a Swiss clinic is summarized. Religious coping is highly prevalent among patients with psychiatric disorders. Surveys indicate that 70–80% use religious or spiritual beliefs and activities to cope with daily difficulties and frustrations. Religion may help patients to enhance emotional adjustment and to maintain hope, purpose and meaning. Patients emphasize that serving a purpose beyond one’s self can make it possible to live with what might otherwise be unbearable. Programs successfully incorporating spirituality into clinical practice are described and discussed. Studies indicate that the outcome of psychotherapy in religious patients can be enhanced by integrating religious elements into the therapy protocol and that this can be successfully done by religious and non-religious therapists alike.

  6. Digital Technologies Supporting Person-Centered Integrated Care – A Perspective

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    John Øvretveit

    2017-09-01

    Full Text Available Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning “digitalisation” of services that gives a glimpse of the potential of digital technology and systems for building coordinated and individualized integrated care. Yet the promise has been greater than the benefits, and progress has been slow compared to other industries. This paper describes for non-technical readers how information technology was used to support integrated care schemes in six EU services, and suggests practical ways forward to use the new opportunities to build person-centered integrated care.

  7. Digital Technologies Supporting Person-Centered Integrated Care – A Perspective

    Science.gov (United States)

    2017-01-01

    Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning “digitalisation” of services that gives a glimpse of the potential of digital technology and systems for building coordinated and individualized integrated care. Yet the promise has been greater than the benefits, and progress has been slow compared to other industries. This paper describes for non-technical readers how information technology was used to support integrated care schemes in six EU services, and suggests practical ways forward to use the new opportunities to build person-centered integrated care. PMID:29588629

  8. Integration of oral health in primary health care through motivational interviewing for mothers of young children: A pilot study.

    Science.gov (United States)

    Batra, Manu; Shah, Aasim Farooq; Virtanen, Jorma I

    2018-01-01

    Early childhood caries (ECC) continues to affect children worldwide. In India, primary health centers (PHCs) comprises the primary tier where Accredited Social Health Activist (ASHA) provide integrated curative and preventive health care. The aim of the study was to pilot test the integration of oral health in primary health care through motivational interviewing (MI) for mothers of young children provided by ASHAs. The pilot study was conducted in Kashipur, Uttarakhand. From the six PHCs in Kashipur, three were randomly selected, one each was assigned to MI group, traditional health education group, and control group. From 60 mothers with 8-12 months child, ASHAs of all three groups gathered mother's knowledge regarding child's oral health using close-ended questionnaire and diagnosed clinical risk markers of ECC in children and ASHAs of Group A and B imparted the oral health education as per their training. The comparison of ASHA's performances on the MI training competency pre- and post-test showed an overall average of 74% improvement in post-test scores. Interexaminer reliability of the parallel clinical measurements by 6 ASHAs and the investigator for the maxillary central incisors showed 93% of agreement for both dental plaque and dental caries assessment with 0.86 and 0.89 kappa values, respectively. The health education through MI is feasible and can be cost-effective by utilization of ASHAs at PHCs to provide the oral health education to mothers which will in turn improve the oral health status of children.

  9. The informatics capability maturity of integrated primary care centres in Australia.

    Science.gov (United States)

    Liaw, Siaw-Teng; Kearns, Rachael; Taggart, Jane; Frank, Oliver; Lane, Riki; Tam, Michael; Dennis, Sarah; Walker, Christine; Russell, Grant; Harris, Mark

    2017-09-01

    Integrated primary care requires systems and service integration along with financial incentives to promote downward substitution to a single entry point to care. Integrated Primary Care Centres (IPCCs) aim to improve integration by co-location of health services. The Informatics Capability Maturity (ICM) describes how well health organisations collect, manage and share information; manage eHealth technology, implementation, change, data quality and governance; and use "intelligence" to improve care. Describe associations of ICM with systems and service integration in IPCCs. Mixed methods evaluation of IPCCs in metropolitan and rural Australia: an enhanced general practice, four GP Super Clinics, a "HealthOne" (private-public partnership) and a Community Health Centre. Data collection methods included self-assessed ICM, document review, interviews, observations in practice and assessment of electronic health record data. Data was analysed and compared across IPCCs. The IPCCs demonstrated a range of funding models, ownership, leadership, organisation and ICM. Digital tools were used with varying effectiveness to collect, use and share data. Connectivity was problematic, requiring "work-arounds" to communicate and share information. The lack of technical, data and software interoperability standards, clinical coding and secure messaging were barriers to data collection, integration and sharing. Strong leadership and governance was important for successful implementation of robust and secure eHealth systems. Patient engagement with eHealth tools was suboptimal. ICM is positively associated with integration of data, systems and care. Improved ICM requires a health workforce with eHealth competencies; technical, semantic and software standards; adequate privacy and security; and good governance and leadership. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Performing Economic Evaluation of Integrated Care: Highway to Hell or Stairway to Heaven?

    Science.gov (United States)

    Stein, K. Viktoria; Evers, Silvia; Rutten-van Mölken, Maureen

    2016-01-01

    Health economists are increasingly interested in integrated care in order to support decision-makers to find cost-effective solutions able to tackle the threat that chronic diseases pose on population health and health and social care budgets. However, economic evaluation in integrated care is still in its early years, facing several difficulties. The aim of this paper is to describe the unique nature of integrated care as a topic for economic evaluation, explore the obstacles to perform economic evaluation, discuss methods and techniques that can be used to address them, and set the basis to develop a research agenda for health economics in integrated care. The paper joins the voices that call health economists to pay more attention to integrated care and argues that there should be no more time wasted for doing it. PMID:28316543

  11. Integrated Care in Prostate Cancer (ICARE-P): Nonrandomized Controlled Feasibility Study of Online Holistic Needs Assessment, Linking the Patient and the Health Care Team

    Science.gov (United States)

    Dale, Jeremy; Roscoe, Julia; Hamborg, Thomas; Ahmedzai, Sam H; Arvanitis, Theodoros N; Badger, Douglas; James, Nicholas; Mendelsohn, Richard; Khan, Omar; Parashar, Deepak; Patel, Prashant

    2017-01-01

    Background The potential of technology to aid integration of care delivery systems is being explored in a range of contexts across a variety of conditions in the United Kingdom. Prostate cancer is the most common cancer in UK men. With a 10-year survival rate of 84%, there is a need to explore innovative methods of care that are integrated between primary health care providers and specialist teams in order to address long-term consequences of the disease and its treatment as well as to provide continued monitoring for recurrence. Objective Our aim was to test the feasibility of a randomized controlled trial to compare a model of prostate cancer continuing and follow-up care integration, underpinned by digital technology, with usual care in terms of clinical and cost-effectiveness, patient-reported outcomes, and experience. Methods A first phase of the study has included development of an online adaptive prostate specific Holistic Needs Assessment system (HNA), training for primary care-based nurses, training of an IT peer supporter, and interviews with health care professionals and men with prostate cancer to explore views of their care, experience of technology, and views of the proposed intervention. In Phase 2, men in the intervention arm will complete the HNA at home to help identify and articulate concerns and share them with their health care professionals, in both primary and specialist care. Participants in the control arm will receive usual care. Outcomes including quality of life and well-being, prostate-specific concerns, and patient enablement will be measured 3 times over a 9-month period. Results Findings from phase 1 indicated strong support for the intervention among men, including those who had had little experience of digital technology. Men expressed a range of views on ways that the online system might be used within a clinical pathway. Health care professionals gave valuable feedback on how the output of the assessment might be presented to

  12. Opportunities for and constraints to integration of health services in Poland

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    Alicja Sobczak

    2002-06-01

    Full Text Available At the beginning of the article the typologies, expected outcomes and forces aiming at health care integration are discussed. Integration is recognised as a multidimensional concept. The suggested typologies of integration are based on structural configurations, co-ordination mechanisms (including clinical co-ordination, and driving forces. A review of the Polish experience in integration/disintegration of health care systems is the main part of the article. Creation of integrated health care management units (ZOZs in the beginning of the 1970s serves as an example of structural vertical integration missing co-ordination mechanisms. ZOZs as huge, costly and inflexible organisations became subjects of public criticism and discredited the idea of health care integration. At the end of the 1980s and in the decade of the 1990s, management of public health care was decentralised, the majority of ZOZs dismantled, and many health care public providers got the status of independent entities. The private sector developed rapidly. Sickness funds, which in 1999 replaced the previous state system, introduced “quasi-market” conditions where health providers have to compete for contracts. Some providers developed strategies of vertical and horizontal integration to get a competitive advantage. Consolidation of private ambulatory clinics, the idea of “integrated care” as a “contracting package”, development of primary health care and ambulatory specialist clinics in hospitals are the examples of such strategies. The new health policy declared in 2002 has recognised integration as a priority. It stresses the development of payment mechanisms and information base (Register of Health Services – RUM that promote integration. The Ministry of Health is involved directly in integrated emergency system designing. It seems that after years of disintegration and deregulation the need for effective integration has become obvious.

  13. A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care.

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    Tamara Flys

    Full Text Available BACKGROUND: Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs. We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities. METHODS: The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions. RESULTS: Of 258 initially active participants, 225 (225/258=87.2% successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85% attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001. The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001. A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills. CONCLUSION: This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills

  14. Boundaries and e-health implementation in health and social care

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    King Gerry

    2012-09-01

    Full Text Available Abstract Background The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost. Methods To explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA in Scotland, using three retrospective, qualitative case studies in three different health board locations. Results Progress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs’ understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals. Conclusions To provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make

  15. Integrating research, clinical care, and education in academic health science centers.

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    King, Gillian; Thomson, Nicole; Rothstein, Mitchell; Kingsnorth, Shauna; Parker, Kathryn

    2016-10-10

    Purpose One of the major issues faced by academic health science centers (AHSCs) is the need for mechanisms to foster the integration of research, clinical, and educational activities to achieve the vision of evidence-informed decision making (EIDM) and optimal client care. The paper aims to discuss this issue. Design/methodology/approach This paper synthesizes literature on organizational learning and collaboration, evidence-informed organizational decision making, and learning-based organizations to derive insights concerning the nature of effective workplace learning in AHSCs. Findings An evidence-informed model of collaborative workplace learning is proposed to aid the alignment of research, clinical, and educational functions in AHSCs. The model articulates relationships among AHSC academic functions and sub-functions, cross-functional activities, and collaborative learning processes, emphasizing the importance of cross-functional activities in enhancing collaborative learning processes and optimizing EIDM and client care. Cross-functional activities involving clinicians, researchers, and educators are hypothesized to be a primary vehicle for integration, supported by a learning-oriented workplace culture. These activities are distinct from interprofessional teams, which are clinical in nature. Four collaborative learning processes are specified that are enhanced in cross-functional activities or teamwork: co-constructing meaning, co-learning, co-producing knowledge, and co-using knowledge. Practical implications The model provides an aspirational vision and insight into the importance of cross-functional activities in enhancing workplace learning. The paper discusses the conceptual and empirical basis to the model, its contributions and limitations, and implications for AHSCs. Originality/value The model's potential utility for health care is discussed, with implications for organizational culture and the promotion of cross-functional activities.

  16. Successful Integration of Hepatitis C Virus Point-of-Care Tests into the Denver Metro Health Clinic

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    A. Jewett

    2013-01-01

    Full Text Available Background. The Centers for Disease Control and Prevention (CDC recommends testing and linkage to care for persons most likely infected with hepatitis C virus (HCV, including persons with human immunodeficiency virus. We explored facilitators and barriers to integrating HCV point-of-care (POC testing into standard operations at an urban STD clinic. Methods. The OraQuick HCV rapid antibody test was integrated at the Denver Metro Health Clinic (DMHC. All clients with at least one risk factor were offered the POC test. Research staff conducted interviews with clients (three HCV positive and nine HCV negative. Focus groups were conducted with triage staff, providers, and linkage-to-care counselors. Results. Clients were pleased with the ease of use and rapid return of results from the HCV POC test. Integrating the test into this setting required more time but was not overly burdensome. While counseling messages were clear to staff, clients retained little knowledge of hepatitis C infection or factors related to risk. Barriers to integrating the HCV POC test into clinic operations were loss to follow-up and access to care. Conclusion. DMHC successfully integrated HCV POC testing and piloted a HCV linkage-to-care program. Providing testing opportunities at STD clinics could increase identification of persons with HCV infection.

  17. Collaborative modeling of an implementation strategy: a case study to integrate health promotion in primary and community care.

    Science.gov (United States)

    Grandes, Gonzalo; Sanchez, Alvaro; Cortada, Josep M; Pombo, Haizea; Martinez, Catalina; Balagué, Laura; Corrales, Mary Helen; de la Peña, Enrique; Mugica, Justo; Gorostiza, Esther

    2017-12-06

    Evidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care. Between 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations. All four centers chose to address physical activity, diet, and smoking. They selected the 5 A's evidence-based clinical intervention to be adapted to the context of the health centers. The planned implementation strategy worked at multiple levels: bottom-up primary care organizational change, top-down support from managers, community involvement, and the development of innovative e-health information and communication tools. Shared decision making and practice facilitation were perceived as the most positive aspects of the collaborative modeling process, which took more time than expected, especially the development of the new e-health tools integrated into electronic health records. Collaborative modeling of an implementation strategy for the integration of health promotion in primary and community care was feasible in motivated centers. However, it was difficult, being hindered by the heavy workload in primary care and generating uncertainty inherent to a bottom-up decision making processes. Lessons from this experience could be useful in diverse settings and for other clinical interventions. Two companion papers report the evaluation of its feasibility and assess quantitatively and qualitatively the implementation process.

  18. Opportunities in the integration of primary care and public health nursing: Two case exemplars on physical activity and nutrition.

    Science.gov (United States)

    Evans-Agnew, Robin A; Mayer, Kala A; Miller, Lori L L

    2018-01-01

    The integration of primary care and public health nursing may provide new opportunities for transforming nursing practice that addresses population health. Effective programs emphasize multilevel approaches that include both downstream (education) and upstream (policy change) actions. The purpose of this article is to identify downstream and upstream nursing actions that integrate public health and primary care practice through two case exemplars concerning disparities in physical activity and nutrition. Describe two research case exemplars: (1) a secondary analysis of school physical activity policy for female adolescents in 36 public middle schools and (2) a focus group study of African American adults in a community kitchen program. In exemplar 1, school policies lacked population-based standards and presented structural disadvantages to African American girls who were already obese. In exemplar 2, participants found the community kitchen program to be more effective than the federally funded nutrition program. Integrating primary care and public health nursing could improve the tailoring of physical activity and nutrition programs to local populations by following core principles of community engagement, infrastructural sustainability, aligned leadership, and data sharing for population health improvement. © 2017 Wiley Periodicals, Inc.

  19. Health care engineering management.

    Science.gov (United States)

    Jarzembski, W B

    1980-01-01

    Today, health care engineering management is merely a concept of dreamers, with most engineering decisions in health care being made by nonengineers. It is the purpose of this paper to present a rationale for an integrated hospital engineering group, and to acquaint the clinical engineer with some of the salient features of management concepts. Included are general management concepts, organization, personnel management, and hospital engineering systems.

  20. Integrated care in an international perspective: EUPHA proceedings December 2001.

    NARCIS (Netherlands)

    Delnoij, D.; Klazinga, N.; Kulu Glasgow, I.

    2002-01-01

    The workshop of the EUPHA section Health Services Research took place on Thursday, December 8th, 2001 in Brussels at the annual conference of the EUPHA (European Public Health Association). The theme of the workshop was integrated care in an international perspective. Integrated care can be defined

  1. Evaluation design of Urban Health Centres Europe (UHCE): Preventive integrated health and social care for community-dwelling older persons in five European cities

    NARCIS (Netherlands)

    Franse, C.B. (Carmen B.); A.J. Voorham; Van Staveren, R. (Rob); E. Koppelaar (Elin); Martijn, R. (Rens); Valía-Cotanda, E. (Elisa); Alhambra-Borrás, T. (Tamara); Rentoumis, T. (Tasos); Bilajac, L. (Lovorka); Marchesi, V.V. (Vanja Vasiljev); Rukavina, T. (Tomislav); Verma, A. (Arpana); Williams, G. (Greg); Clough, G. (Gary); Garcés-Ferrer, J. (Jorge); F.U.S. Mattace Raso (Francesco); H. Raat (Hein)

    2017-01-01

    textabstractBackground: Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living

  2. Developing Integrated Care: Towards a development model for integrated care

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella)

    2012-01-01

    textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated

  3. Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots

    Directory of Open Access Journals (Sweden)

    Tom Ling

    2012-07-01

    Full Text Available Background. In 2008, the English Department of Health appointed 16 'Integrated Care Pilots' which used a range of approaches to provide better integrated care. We report qualitative analyses from a three year multi-method evaluation to identify barriers and facilitators to successful integration of care.  Theory and methods. Data were analysed from transcripts of 213 in-depth staff interviews, and from semi-structured questionnaires (the 'Living Document' completed by staff in pilot sites at six points over a two-year period. Emerging findings were therefore built from 'bottom up' and grounded in the data. However, we were then interested in how these findings compared and contrasted with more generic analyses. Therefore after our analyses were complete we then systematically compared and contrasted the findings with the analysis of barriers and facilitators to quality improvement identified in a systematic review by Kaplan et al (2010 and the analysis of more micro-level shapers of behaviour found in Normalisation Process Theory (May et al 2007. Neither of these approaches claims to be full blown theories but both claim to provide mid-range theoretical arguments which may be used to structure existing data and which can be undercut or reinforced by new data. Results and discussion. Many barriers and facilitators to integrating care are those of any large scale organisational change. These include issues relating to leadership, organisational culture, information technology, physician involvement, and availability of resources. However, activities which appear particularly important for delivering integrated care include personal relationships between leaders in different organisations, the scale of planned activities, governance and finance arrangements, support for staff in new roles, and organisational and staff stability. We illustrate our analyses with a 'routemap' which identifies questions that providers may wish to consider when

  4. Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots

    Directory of Open Access Journals (Sweden)

    Tom Ling

    2012-07-01

    Full Text Available Background. In 2008, the English Department of Health appointed 16 'Integrated Care Pilots' which used a range of approaches to provide better integrated care. We report qualitative analyses from a three year multi-method evaluation to identify barriers and facilitators to successful integration of care. Theory and methods. Data were analysed from transcripts of 213 in-depth staff interviews, and from semi-structured questionnaires (the 'Living Document' completed by staff in pilot sites at six points over a two-year period. Emerging findings were therefore built from 'bottom up' and grounded in the data. However, we were then interested in how these findings compared and contrasted with more generic analyses. Therefore after our analyses were complete we then systematically compared and contrasted the findings with the analysis of barriers and facilitators to quality improvement identified in a systematic review by Kaplan et al (2010 and the analysis of more micro-level shapers of behaviour found in Normalisation Process Theory (May et al 2007. Neither of these approaches claims to be full blown theories but both claim to provide mid-range theoretical arguments which may be used to structure existing data and which can be undercut or reinforced by new data.Results and discussion. Many barriers and facilitators to integrating care are those of any large scale organisational change. These include issues relating to leadership, organisational culture, information technology, physician involvement, and availability of resources. However, activities which appear particularly important for delivering integrated care include personal relationships between leaders in different organisations, the scale of planned activities, governance and finance arrangements, support for staff in new roles, and organisational and staff stability. We illustrate our analyses with a 'routemap' which identifies questions that providers may wish to consider when planning

  5. Integration of oral health in primary health care through motivational interviewing for mothers of young children: A pilot study

    Directory of Open Access Journals (Sweden)

    Manu Batra

    2018-01-01

    Full Text Available Introduction: Early childhood caries (ECC continues to affect children worldwide. In India, primary health centers (PHCs comprises the primary tier where Accredited Social Health Activist (ASHA provide integrated curative and preventive health care. The aim of the study was to pilot test the integration of oral health in primary health care through motivational interviewing (MI for mothers of young children provided by ASHAs. Subjects and Methods: The pilot study was conducted in Kashipur, Uttarakhand. From the six PHCs in Kashipur, three were randomly selected, one each was assigned to MI group, traditional health education group, and control group. From 60 mothers with 8–12 months child, ASHAs of all three groups gathered mother's knowledge regarding child's oral health using close-ended questionnaire and diagnosed clinical risk markers of ECC in children and ASHAs of Group A and B imparted the oral health education as per their training. Results: The comparison of ASHA's performances on the MI training competency pre- and post-test showed an overall average of 74% improvement in post–test scores. Interexaminer reliability of the parallel clinical measurements by 6 ASHAs and the investigator for the maxillary central incisors showed 93% of agreement for both dental plaque and dental caries assessment with 0.86 and 0.89 kappa values, respectively. Conclusion: The health education through MI is feasible and can be cost-effective by utilization of ASHAs at PHCs to provide the oral health education to mothers which will in turn improve the oral health status of children.

  6. The medical home and integrated behavioral health: advancing the policy agenda.

    Science.gov (United States)

    Ader, Jeremy; Stille, Christopher J; Keller, David; Miller, Benjamin F; Barr, Michael S; Perrin, James M

    2015-05-01

    There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patient-centered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration. Copyright © 2015 by the American Academy of Pediatrics.

  7. Evaluation design of Urban Health Centres Europe (UHCE): preventive integrated health and social care for community-dwelling older persons in five European cities

    NARCIS (Netherlands)

    A.J.J. Voorham; R. van Staveren; E. Koppelaar; L.F.J. Martijn; E. Valía-Cotanda; T. Alhambra-Borrás; T. Rentoumis; L. Bilajac; V. Vasiljev Marchesi; T. Rukavina; A. Verma; G. Williams; G. Clough; J. Garcés-Ferrer; F. Mattace Raso; H. Raat; C.B. Franse

    2017-01-01

    Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In

  8. Strengthening of Oral Health Systems: Oral Health through Primary Health Care

    Science.gov (United States)

    Petersen, Poul Erik

    2014-01-01

    Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

  9. The Oral Health Care Manager in a Patient-Centered Health Facility.

    Science.gov (United States)

    Theile, Cheryl Westphal; Strauss, Shiela M; Northridge, Mary Evelyn; Birenz, Shirley

    2016-06-01

    The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Nurses on health care governing boards: An integrative review.

    Science.gov (United States)

    Sundean, Lisa J; Polifroni, E Carol; Libal, Kathryn; McGrath, Jacqueline M

    Nurses are key change agents in health care; yet, nurses have not been sufficiently engaged on boards to shape decision making. Without an equal voice in the boardroom, nurses cannot fulfill their professional obligation to society. The purpose of this study was to understand the progression in research focus and recommendations over time about nurses on boards (NOB), identify research gaps, and make research/practice recommendations. An integrative review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (2009) for data evaluation and analysis. Eleven studies (six quantitative, three qualitative, and two quasi-mixed methods) were included in the review. The focus/recommendations of research about NOB have changed from passive observation to action-oriented inquiry that considers nurse expertise and value but lacks a coordinated approach to advance board appointments for nurses. A systematic approach to the research is needed to advance NOB as key agents in health care transformation and social justice. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Integrated Care in Prostate Cancer (ICARE-P): Nonrandomized Controlled Feasibility Study of Online Holistic Needs Assessment, Linking the Patient and the Health Care Team.

    Science.gov (United States)

    Nanton, Veronica; Appleton, Rebecca; Dale, Jeremy; Roscoe, Julia; Hamborg, Thomas; Ahmedzai, Sam H; Arvanitis, Theodoros N; Badger, Douglas; James, Nicholas; Mendelsohn, Richard; Khan, Omar; Parashar, Deepak; Patel, Prashant

    2017-07-28

    The potential of technology to aid integration of care delivery systems is being explored in a range of contexts across a variety of conditions in the United Kingdom. Prostate cancer is the most common cancer in UK men. With a 10-year survival rate of 84%, there is a need to explore innovative methods of care that are integrated between primary health care providers and specialist teams in order to address long-term consequences of the disease and its treatment as well as to provide continued monitoring for recurrence. Our aim was to test the feasibility of a randomized controlled trial to compare a model of prostate cancer continuing and follow-up care integration, underpinned by digital technology, with usual care in terms of clinical and cost-effectiveness, patient-reported outcomes, and experience. A first phase of the study has included development of an online adaptive prostate specific Holistic Needs Assessment system (HNA), training for primary care-based nurses, training of an IT peer supporter, and interviews with health care professionals and men with prostate cancer to explore views of their care, experience of technology, and views of the proposed intervention. In Phase 2, men in the intervention arm will complete the HNA at home to help identify and articulate concerns and share them with their health care professionals, in both primary and specialist care. Participants in the control arm will receive usual care. Outcomes including quality of life and well-being, prostate-specific concerns, and patient enablement will be measured 3 times over a 9-month period. Findings from phase 1 indicated strong support for the intervention among men, including those who had had little experience of digital technology. Men expressed a range of views on ways that the online system might be used within a clinical pathway. Health care professionals gave valuable feedback on how the output of the assessment might be presented to encourage engagement and uptake by

  12. A Prospective Validation Study of a Rainbow Model of Integrated Care Measurement Tool in Singapore.

    Science.gov (United States)

    Nurjono, Milawaty; Valentijn, Pim P; Bautista, Mary Ann C; Wei, Lim Yee; Vrijhoef, Hubertus Johannes Maria

    2016-04-08

    The conceptual ambiguity of the integrated care concept precludes a full understanding of what constitutes a well-integrated health system, posing a significant challenge in measuring the level of integrated care. Most available measures have been developed from a disease-specific perspective and only measure certain aspects of integrated care. Based on the Rainbow Model of Integrated Care, which provides a detailed description of the complex concept of integrated care, a measurement tool has been developed to assess integrated care within a care system as a whole gathered from healthcare providers' and managerial perspectives. This paper describes the methodology of a study seeking to validate the Rainbow Model of Integrated Care measurement tool within and across the Singapore Regional Health System. The Singapore Regional Health System is a recent national strategy developed to provide a better-integrated health system to deliver seamless and person-focused care to patients through a network of providers within a specified geographical region. The validation process includes the assessment of the content of the measure and its psychometric properties. If the measure is deemed to be valid, the study will provide the first opportunity to measure integrated care within Singapore Regional Health System with the results allowing insights in making recommendations for improving the Regional Health System and supporting international comparison.

  13. Integrated homecare to bridge transition from health care to social services in EU

    DEFF Research Database (Denmark)

    Larsen, Torben

    2009-01-01

    to develop a turn-key-solution for better clinical continuity to European health regions. Method: The general framework of the project is the international concept of health technology assessment (HTA) as implemented in the EUnetHTA Core Model focusing nine analytical domains. Based on a systematic...... dominant intervention. 3) Based on a SWOT-analysis a meso-strategy implementing IHC at a regional level is planned to combine the advantages of a goal-directed centralized approach with the adaption to local conditions in a decentralized approach. Discussion: Clinical and social IHC-network...... literature review of trials on integrated care integrated homecare (IHC) is defined and selected as prototype for continued rehabilitation of disabled chronic patients. Preliminary results: 1) The efficacy of IHC are hypothesized to have a common neuroeconomic explanation in the finding that the blood...

  14. Significance of mental health legislation for successful primary care for mental health and community mental health services: A review

    Directory of Open Access Journals (Sweden)

    Getinet Ayano

    2018-03-01

    Conclusion: Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.

  15. Primary health care and public health: foundations of universal health systems.

    Science.gov (United States)

    White, Franklin

    2015-01-01

    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

  16. Integrating Environmental Management of Asthma into Pediatric Health Care: What Worked and What Still Needs Improvement?

    Science.gov (United States)

    Roberts, James R; Newman, Nicholas; McCurdy, Leyla E; Chang, Jane S; Salas, Mauro A; Eskridge, Bernard; De Ybarrondo, Lisa; Sandel, Megan; Mazur, Lynnette; Karr, Catherine J

    2016-12-01

    The National Environmental Education Foundation (NEEF) launched an initiative in 2005 to integrate environmental management of asthma into pediatric health care. This study, a follow-up to a 2013 study, evaluated the program's impact and assessed training results by 5 new faculty champions. We surveyed attendees at training sessions to measure knowledge and the likelihood of asking about and managing environmental triggers of asthma. To conduct the program evaluation, a workshop was held with the faculty champions and NEEF staff in which we identified major program benefits, as well as challenges and suggestions for the future. Trainee baseline knowledge of environmental triggers was low, but they reported robust improvement in environmental triggers knowledge and intention to recommend environmental management. The program has a broad, national scope, reaching more than 12 000 physicians, health care providers, and students, and some faculty champions successfully integrated materials into health record. Program barriers and future endeavors were identified.

  17. Measuring horizontal integration among health care providers in the community: an examination of a collaborative process within a palliative care network.

    Science.gov (United States)

    Bainbridge, Daryl; Brazil, Kevin; Krueger, Paul; Ploeg, Jenny; Taniguchi, Alan; Darnay, Julie

    2015-05-01

    In many countries formal or informal palliative care networks (PCNs) have evolved to better integrate community-based services for individuals with a life-limiting illness. We conducted a cross-sectional survey using a customized tool to determine the perceptions of the processes of palliative care delivery reflective of horizontal integration from the perspective of nurses, physicians and allied health professionals working in a PCN, as well as to assess the utility of this tool. The process elements examined were part of a conceptual framework for evaluating integration of a system of care and centred on interprofessional collaboration. We used the Index of Interdisciplinary Collaboration (IIC) as a basis of measurement. The 86 respondents (85% response rate) placed high value on working collaboratively and most reported being part of an interprofessional team. The survey tool showed utility in identifying strengths and gaps in integration across the network and in detecting variability in some factors according to respondent agency affiliation and profession. Specifically, support for interprofessional communication and evaluative activities were viewed as insufficient. Impediments to these aspects of horizontal integration may be reflective of workload constraints, differences in agency operations or an absence of key structural features.

  18. Integrating evidence-based interventions into client care plans.

    Science.gov (United States)

    Doran, Diane; Carryer, Jennifer; Paterson, Jane; Goering, Paula; Nagle, Lynn; Kushniruk, Andre; Bajnok, Irmajean; Clark, Carrie; Srivastava, Rani

    2009-01-01

    Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory - Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

  19. Workshop: integration of care at the interface of primary and secondary care: work in progress.

    NARCIS (Netherlands)

    Zee, J. van der

    2010-01-01

    Background and aim: Existing health care arrangements do not always provide a well-organized response to health problems occurring in society. Inadequate coordination of care for people with chronic conditions or elderly in need for home care services provide examples of important integration issues

  20. Integrating complementary and alternative medicine into cancer care: Canadian oncology nurses′ perspectives

    OpenAIRE

    Tracy L Truant; Lynda G Balneaves; Margaret I Fitch

    2015-01-01

    The integration of complementary and alternative medicine (CAM) and conventional cancer care in Canada is in its nascent stages. While most patients use CAM during their cancer experience, the majority does not receive adequate support from their oncology health care professionals (HCPs) to integrate CAM safely and effectively into their treatment and care. A variety of factors influence this lack of integration in Canada, such as health care professional(HCP) education and attitudes about CA...

  1. Significance of mental health legislation for successful primary care for mental health and community mental health services: A review.

    Science.gov (United States)

    Ayano, Getinet

    2018-03-29

     Mental health legislation (MHL) is required to ensure a regulatory framework for mental health services and other providers of treatment and care, and to ensure that the public and people with a mental illness are afforded protection from the often-devastating consequences of mental illness.  To provide an overview of evidence on the significance of MHL for successful primary care for mental health and community mental health servicesMethod: A qualitative review of the literature on the significance of MHL for successful primary care for mental health and community mental health services was conducted.  In many countries, especially in those who have no MHL, people do not have access to basic mental health care and treatment they require. One of the major aims of MHL is that all people with mental disorders should be provided with treatment based on the integration of mental health care services into the primary healthcare (PHC). In addition, MHL plays a crucial role in community integration of persons with mental disorders, the provision of care of high quality, the improvement of access to care at community level. Community-based mental health care further improves access to mental healthcare within the city, to have better health and mental health outcomes, and better quality of life, increase acceptability, reduce associated social stigma and human rights abuse, prevent chronicity and physical health comorbidity will likely to be detected early and managed.  Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.

  2. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.

    Directory of Open Access Journals (Sweden)

    Charlotte Hanlon

    Full Text Available Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda participating in the PRogramme for Improving Mental health carE (PRIME. The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts.The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care.The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential

  3. Open innovation in health care: analysis of an open health platform.

    Science.gov (United States)

    Bullinger, Angelika C; Rass, Matthias; Adamczyk, Sabrina; Moeslein, Kathrin M; Sohn, Stefan

    2012-05-01

    Today, integration of the public in research and development in health care is seen as essential for the advancement of innovation. This is a paradigmatic shift away from the traditional assumption that solely health care professionals are able to devise, develop, and disseminate novel concepts and solutions in health care. The present study builds on research in the field of open innovation to investigate the adoption of an open health platform by patients, care givers, physicians, family members, and the interested public. Results suggest that open innovation practices in health care lead to interesting innovation outcomes and are well accepted by participants. During the first three months, 803 participants of the open health platform submitted challenges and solutions and intensively communicated by exchanging 1454 personal messages and 366 comments. Analysis of communication content shows that empathic support and exchange of information are important elements of communication on the platform. The study presents first evidence for the suitability of open innovation practices to integrate the general public in health care research in order to foster both innovation outcomes and empathic support. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  4. Fostering development of nursing practices to support integrated care when implementing integrated care pathways: what levers to use?

    Science.gov (United States)

    Longpré, Caroline; Dubois, Carl-Ardy

    2017-11-29

    Care integration has been the focus of recent health system reforms. Given their functions at all levels of the care continuum, nurses have a substantial and primordial role to play in such integration processes. The aim of this study was to identify levers and strategies that organizations can use to support the development of a nursing practice aligned with the requirements of care integration in a health and social services centre (HSSC) in Quebec. The research design was a cross-sectional descriptive qualitative study based on a single case study with nested levels of analysis. The case was a public, multi-disciplinary HSSC in a semi-urban region of Quebec. Semi-structured interviews with 37 persons (nurses, professionals, managers, administrators) allowed for data saturation and ensured theoretical representation by covering four care pathways constituting different care integration contexts. Analysis involved four steps: preparing a predetermined list of codes based on the reference framework developed by Minkman (2011); coding transcript content; developing general and summary matrices to group observations for each care pathway; and creating a general model showing the overall results for the four pathways. The organization's capacity for response with regard to developing an integrated system of services resulted in two types of complementary interventions. The first involved investing in key resources and renewing organizational structures; the second involved deploying a series of organizational and clinical-administrative processes. In resource terms, integration efforts resulted in setting up new strategic services, re-arranging physical infrastructures, and deploying new technological resources. Organizational and clinical-administrative processes to promote integration involved renewing governance, improving the flow of care pathways, fostering continuous quality improvement, developing new roles, promoting clinician collaboration, and strengthening

  5. Joint principles: Integrating behavioral health care into the patient-centered medical home.

    Science.gov (United States)

    2014-06-01

    The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. The Joint Principles of the PCMH, formulated and endorsed in February 2007, are sound and describe the ideal toward which we aspire. However, there is an element running implicitly through these joint principles that is difficult to achieve yet indispensable to the success of the entire PCMH concept. The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals. This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element, and retrofitting will be much more difficult than prospectively integrating into the original design of the PCMH. Therefore we offer a complementary set of joint principles that recognizes the centrality of behavioral health care as part of the PCMH. This document follows the order and language of the original joint principles while emphasizing what needs to be addressed to insure incorporation of the essential behavioral elements. It is intended to supplement and not replace the original Joint Principles document, which still stands.

  6. Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context.

    Science.gov (United States)

    Rodrigues, Ludmila Barbosa Bandeira; Dos Santos, Claudia Benedita; Goyatá, Sueli Leiko Takamatsu; Popolin, Marcela Paschoal; Yamamura, Mellina; Deon, Keila Christiane; Lapão, Luis Miguel Veles; Santos Neto, Marcelino; Uchoa, Severina Alice da Costa; Arcêncio, Ricardo Alexandre

    2015-07-22

    Health systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to assess the coordination of Integrated Health Service Delivery Networks by the Primary Health Care. A cross sectional approach was used. The population was pooled from Family Health Strategy healthcare professionals, of the Alfenas region (Minas Gerais, Brazil). Data collection was performed from August to October 2013. The results were checked for the presence of floor and ceiling effects and the internal consistency measured through Cronbach alpha. Construct validity was verified through convergent and discriminant values following Multitrait-Multimethod (MTMM) analysis. Floor and ceiling effects were absent. The internal consistency of the instrument was satisfactory; as was the convergent validity, with a few correlations lower then 0.30. The discriminant validity values of the majority of items, with respect to their own dimension, were found to be higher or significantly higher than their correlations with the dimensions to which they did not belong. The results showed that the COPAS instrument has satisfactory initial psychometric properties and may be used by healthcare managers and workers to assess the PHC coordination performance within the Integrated Health Service Delivery Network.

  7. Health-care professionals' knowledge, attitudes and behaviours relating to patient capacity to consent to treatment: an integrative review.

    Science.gov (United States)

    Lamont, Scott; Jeon, Yun-Hee; Chiarella, Mary

    2013-09-01

    This integrative review aims to provide a synthesis of research findings of health-care professionals' knowledge, attitudes and behaviours relating to patient capacity to consent to or refuse treatment within the general hospital setting. Search strategies included relevant health databases, hand searching of key journals, 'snowballing' and expert recommendations. The review identified various knowledge gaps and attitudinal dispositions of health-care professionals, which influence their behaviours and decision-making in relation to capacity to consent processes. The findings suggest that there is tension between legal, ethical and professional standards relating to the assessment of capacity and consent within health care. Legislation and policy guidance concerning capacity assessment processes are lacking, and this may contribute to inconsistencies in practice.

  8. Integrating mental health into primary care for displaced populations: the experience of Mindanao, Philippines

    Directory of Open Access Journals (Sweden)

    Gil Tatiana

    2011-03-01

    Full Text Available Abstract Background For more than forty years, episodes of violence in the Mindanao conflict have recurrently led to civilian displacement. In 2008, Medecins Sans Frontieres set up a mental health program integrated into primary health care in Mindanao Region. In this article, we describe a model of mental health care and the characteristics and outcomes of patients attending mental health services. Methods Psychologists working in mobile clinics assessed patients referred by trained clinicians located at primary level. They provided psychological first aid, brief psychotherapy and referral for severe patients. Patient characteristics and outcomes in terms of Self-Reporting Questionnaire (SRQ20 and Global Assessment of Functioning score (GAF are described. Results Among the 463 adult patients diagnosed with a common mental disorder with at least two visits, median SRQ20 score diminished from 7 to 3 (p Conclusions Brief psychotherapy sessions provided at primary level during emergencies can potentially improve patients' symptoms of distress.

  9. The impact of emotional intelligence in health care professionals on caring behaviour towards patients in clinical and long-term care settings: Findings from an integrative review.

    Science.gov (United States)

    Nightingale, Suzanne; Spiby, Helen; Sheen, Kayleigh; Slade, Pauline

    2018-04-01

    Over recent years there has been criticism within the United Kingdom's health service regarding a lack of care and compassion, resulting in adverse outcomes for patients. The impact of emotional intelligence in staff on patient health care outcomes has been recently highlighted. Many recruiters now assess emotional intelligence as part of their selection process for health care staff. However, it has been argued that the importance of emotional intelligence in health care has been overestimated. To explore relationships between emotional intelligence in health care professionals, and caring behaviour. To further explore any additional factors related to emotional intelligence that may impact upon caring behaviour. An integrative review design was used. Psychinfo, Medline, CINAHL Plus, Social Sciences Citation Index, Science Citation Index, and Scopus were searched for studies from 1995 to April 2017. Studies providing quantitative or qualitative exploration of how any healthcare professionals' emotional intelligence is linked to caring in healthcare settings were selected. Twenty two studies fulfilled the inclusion criteria. Three main types of health care professional were identified: nurses, nurse leaders, and physicians. Results indicated that the emotional intelligence of nurses was related to both physical and emotional caring, but emotional intelligence may be less relevant for nurse leaders and physicians. Age, experience, burnout, and job satisfaction may also be relevant factors for both caring and emotional intelligence. This review provides evidence that developing emotional intelligence in nurses may positively impact upon certain caring behaviours, and that there may be differences within groups that warrant further investigation. Understanding more about which aspects of emotional intelligence are most relevant for intervention is important, and directions for further large scale research have been identified. Copyright © 2018 Elsevier Ltd. All

  10. Health care delivery update: Part 1. Trends: less and more integration, bundled services, rethinking IPAs.

    Science.gov (United States)

    Ellwood, P M

    1988-01-01

    Vertical integration of national medical firms that contract with physicians has slowed dramatically. At the same time, several top-level group practices, taking advantage of reputations for excellence, are integrating vertically on a national or regional scale. A shift from buying well to actually managing medical care will separate the "prospective supermeds" that learned to collaborate with physicians from those that are attempting to manipulate them. In view of the budget deficit and the needs for long-term care, Congress is likely to espouse more drastic Part B cost-cutting measures such as a physician PPO or an indexed relative-value scale. An emerging feature in health care is the growing variety of prospective payment arrangements in which the price for various combination services is set in advance. To be truly competitive, medical care organizations will have to be more selective, choosing physicians because they are cooperative and economical and because they are capable practitioners.

  11. Multiple sclerosis care: an integrated disease-management model.

    Science.gov (United States)

    Burks, J

    1998-04-01

    A disease-management model must be integrated, comprehensive, individual patient focused and outcome driven. In addition to high quality care, the successful model must reduce variations in care and costs. MS specialists need to be intimately involved in the long-term care of MS patients, while not neglecting primary care issues. A nurse care manager is the "glue" between the managed care company, health care providers and the patient/family. Disease management focuses on education and prevention, and can be cost effective as well as patient specific. To implement a successful program, managed care companies and health care providers must work together.

  12. The institutional logic of integrated care: an ethnography of patient transitions.

    Science.gov (United States)

    Shaw, James A; Kontos, Pia; Martin, Wendy; Victor, Christina

    2017-03-20

    Purpose The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service. Design/methodology/approach The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community "hub" meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship. Findings Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care. Originality/value This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the "spread" of logics between macro-, meso-, and micro-level influences on inter-organizational change.

  13. Integrative health care - Toward a common understanding: A mixed method study.

    Science.gov (United States)

    Leach, Matthew J; Wiese, Marlene; Thakkar, Manisha; Agnew, Tamara

    2018-02-01

    To generate a multidisciplinary stakeholder-informed definition of integrative health care (IHC). A mixed-method study design was used, employing the use of focus groups/semi-structured interviews (phase-1) and document analysis (phases 2 and 3). Phase-1 recruited a purposive sample of Australian health consumers/health providers. Phase-2 interrogated websites of international IHC organisations for definitions of IHC. Phase-3 systematically searched bibliographic databases for articles defining IHC. Data were analysed using thematic analysis. Data were drawn from 54 health consumers/providers (phase-1), 23 IHC organisation webpages (phase-2) and 23 eligible articles (phase-3). Seven themes emerged from the data. Consensus was reached on a single, 65-word definition of IHC. An unambiguous definition of IHC is critical to establishing a clearer identity for IHC, as well as providing greater clarity for consumers, health providers and policy makers. In recognising the need for a clearer description, we propose a scientifically-grounded, multi-disciplinary stakeholder-informed definition of IHC. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Consulting Psychiatry within an Integrated Primary Care Model

    Science.gov (United States)

    Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L.; Serrano, Neftali

    2014-01-01

    Summary After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population. PMID:24185149

  15. Medical knowledge packages and their integration into health-care information systems and the World Wide Web.

    Science.gov (United States)

    Adlassnig, Klaus-Peter; Rappelsberger, Andrea

    2008-01-01

    Software-based medical knowledge packages (MKPs) are packages of highly structured medical knowledge that can be integrated into various health-care information systems or the World Wide Web. They have been established to provide different forms of clinical decision support such as textual interpretation of combinations of laboratory rest results, generating diagnostic hypotheses as well as confirmed and excluded diagnoses to support differential diagnosis in internal medicine, or for early identification and automatic monitoring of hospital-acquired infections. Technically, an MKP may consist of a number of inter-connected Arden Medical Logic Modules. Several MKPs have been integrated thus far into hospital, laboratory, and departmental information systems. This has resulted in useful and widely accepted software-based clinical decision support for the benefit of the patient, the physician, and the organization funding the health care system.

  16. Health psychology in primary care: recent research and future directions

    Directory of Open Access Journals (Sweden)

    Thielke S

    2011-06-01

    Full Text Available Stephen Thielke1, Alexander Thompson2, Richard Stuart31Psychiatry and Behavioral Sciences, University of Washington, Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA; 2Group Health Cooperative, Seattle, WA, USA; 3Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USAAbstract: Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery. Recent meta-analyses have generated mixed results about the effectiveness and cost-effectiveness of health psychology interventions. There have been few studies of health psychology interventions in real-world treatment settings. Several key challenges exist: determining the degree of penetration of health psychology into primary care settings; clarifying the specific roles of health psychologists in integrated care; resolving reimbursement issues; and adapting to the increased prescription of psychotropic medications. Identifying and exploring these issues can help health psychologists and primary care providers to develop the most effective ways of applying psychological principles in primary care settings. In a changing health care landscape, health psychologists must continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and to measure the outcomes of their work.Keywords: health psychology, primary care, integrated care, collaborative care, referral, colocation

  17. Integration of depression and primary care: barriers to adoption.

    Science.gov (United States)

    Grazier, Kyle L; Smith, Judith E; Song, Jean; Smiley, Mary L

    2014-01-01

    Despite the prevailing consensus as to its value, the adoption of integrated care models is not widespread. Thus, the objective of this article it to examine the barriers to the adoption of depression and primary care models in the United States. A literature search focused on peer-reviewed journal literature in Medline and PsycInfo. The search strategy focused on barriers to integrated mental health care services in primary care, and was based on previously existing searches. The search included: MeSH terms combined with targeted keywords; iterative citation searches in Scopus; searches for grey literature (literature not traditionally indexed by commercial publishers) in Google and organization websites, examination of reference lists, and discussions with researchers. Integration of depression care and primary care faces multiple barriers. Patients and families face numerous barriers, linked inextricably to create challenges not easily remedied by any one party, including the following: vulnerable populations with special needs, patient and family factors, medical and mental health comorbidities, provider supply and culture, financing and costs, and organizational issues. An analysis of barriers impeding integration of depression and primary care presents information for future implementation of services.

  18. Integrated Health Care Systems and Indigenous Medicine: Reflections from the Sub-Sahara African Region

    Directory of Open Access Journals (Sweden)

    Beth Maina Ahlberg

    2017-09-01

    Full Text Available Indigenous or traditional medicine has, since the 1970s, been widely regarded as a resource likely to contribute to strengthening the health care systems in low income countries. This paper examines the state of traditional medicine using evidence from three case studies in Central Kenya. While the cases are too few to represent the broad diversity of cultures and related healing systems in the Sub-Sahara African Region, the way they seem to refute the main assumptions in the integration discourse is important, also because studies from other countries in the region report perspectives, similar to the case studies in Kenya. It is often argued that people continue to use traditional medicine because it is affordable, available, and culturally familiar. Its integration into the health care system would therefore promote cultural familiarity. The case studies however point to the loss of essential cultural elements central to traditional medicine in this particular area while users travel long distances to reach the healers. In addition, there are significant paradigm differences that may present obstacles to integration of the two systems. More problematic however is that integration is, as in many development interventions, a top-down policy that is rarely based on contextual realities and conditions. Instead, integration is often defined and dominated by biomedical professionals and health planners who may be unfamiliar or even hostile to some aspects of traditional medicine. Furthermore, integration efforts have tended to embrace selected components mostly herbal medicine. This has led to isolating herbal medicine from spiritualism, which may in turn affect the holistic perspective of traditional medicine. While familiarity and relevance may explain the continued use of traditional medicine, its services may not be as readily available, accessible, or even affordable as is often asserted. Globalization set in motion through colonization and

  19. Patient perceptions of integrated care: confused by the term, clear on the concept

    Directory of Open Access Journals (Sweden)

    Kara Odom Walker

    2013-03-01

    Full Text Available Purpose: Health care reform in the United States has introduced terms such as “the patient-centered medical home” and “integrated care” that are often unclear and unfamiliar to patients. This study explored patient experiences with the functional domains of integrated care. Theory and methods: Patients first wrote their definitions of integrated care and then participated in focus group discussions about their experiences with the health care system. Transcripts were analyzed for thematic content. Results: Forty-four patients participated in one of seven focus groups in San Francisco, CA in English and Spanish. Many patients were not clear about the meaning of the term integrated care. However, patients described experiences largely reflected in an existing conceptual model of integrated care and the importance of coordination within and across teams and with community resources, continuity and sharing of information, and patient engagement. Patients with high medical needs described the ubiquitous challenges they faced in experiencing coordinated care. Conclusions: Patients may not understand the term integrated care but are relatively clear on what the concept of integrated care entails and support its successful implementation. Patients and their families are at the center of integrated care, and health systems need to support and empower them to successfully navigate the medical neighborhood.

  20. Integrating Complementary and Alternative Medicine Into Conventional Health Care System in Developing Countries

    DEFF Research Database (Denmark)

    Mishra, Shiva Raj; Neupane, Dinesh; Kallestrup, Per

    2015-01-01

    Complementary and alternative medicine has been a part of human life and practices since the beginning of time. The role of complementary and alternative medicine for the health of humans is undisputed particularly in light of its role in health promotion and well-being. This article discusses wa...... through which complementary and alternative medicine can be promoted and sustained as an integrated element of health care in developing countries. We specifically present the exemplary of Amchi traditional doctors of Northern Himalayas......Complementary and alternative medicine has been a part of human life and practices since the beginning of time. The role of complementary and alternative medicine for the health of humans is undisputed particularly in light of its role in health promotion and well-being. This article discusses ways...

  1. Integrated Personal Health and Care Services deployment: Experiences in eight European countries

    DEFF Research Database (Denmark)

    Villalba, Elena; Casas, Isabel; Abadie, Fabienne

    2013-01-01

    conditions for mainstreaming these services into care provision. Methods: We conducted a qualitative analysis of 27 Telehealth, Telecare and Integrated Personal Health System projects, implemented across 20 regions in eight European countries. The analysis was based on Suter’s ten key principles...... mechanisms, interoperable information systems, policy commitment, engaged professionals, national investments and funding programmes, and incentives and financing. Conclusion: In those cases which provided evidence of success beyond the pilot stage, we observed a promising trend: awareness and introduction...

  2. The Times They Are a Changin': Neuropsychology and Integrated Care Teams.

    Science.gov (United States)

    Kubu, Cynthia S; Ready, Rebecca E; Festa, Joanne R; Roper, Brad L; Pliskin, Neil H

    2016-01-01

    To gather illustrative data from clinical neuropsychologists who are working in integrated care settings in order to provide an initial blueprint for moving forward in this new era of health care. A survey was designed to illustrate the ways in which neuropsychologists are participating in integrated care teams and distributed on major neuropsychology listservs. The survey evaluated the settings, roles, services provided, practice issues, remuneration, and impact of neuropsychologists' participation in integrated care teams with respect to patient care and health outcomes. Frequencies were used to summarize the findings as well as qualitative coding of narrative responses. There were 412 respondents to the survey and 261 of those indicated that they worked in at least one integrated care setting. Neuropsychologists work in a variety of integrated care settings and provide diverse services which contribute to improved patient care and outcomes. Three primary themes emerge from the findings with regard to the engagement and teams: advocacy, collaboration, and communication. We argue for the need for more easily accessible outcome studies illustrating the clinical benefits and cost-savings associated with inclusion of neuropsychologists in integrated care teams. In addition, educational and training initiatives are needed to better equip current and future clinical neuropsychologists to function effectively in integrated care settings.

  3. Integrated primary care in Germany: the road ahead

    Directory of Open Access Journals (Sweden)

    Sophia Schlette

    2009-04-01

    Full Text Available Problem statement: Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Description of policy development: Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and ‘community medicine nurses’. Conclusion and discussion: Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans

  4. Integrated primary care in Germany: the road ahead.

    Science.gov (United States)

    Schlette, Sophia; Lisac, Melanie; Blum, Kerstin

    2009-04-20

    Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and 'community medicine nurses'. Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers.

  5. Health Care Personnel Perception of the Privacy of Electronic Health Records.

    Science.gov (United States)

    Saito, Kenji; Shofer, Frances S; Saberi, Poune; Green-McKenzie, Judith

    2017-06-01

    : Health care facilities are increasingly converting paper medical records to electronic health records. This study investigates the perception of privacy health care personnel have of electronic health records. A pilot tested, anonymous survey was administered to a convenience sample of health care personnel. Standard summary statistics and Chi-square analysis were used to assess differences in perception. Of the 93% (96/103) who responded, 65% were female and 43% white. The mean age was 44.3 years. Most (94%) felt that Medical Record privacy was important and one-third reported they would not seek care at their workplace if Electronic Health Records were used. Efforts to assure and communicate the integrity of electronic health records are essential toward reducing deterrents for health care personnel to access geographically convenient and timely health care.

  6. Acute mental health care and South African mental health legislation

    African Journals Online (AJOL)

    information on mental health care outcome, to do a cost analysis and to establish a quality assurance cycle that may facilitate a cost ... clinical record reviews of mental health service delivery, training ... (d) describe the demographic and clinical profile of HIV positive ..... accommodate the differentiated but integrated care of.

  7. Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

    Science.gov (United States)

    McLellan, Robert K; Sherman, Bruce; Loeppke, Ronald R; McKenzie, Judith; Mueller, Kathryn L; Yarborough, Charles M; Grundy, Paul; Allen, Harris; Larson, Paul W

    2012-04-01

    In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation-the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them-including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering

  8. Health care development: integrating transaction cost theory with social support theory.

    Science.gov (United States)

    Hajli, M Nick; Shanmugam, Mohana; Hajli, Ali; Khani, Amir Hossein; Wang, Yichuan

    2014-07-28

    The emergence of Web 2.0 technologies has already been influential in many industries, and Web 2.0 applications are now beginning to have an impact on health care. These new technologies offer a promising approach for shaping the future of modern health care, with the potential for opening up new opportunities for the health care industry as it struggles to deal with challenges including the need to cut costs, the increasing demand for health services and the increasing cost of medical technology. Social media such as social networking sites are attracting more individuals to online health communities, contributing to an increase in the productivity of modern health care and reducing transaction costs. This study therefore examines the potential effect of social technologies, particularly social media, on health care development by adopting a social support/transaction cost perspective. Viewed through the lens of Information Systems, social support and transaction cost theories indicate that social media, particularly online health communities, positively support health care development. The results show that individuals join online health communities to share and receive social support, and these social interactions provide both informational and emotional support.

  9. Workplace spirituality in health care: an integrated review of the literature.

    Science.gov (United States)

    Pirkola, Heidi; Rantakokko, Piia; Suhonen, Marjo

    2016-10-01

    The aim is to describe workplace spirituality as a concept and phenomenon in health care and to explore the points of view from which it has been studied in nursing. Personnel in nursing are ageing and recruitment is challenging; workplace spirituality might benefit both employees and organisations. Workplace spirituality has three levels - individual, group and organisational - and presents different components at each level. An integrated literature search identified 632 studies; after screening for relevance and quality, we identified eight peer-reviewed articles. The data were analysed with qualitative content analysis. Workplace spirituality in nursing is mostly defined and researched from the individual viewpoint. The definition includes dimensions of inner life, meaningful work, interconnectedness, transcendence and alignment between values. A sense of community and meaningful work are the most important dimensions of workplace spirituality in health care. Group and organisational levels of workplace spirituality are the most important and still the least studied. Research is concentrated in Canada and Asia; more research in Europe is needed. Nurse managers can enhance workplace spirituality by contributing to organisational culture and emphasising teamwork. This requires more education and training in workplace spirituality. © 2016 John Wiley & Sons Ltd.

  10. Primary care and public health: exploring integration to improve population health

    National Research Council Canada - National Science Library

    Committee on Integrating Primary Care and Public Health; Board on Population Health and Public Health Practice; Institute of Medicine

    ...; and the provision of timely, effective, and coordinated health care. Achieving substantial and lasting improvements in population health will require a concerted effort from all these entities, aligned with a common goal...

  11. The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

    Science.gov (United States)

    Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

    2018-05-01

    Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

  12. The Evidence-base for Using Ontologies and Semantic Integration Methodologies to Support Integrated Chronic Disease Management in Primary and Ambulatory Care: Realist Review. Contribution of the IMIA Primary Health Care Informatics WG.

    Science.gov (United States)

    Liyanage, H; Liaw, S-T; Kuziemsky, C; Terry, A L; Jones, S; Soler, J K; de Lusignan, S

    2013-01-01

    Most chronic diseases are managed in primary and ambulatory care. The chronic care model (CCM) suggests a wide range of community, technological, team and patient factors contribute to effective chronic disease management. Ontologies have the capability to enable formalised linkage of heterogeneous data sources as might be found across the elements of the CCM. To describe the evidence base for using ontologies and other semantic integration methods to support chronic disease management. We reviewed the evidence-base for the use of ontologies and other semantic integration methods within and across the elements of the CCM. We report them using a realist review describing the context in which the mechanism was applied, and any outcome measures. Most evidence was descriptive with an almost complete absence of empirical research and important gaps in the evidence-base. We found some use of ontologies and semantic integration methods for community support of the medical home and for care in the community. Ubiquitous information technology (IT) and other IT tools were deployed to support self-management support, use of shared registries, health behavioural models and knowledge discovery tools to improve delivery system design. Data quality issues restricted the use of clinical data; however there was an increased use of interoperable data and health system integration. Ontologies and semantic integration methods are emergent with limited evidence-base for their implementation. However, they have the potential to integrate the disparate community wide data sources to provide the information necessary for effective chronic disease management.

  13. Health care utilization

    DEFF Research Database (Denmark)

    Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren

    An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... containment measures affect the utilization of health services, and how these measures interact with the number of patients per provider. Based on very valid register data, this is investigated for 9.556 Danish physiotherapists between 2001 and 2008. We find that higher (relative) fees for a given service...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...

  14. Health care multidisciplinary teams: The sociotechnical approach for an integrated system-wide perspective.

    Science.gov (United States)

    Marsilio, Marta; Torbica, Aleksandra; Villa, Stefano

    The current literature on the enabling conditions of multidisciplinary teams focuses on the singular dimensions of the organizations (i.e., human resources, clinical pathways, objects) without shedding light on to the way in which these organizational factors interact and mutually influence one another. Drawing on a system perspective of organizations, the authors analyze the organizational patterns that promote and support multidisciplinary teams and how they interrelate and interact to enforce the organization work system. The authors develop a modified sociotechnical system (STS) model to understand how the two dimensions of technical (devices/tools, layout/organization of space, core process standardization) and social (organizational structure, management of human resources and operations) can facilitate the implementation of multidisciplinary teams in health care. The study conducts an empirical analysis based on a sample of hospital adopters of transcatheter aortic valve implantation using the revised STS model. The modified STS model applied to the case studies improves our understanding of the critical implementation factors of a multidisciplinary approach and the importance of coordinating radical changes in the technical and the social subsystems of health care organizations. The analysis informs that the multidisciplinary effort is not a sequential process and that the interplay between the two subsystems needs to be managed efficaciously as an integrated organizational whole to deliver the goals set. Hospital managers must place equal focus on the closely interrelated technical and social dimensions by investing in (a) shared layouts and spaces that cross the boundaries of the specialized health care units, (b) standardization of the core processes through the implementation of local clinical pathways, (c) structured knowledge management mechanisms, (d) the creation of clinical directorates, and (e) the design of a planning and budgeting system that

  15. Mental health care roles of non-medical primary health and social care services.

    Science.gov (United States)

    Mitchell, Penny

    2009-02-01

    Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

  16. [Governance of primary health-care-based health-care organization].

    Science.gov (United States)

    Báscolo, Ernesto

    2010-01-01

    An analytical framework was developed for explaining the conditions for the effectiveness of different strategies promoting integrated primary health-care (PHC) service-based systems in Latin-America. Different modes of governance (clan, incentives and hierarchy) were characterised from a political economics viewpoint for representing alternative forms of regulation promoting innovation in health-service-providing organisations. The necessary conditions for guaranteeing the modes of governance's effectiveness are presented, as are their implications in terms of posts in play. The institutional construction of an integrated health system is interpreted as being a product of a social process in which different modes of governance are combined, operating with different ways of resolving normative aspects for regulating service provision (with the hierarchical mode), resource distribution (with the incentives mode) and on the social values legitimising such process (with the clan mode).

  17. Dual Loyalty in Prison Health Care

    Science.gov (United States)

    Stöver, Heino; Wolff, Hans

    2012-01-01

    Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners. PMID:22390510

  18. The paradox of conscientious objection and the anemic concept of 'conscience': downplaying the role of moral integrity in health care.

    Science.gov (United States)

    Giubilini, Alberto

    2014-06-01

    Conscientious objection in health care is a form of compromise whereby health care practitioners can refuse to take part in safe, legal, and beneficial medical procedures to which they have a moral opposition (for instance abortion). Arguments in defense of conscientious objection in medicine are usually based on the value of respect for the moral integrity of practitioners. I will show that philosophical arguments in defense of conscientious objection based on respect for such moral integrity are extremely weak and, if taken seriously, lead to consequences that we would not (and should not) accept. I then propose that the best philosophical argument that defenders of conscientious objection in medicine can consistently deploy is one that appeals to (some form of) either moral relativism or subjectivism. I suggest that, unless either moral relativism or subjectivism is a valid theory--which is exactly what many defenders of conscientious objection (as well as many others) do not think--the role of moral integrity and conscientious objection in health care should be significantly downplayed and left out of the range of ethically relevant considerations.

  19. Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

    Science.gov (United States)

    King, Michael W

    2017-11-01

    Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for

  20. Women's self-perception and self-care practice: implications for health care delivery.

    Science.gov (United States)

    Mendias, E P; Clark, M C; Guevara, E B

    2001-01-01

    Mexican American women experience unique health care needs related to integration of Mexican and American cultures. To learn how to better promote self-care practices and service utilization in women of Mexican origin living in Texas, researchers used a qualitative approach to interview a convenience sample of 11 low-income women attending a health clinic. Researchers collected narrative data about the women's perceptions of health, wellness, and self-care. Using the matrix approach described by Miles and Huberman, we organized findings around women's roles, including participants' descriptions of themselves, their health and wellness awareness, self-care practices for health/illness and wellness/nonwellness, barriers to self-care, origin of self-care practices, and perceptions of life control. Implications for health planning and service delivery are presented.

  1. Health psychology in primary care: recent research and future directions.

    Science.gov (United States)

    Thielke, Stephen; Thompson, Alexander; Stuart, Richard

    2011-01-01

    Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery. Recent meta-analyses have generated mixed results about the effectiveness and cost-effectiveness of health psychology interventions. There have been few studies of health psychology interventions in real-world treatment settings. Several key challenges exist: determining the degree of penetration of health psychology into primary care settings; clarifying the specific roles of health psychologists in integrated care; resolving reimbursement issues; and adapting to the increased prescription of psychotropic medications. Identifying and exploring these issues can help health psychologists and primary care providers to develop the most effective ways of applying psychological principles in primary care settings. In a changing health care landscape, health psychologists must continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and to measure the outcomes of their work.

  2. World Health Organization Public Health Model: A Roadmap for Palliative Care Development.

    Science.gov (United States)

    Callaway, Mary V; Connor, Stephen R; Foley, Kathleen M

    2018-02-01

    The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made. Copyright © 2017. Published by Elsevier Inc.

  3. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  4. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection.Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  5. Mergers and integrated care: the Quebec experience.

    Science.gov (United States)

    Demers, Louis

    2013-01-01

    As a researcher, I have studied the efforts to increase the integration of health and social services in Quebec, as well as the mergers in the Quebec healthcare system. These mergers have often been presented as a necessary transition to break down the silos that compartmentalize the services dispensed by various organisations. A review of the studies about mergers and integrated care projects in the Quebec healthcare system, since its inception, show that mergers cannot facilitate integrated care unless they are desired and represent for all of the actors involved an appropriate way to deal with service organisation problems. Otherwise, mergers impede integrated care by creating increased bureaucratisation and standardisation and by triggering conflicts and mistrust among the staff of the merged organisations. It is then preferable to let local actors select the most appropriate organisational integration model for their specific context and offer them resources and incentives to cooperate.

  6. Integrative Mental Health (IMH): paradigm, research, and clinical practice.

    Science.gov (United States)

    Lake, James; Helgason, Chanel; Sarris, Jerome

    2012-01-01

    This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to non-allopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidence-based methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: www.INIMH.org) was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Organizing integrated care in a university hospital: application of a conceptual framework.

    Science.gov (United States)

    Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

    2014-04-01

    As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

  8. [Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings].

    Science.gov (United States)

    Diez-Canseco, Francisco; Ipince, Alessandra; Toyama, Mauricio; Benate-Galvez, Ysabel; Galán-Rodas, Edén; Medina-Verástegui, Julio César; Sánchez-Moreno, David; Araya, Ricardo; Miranda, J Jaime

    2014-01-01

    In this article, the relationship between mental health and chronic non-communicable diseases is discussed as well as the possibility to address them in a comprehensive manner in the Peruvian health system. First, the prevalence estimates and the burden of chronic non-communicable diseases and mental disorders worldwide and in Peru are reviewed. Then, the detrimental impact of depression in the early stages as well as the progress of diabetes and cardiovascular diseases is described. Additionally, the gap between access to mental health care in Peru is analyzed. Lastly, the alternatives to reduce the gap are explored. Of these alternatives, the integration of mental health into primary care services is emphasized; as a feasible way to meet the care needs of the general population, and people with chronic diseases in particular, in the Peruvian context.

  9. Integrating a suicide prevention program into the primary health care network: a field trial study in Iran.

    Science.gov (United States)

    Malakouti, Seyed Kazem; Nojomi, Marzieh; Poshtmashadi, Marjan; Hakim Shooshtari, Mitra; Mansouri Moghadam, Fariba; Rahimi-Movaghar, Afarin; Afghah, Susan; Bolhari, Jafar; Bazargan-Hejazi, Shahrzad

    2015-01-01

    To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ (2) = 14.8, P suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas.

  10. Phytotherapy in primary health care

    Science.gov (United States)

    Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

    2014-01-01

    OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

  11. Netherlands: The potentials of integrating care via payment reforms

    NARCIS (Netherlands)

    Struijs, Jeroen N.; Drewes, Hanneke W.; Heijink, Richard; Baan, Caroline A.

    This chapter provides insight in the potential of integrating care through payment reform in the Netherlands. We begin by briefly outlining the main characteristics of the Dutch health care system, which has been transformed into a system of managed competition in the past decade. We focus on health

  12. Cultural Expressions of Intergenerational Trauma and Mental Health Nursing Implications for U.S. Health Care Delivery Following Refugee Resettlement: An Integrative Review of the Literature.

    Science.gov (United States)

    Hudson, Christina Camille; Adams, Susie; Lauderdale, Jana

    2016-05-01

    The purpose of this integrative review of the literature is to examine cultural expressions of intergenerational trauma among refugees following resettlement, and to determine culturally sensitive mental health care practice implications for health care practitioners working in U.S. health care delivery. Data were collected utilizing a comprehensive computer-assisted search in CINAHL and PsychARTICLES/ProQuest from 2003 to 2013 of full text, peer-reviewed, scholarly journal articles, published in English. Eight articles met selection criteria and were analyzed using Gadamer's philosophical interpretation of play, symbolism, and festival in The Relevance of the Beautiful Six recurrent themes were identified important to refugee health care delivery: silence, communication, adaptation, relationship, remembering, and national redress. Practitioners need to consider cultural influences of intergenerational trauma in processing grief related to loss and how artistic modes of expression are experienced, both individually and communally, in refugee health care delivery. © The Author(s) 2015.

  13. Elements of integrated care approaches for older people: a review of reviews.

    Science.gov (United States)

    Briggs, Andrew M; Valentijn, Pim P; Thiyagarajan, Jotheeswaran A; Araujo de Carvalho, Islene

    2018-04-07

    The World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature. Review of reviews using a systematic search method. A systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged ≥60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool. Fifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical 'micro' and organisational 'meso' care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1-11). Seven (47%) reviews were scored as high quality (AMSTAR score ≥8). Evidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there

  14. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia.

    Science.gov (United States)

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2015-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient's departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia.

  15. Does integrated care lead to both improved service quality and lower care cost

    Science.gov (United States)

    Waldeyer, Regina; Siegel, Achim; Daul, Gisela; Gaiser, Karin; Hildebrandt, Helmut; Köster, Ingrid; Schubert, Ingrid; Stunder, Brigitte; Stützle, Yvonne

    2010-01-01

    Purpose and context ‘Gesundes Kinzigtal’ is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The management company and its contracting partners (the physicians’ network in the region and two statutory health insurers) strive to reach a higher quality of care at a lower overall cost as compared with the German standard. During its first two years of operation (2006–2007), the Kinzigtal project achieved surprisingly positive financial results compared with its reference value. To gain independent evidence on the quality aspects of the system, the management company and its partners provided a remarkable budget for its evaluation by independent scientific institutions. Case description and data sources We will present interim results of a population-based controlled cohort study. In this study, quality of care is checked by relying on health and service quality indicators that have been constructed from health insurers’ administrative data (claims data). Interim results are presented for the intervention region (Kinzigtal area) and the control region (the rest of Baden-Württemberg, i.e., Southwest Germany). Preliminary conclusions and discussion The evaluation of ‘Gesundes Kinzigtal’ is in full progress. Until now, there is no evidence that the surprisingly positive financial results of the Kinzigtal system have been achieved at the expense of care quality. Rather, Gesundes Kinzigtal Integrated Care seems to be about to increasingly realize comparative advantages regarding health service quality (in comparison to the control region).

  16. [A pilot project of the integration of oro-dental care into the primary health care system in Cameroon].

    Science.gov (United States)

    Ngapeth-Etoundi, M; Ekoto, E

    2001-06-01

    The objective of this work is to analyse the situation of the Oral Health Care (OHC) of the population of operational district health unit in Primary Health Care (PHC) and finally integrate the component of OHC. Indeed in many countries in Africa, the World Health Organisation (WHO), in accord with the countries, have set up the policy of PHC. The agreement is that the component of OHC was neglected for quite sometimes in Cameroon. It's for this reason that a pilot project was initiated as a model so that it would be extended to all districts in this country. The method consist in investigation into the prevalence by means of questionnaire and clinical examination of the population of varied age; 900 persons were examined in the Sangmelina health district in order to master the situation of OHC. Oral dental hygiene: 70.5% of the population had a tooth brush, 79% declared they brush their teeth, The state of periodontal tissue: 75% had debris, 70% calculus, 60.7% gingivitis, The prevalence of caries: 66.9% (91.9% had between 21 and 32 teeth), 44.8% follon teeth, 50.8% of this population needed artificial teeth. The situation of the OHC in the health district of Sangmelina requires an effective prevention, consequently the importance of including this situation in PHC program of the said district.

  17. Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

    Science.gov (United States)

    Madzimbamuto, Farai D; Ray, Sunanda; Mogobe, Keitshokile D

    2013-06-10

    The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes

  18. The access of the homeless persons with tuberculosis to the health care: an integrative review

    Directory of Open Access Journals (Sweden)

    Annelissa Andrade Virgínio de Oliveira

    2017-04-01

    Full Text Available Introduction: The Tuberculosis (TB keeps being a big public health problem in the world, having the poverty, the bad life condition, the bad income distribution, the social iniquity and the disability on the health system as a substrate to its maintenance. Objective: To identify the scientific knowledge produced under the access to the health service of the homeless person sick by TB. Method: Integrative literature review conducted from April to June, 2016, having as inclusion criteria: publications written in Portuguese, English or Spanish, published from 1990 to 2015, indexed on the data basis: LILACS, SciELO, MEDLINE and Web of Science and portals Virtual Health Library (VHL and MEDLINE/PubMed, that had the text completely available online. As searching strategy was used the Boolean operator AND, with the descriptors: Tuberculosis, health services accessibility; homeless persons. To obtain the information that answered the research guideline question was elaborated a form that contemplated the following items: identification, theme, descriptors or key-words, abstract, introduction, method, results, discussion, conclusions and references. The search resulted in 51 articles that, observed with the inclusion and exclusion criteria, resulted in 10 complete articles. The data analyzes was made in qualitative terms, summarized in three categories: I Specific characteristics of the homeless people access to the health services to tuberculosis diagnostic and treatment; II Access difficulty to the health care: factors related to homeless people and factors related to health services; III Strategies to overcome the access difficulties of the homeless person (HLP  to the health care. Results: pointed that the homeless people have a higher risk to get sick by TB, presenting TB incidence rate 10 to 20 times higher than the general population. Many obstacles that limited those people access to the health services were identified. Many times they presented

  19. Implementation of integration strategies between primary care units and a regional general hospital in Brazil to update and connect health care professionals: a quasi-experimental study protocol.

    Science.gov (United States)

    Bracco, Mario Maia; Mafra, Ana Carolina Cintra Nunes; Abdo, Alexandre Hannud; Colugnati, Fernando Antonio Basile; Dalla, Marcello Dala Bernardina; Demarzo, Marcelo Marcos Piva; Abrahamsohn, Ises; Rodrigues, Aline Pacífico; Delgado, Ana Violeta Ferreira de Almeida; Dos Prazeres, Glauber Alves; Teixeira, José Carlos; Possa, Silvio

    2016-08-12

    Better communication among field health care teams and points of care, together with investments focused on improving teamwork, individual management, and clinical skills, are strategies for achieving better outcomes in patient-oriented care. This research aims to implement and evaluate interventions focused on improving communication and knowledge among health teams based on points of care in a regional public health outreach network, assessing the following hypotheses: 1) A better-working communication process between hospitals and primary health care providers can improve the sharing of information on patients as well as patients' outcomes. 2) A skill-upgrading education tool offered to health providers at their work sites can improve patients' care and outcomes. A quasi-experimental study protocol with a mixed-methods approach (quantitative and qualitative) was developed to evaluate communication tools for health care professionals based in primary care units and in a general hospital in the southern region of São Paulo City, Brazil. The usefulness and implementation processes of the integration strategies will be evaluated, considering: 1) An Internet-based communication platform that facilitates continuity and integrality of care to patients, and 2) A tailored updating distance-learning course on ambulatory care sensitive conditions for clinical skills improvements. The observational study will evaluate a non-randomized cohort of adult patients, with historical controls. Hospitalized patients diagnosed with an ambulatory care sensitive condition will be selected and followed for 1 year after hospital discharge. Data will be collected using validated questionnaires and from patients' medical records. Health care professionals will be evaluated related to their use of education and communication tools and their demographic and psychological profiles. The primary outcome measured will be the patients' 30-day hospital readmission rates. A sample size of 560

  20. Mergers and integrated care: the Quebec experience

    Directory of Open Access Journals (Sweden)

    Louis Demers

    2013-02-01

    Full Text Available As a researcher, I have studied the efforts to increase the integration of health and social services in Quebec, as well as the mergers in the Quebec healthcare system. These mergers have often been presented as a necessary transition to break down the silos that compartmentalize the services dispensed by various organisations. A review of the studies about mergers and integrated care projects in the Quebec healthcare system, since its inception, show that mergers cannot facilitate integrated care unless they are desired and represent for all of the actors involved an appropriate way to deal with service organisation problems. Otherwise, mergers impede integrated care by creating increased bureaucratisation and standardisation and by triggering conflicts and mistrust among the staff of the merged organisations. It is then preferable to let local actors select the most appropriate organisational integration model for their specific context and offer them resources and incentives to cooperate.

  1. A decision technology system for health care electronic commerce.

    Science.gov (United States)

    Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

    1999-08-01

    Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

  2. Health care policy and community pharmacy: implications for the New Zealand primary health care sector.

    Science.gov (United States)

    Scahill, Shane; Harrison, Jeff; Carswell, Peter; Shaw, John

    2010-06-25

    The aim of our paper is to expose the challenges primary health care reform is exerting on community pharmacy and other groups. Our paper is underpinned by the notion that a broad understanding of the issues facing pharmacy will help facilitate engagement by pharmacy and stakeholders in primary care. New models of remuneration are required to deliver policy expectations. Equally important is redefining the place of community pharmacy, outlining the roles that are mooted and contributions that can be made by community pharmacy. Consistent with international policy shifts, New Zealand primary health care policy outlines broad directives which community pharmacy must respond to. Policymakers are calling for greater integration and collaboration, a shift from product to patient-centred care; a greater population health focus and the provision of enhanced cognitive services. To successfully implement policy, community pharmacists must change the way they think and act. Community pharmacy must improve relationships with other primary care providers, District Health Boards (DHBs) and Primary Health Organisations (PHOs). There is a requirement for DHBs to realign funding models which increase integration and remove the requirement to sell products in pharmacy in order to deliver services. There needs to be a willingness for pharmacy to adopt a user pays policy. General practitioners (GPs) and practice nurses (PNs) need to be aware of the training and skills that pharmacists have, and to understand what pharmacists can offer that benefits their patients and ultimately general practice. There is also a need for GPs and PNs to realise the fiscal and professional challenges community pharmacy is facing in its attempt to improve pharmacy services and in working more collaboratively within primary care. Meanwhile, community pharmacists need to embrace new approaches to practice and drive a clearly defined agenda of renewal in order to meet the needs of health funders, patients

  3. Integrative mental health care: from theory to practice, part 1.

    Science.gov (United States)

    Lake, James

    2007-01-01

    Integrative approaches will lead to more accurate and different understandings of mental illness. Beneficial responses to complementary and alternative therapies provide important clues about the phenomenal nature of the human body in space-time and disparate biological, informational, and energetic factors associated with normal and abnormal psychological functioning. The conceptual framework of contemporary Western psychiatry includes multiple theoretical viewpoints, and there is no single best explanatory model of mental illness. Future theories of mental illness causation will not depend exclusively on empirical verification of strictly biological processes but will take into account both classically described biological processes and non-classical models, including complexity theory, resulting in more complete explanations of the characteristics and causes of symptoms and mechanisms of action that result in beneficial responses to treatments. Part 1 of this article examines the limitations of the theory and contemporary clinical methods employed in Western psychiatry and discusses implications of emerging paradigms in physics and the biological sciences for the future of psychiatry. In part 2, a practical methodology for planning integrative assessment and treatment strategies in mental health care is proposed. Using this methodology the integrative management of moderate and severe psychiatric symptoms is reviewed in detail. As the conceptual framework of Western medicine evolves toward an increasingly integrative perspective, novel understandings of complex relationships between biological, informational, and energetic processes associated with normal psychological functioning and mental illness will lead to more effective integrative assessment and treatment strategies addressing the causes or meanings of symptoms at multiple hierarchic levels of body-brain-mind.

  4. Integrative mental health care: from theory to practice, Part 2.

    Science.gov (United States)

    Lake, James

    2008-01-01

    Integrative approaches will lead to more accurate and different understandings of mental illness. Beneficial responses to complementary and alternative therapies provide important clues about the phenomenal nature of the human body in space-time and disparate biological, informational, and energetic factors associated with normal and abnormal psychological functioning. The conceptual framework of contemporary Western psychiatry includes multiple theoretical viewpoints, and there is no single best explanatory model of mental illness. Future theories of mental illness causation will not depend exclusively on empirical verification of strictly biological processes but will take into account both classically described biological processes and non-classical models, including complexity theory, resulting in more complete explanations of the characteristics and causes of symptoms and mechanisms of action that result in beneficial responses to treatments. Part 1 of this article examined the limitations of the theory and contemporary clinical methods employed in Western psychiatry and discussed implications of emerging paradigms in physics and the biological sciences for the future of psychiatry. In part 2, a practical methodology, for planning integrative assessment and treatment strategies in mental health care is proposed. Using this methodology the integrative management of moderate and severe psychiatric symptoms is reviewed in detail. As the conceptual framework of Western medicine evolves toward an increasingly integrative perspective, novel understanding of complex relationships between biological, informational, and energetic processes associated with normal psychological functioning and mental illness will lead to more effective integrative assessment and treatment strategies addressing the causes or meanings of symptoms at multiple hierarchic levels of body-brain-mind.

  5. Health coaching in primary care: a feasibility model for diabetes care.

    Science.gov (United States)

    Liddy, Clare; Johnston, Sharon; Nash, Kate; Ward, Natalie; Irving, Hannah

    2014-04-03

    Health coaching is a new intervention offering a one-on-one focused self-management support program. This study implemented a health coaching pilot in primary care clinics in Eastern Ontario, Canada to evaluate the feasibility and acceptability of integrating health coaching into primary care for patients who were either at risk for or diagnosed with diabetes. We implemented health coaching in three primary care practices. Patients with diabetes were offered six months of support from their health coach, including an initial face-to-face meeting and follow-up by email, telephone, or face-to-face according to patient preference. Feasibility was assessed through provider focus groups and qualitative data analysis methods. All three sites were able to implement the program. A number of themes emerged from the focus groups, including the importance of physician buy-in, wide variation in understanding and implementing of the health coach role, the significant impact of different systems of team communication, and the significant effect of organizational structure and patient readiness on Health coaches' capacity to perform their role. It is feasible to implement health coaching as an integrated program within small primary care clinics in Canada without adding additional resources into the daily practice. Practices should review their organizational and communication processes to ensure optimal support for health coaches if considering implementing this intervention.

  6. Implementation and integration of regional health care data networks in the Hellenic National Health Service.

    Science.gov (United States)

    Lampsas, Petros; Vidalis, Ioannis; Papanikolaou, Christos; Vagelatos, Aristides

    2002-12-01

    Modern health care is provided with close cooperation among many different institutions and professionals, using their specialized expertise in a common effort to deliver best-quality and, at the same time, cost-effective services. Within this context of the growing need for information exchange, the demand for realization of data networks interconnecting various health care institutions at a regional level, as well as a national level, has become a practical necessity. To present the technical solution that is under consideration for implementing and interconnecting regional health care data networks in the Hellenic National Health System. The most critical requirements for deploying such a regional health care data network were identified as: fast implementation, security, quality of service, availability, performance, and technical support. The solution proposed is the use of proper virtual private network technologies for implementing functionally-interconnected regional health care data networks. The regional health care data network is considered to be a critical infrastructure for further development and penetration of information and communication technologies in the Hellenic National Health System. Therefore, a technical approach was planned, in order to have a fast cost-effective implementation, conforming to certain specifications.

  7. Organizing integrated care in a university hospital: application of a conceptual framework

    Directory of Open Access Journals (Sweden)

    Runo Axelsson

    2014-06-01

    Full Text Available Background and aim: As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals.Theory and methods: The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews.Results: The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location.Conclusions: It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

  8. Organizing integrated care in a university hospital: application of a conceptual framework

    Directory of Open Access Journals (Sweden)

    Runo Axelsson

    2014-06-01

    Full Text Available Background and aim: As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods: The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results: The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions: It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

  9. Organizing integrated care in a university hospital: application of a conceptual framework

    Science.gov (United States)

    Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

    2014-01-01

    Background and aim As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care. PMID:24966806

  10. Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations.

    Science.gov (United States)

    Kiima, David; Jenkins, Rachel

    2010-06-28

    Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco

  11. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

    Science.gov (United States)

    Spoorenberg, Sophie L W; Wynia, Klaske; Fokkens, Andrea S; Slotman, Karin; Kremer, Hubertus P H; Reijneveld, Sijmen A

    2015-01-01

    Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2) Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  12. The integration of occupational therapy into primary care: a multiple case study design

    Science.gov (United States)

    2013-01-01

    Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group

  13. “Partners rather than just providers…”: A qualitative study on health care professionals’ views on implementation of multidisciplinary group meetings in the North West London Integrated Care Pilot

    Directory of Open Access Journals (Sweden)

    Angelos P Kassianos

    2015-09-01

    Full Text Available Introduction: Multidisciplinary group meetings are one of the key drivers of facilitating integrated care. Health care professionals attending such groups have a key role in the success of these discussions and hence, in the forming of multi-professional integrated care. The study aimed to explore the professionals’ experiences and views of participating and implementing the groups in integrated care context. Methods: A qualitative study including 25 semi-structured interviews with professionals participating in the Northwest London Integrated Care Pilot analysed using thematic content analysis. Results: Participants mentioned a number of benefits of participating in the meetings, including shared learning and shared decision-making between different services and specialties. Yet, they perceived barriers that diminish the efficiency of the groups, such as time constraints, group dynamics and technicalities. The participants felt that the quality of discussions and facilitation could be improved, as well as technical arrangements that would make them easier to participate. Most of the participants perceived the groups to be beneficial for providers mostly questioning the benefits for patient care. Conclusion: Findings provide an insight into how health professionals’ views of their participation to the multidisciplinary group meetings can be more effectively translated into more tangible benefits to the patients. To benefit patient care, the multidisciplinary groups need to be more patient-oriented rather than provider-oriented, while overcoming professional boundaries for participating.

  14. Integrating mental health care into residential homes for the elderly: an analysis of six Dutch programs for older people with severe and persistent mental illness

    NARCIS (Netherlands)

    Depla, Marja F. I. A.; Pols, Jeannette; de Lange, Jacomine; Smits, Carolien H. M.; de Graaf, Ron; Heeren, Thea J.

    2003-01-01

    Integrating mental health care into residential homes for the elderly is a potentially effective model to address the complex care needs of older chronically mentally ill people. Because no research was available on the implementation of such integrated care in practice, six programs already

  15. Experiences of technology integration in home care nursing.

    Science.gov (United States)

    Johnson, K A; Valdez, R S; Casper, G R; Kossman, S P; Carayon, P; Or, C K L; Burke, L J; Brennan, P F

    2008-11-06

    The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients.

  16. Integrated Payment And Delivery Models Offer Opportunities And Challenges For Residential Care Facilities.

    Science.gov (United States)

    Grabowski, David C; Caudry, Daryl J; Dean, Katie M; Stevenson, David G

    2015-10-01

    Under health care reform, new financing and delivery models are being piloted to integrate health and long-term care services for older adults. Programs using these models generally have not included residential care facilities. Instead, most of them have focused on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with matched individuals in the community and nursing home, and rates of functional dependency that fall between those of their counterparts in the other two settings. These results suggest that the residential care facility population could benefit greatly from models that coordinated health and long-term care services. However, few providers have invested in the infrastructure needed to support integrated delivery models. Challenges to greater care integration include the private-pay basis for residential care facility services, which precludes shared savings from reduced Medicare costs, and residents' preference for living in a home-like, noninstitutional environment. Project HOPE—The People-to-People Health Foundation, Inc.

  17. The dynamics and limits of corporate growth in health care.

    Science.gov (United States)

    Robinson, J C

    1996-01-01

    This paper analyzes the economic dynamics of five forms of organizational growth in health care: horizontal integration within a single geographic market; horizontal integration across different geographic markets; diversification among multiple products and types of service; diversification among multiple distribution channels; and vertical integration with suppliers. These principles are illustrated through brief case studies of three firms that have grown by way of internal expansion, mergers, acquisitions, and diversification: WellPoint Health Networks, UniHealth America, and Mullikin Medical Enterprises. The paper analyzes the potential limits of organizational growth in health care and explores the implications of integration and diversification for antitrust policy.

  18. Future trends in health and health care: implications for social work practice in an aging society.

    Science.gov (United States)

    Spitzer, William J; Davidson, Kay W

    2013-01-01

    Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.

  19. Coordination of care in the Chinese health care systems: a gap analysis of service delivery from a provider perspective.

    Science.gov (United States)

    Wang, Xin; Birch, Stephen; Zhu, Weiming; Ma, Huifen; Embrett, Mark; Meng, Qingyue

    2016-10-12

    Increases in health care utilization and costs, resulting from the rising prevalence of chronic conditions related to the aging population, is exacerbated by a high level of fragmentation that characterizes health care systems in China. There have been several pilot studies in China, aimed at system-level care coordination and its impact on the full integration of health care system, but little is known about their practical effects. Huangzhong County is one of the pilot study sites that introduced organizational integration (a dimension of integrated care) among health care institutions as a means to improve system-level care coordination. The purposes of this study are to examine the effect of organizational integration on system-level care coordination and to identify factors influencing care coordination and hence full integration of county health care systems in rural China. We chose Huangzhong and Hualong counties in Qinghai province as study sites, with only Huangzhong having implemented organizational integration. A mixed methods approach was used based on (1) document analysis and expert consultation to develop Best Practice intervention packages; (2) doctor questionnaires, identifying care coordination from the perspective of service provision. We measured service provision with gap index, overlap index and over-provision index, by comparing observed performance with Best Practice; (3) semi-structured interviews with Chiefs of Medicine in each institution to identify barriers to system-level care coordination. Twenty-nine institutions (11 at county-level, 6 at township-level and 12 at village-level) were selected producing surveys with a total of 19 schizophrenia doctors, 23 diabetes doctors and 29 Chiefs of Medicine. There were more care discontinuities for both diabetes and schizophrenia in Huangzhong than in Hualong. Overall, all three index scores (measuring service gaps, overlaps and over-provision) showed similar tendencies for the two conditions

  20. Integrated HIV-Care Into Primary Health Care Clinics and the Influence on Diabetes and Hypertension Care: An Interrupted Time Series Analysis in Free State, South Africa Over 4 Years.

    Science.gov (United States)

    Rawat, Angeli; Uebel, Kerry; Moore, David; Yassi, Annalee

    2018-04-15

    Noncommunicable diseases (NCDs), specifically diabetes and hypertension, are rising in high HIV-burdened countries such as South Africa. How integrated HIV care into primary health care (PHC) influences NCD care is unknown. We aimed to understand whether differences existed in NCD care (pre- versus post-integration) and how changes may relate to HIV patient numbers. Public sector PHC clinics in Free State, South Africa. Using a quasiexperimental design, we analyzed monthly administrative data on 4 indicators for diabetes and hypertension (clinic and population levels) during 4 years as HIV integration was implemented in PHC. Data represented 131 PHC clinics with a catchment population of 1.5 million. We used interrupted time series analysis at ±18 and ±30 months from HIV integration in each clinic to identify changes in trends postintegration compared with those in preintegration. We used linear mixed-effect models to study relationships between HIV and NCD indicators. Patients receiving antiretroviral therapy in the 131 PHC clinics studied increased from 1614 (April 2009) to 57, 958 (April 2013). Trends in new diabetes patients on treatment remained unchanged. However, population-level new hypertensives on treatment decreased at ±30 months from integration by 6/100, 000 (SE = 3, P < 0.02) and was associated with the number of new patients with HIV on treatment at the clinics. Our findings suggest that during the implementation of integrated HIV care into PHC clinics, care for hypertensive patients could be compromised. Further research is needed to understand determinants of NCD care in South Africa and other high HIV-burdened settings to ensure patient-centered PHC.

  1. Measuring integrated care

    DEFF Research Database (Denmark)

    Strandberg-Larsen, Martin

    2011-01-01

    respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser...... differences were found in the perception of clinical integration in the two settings. More primary care clinicians in the Northern California region of Kaiser Permanente reported being part of a clinical integrated environment than did Danish general practitioners. By measuring the level of clinical...... and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine...

  2. Building multidisciplinary health workforce capacity to support the implementation of integrated, people-centred Models of Care for musculoskeletal health.

    Science.gov (United States)

    Chehade, M J; Gill, T K; Kopansky-Giles, D; Schuwirth, L; Karnon, J; McLiesh, P; Alleyne, J; Woolf, A D

    2016-06-01

    To address the burden of musculoskeletal (MSK) conditions, a competent health workforce is required to support the implementation of MSK models of care. Funding is required to create employment positions with resources for service delivery and training a fit-for-purpose workforce. Training should be aligned to define "entrustable professional activities", and include collaborative skills appropriate to integrated and people-centred care and supported by shared education resources. Greater emphasis on educating MSK healthcare workers as effective trainers of peers, students and patients is required. For quality, efficiency and sustainability of service delivery, education and research capabilities must be integrated across disciplines and within the workforce, with funding models developed based on measured performance indicators from all three domains. Greater awareness of the societal and economic burden of MSK conditions is required to ensure that solutions are prioritised and integrated within healthcare policies from local to regional to international levels. These healthcare policies require consumer engagement and alignment to social, economic, educational and infrastructure policies to optimise effectiveness and efficiency of implementation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Communities as co-producers in integrated care

    Directory of Open Access Journals (Sweden)

    Henk Nies

    2014-06-01

    Full Text Available Integrated care has become too much a professionals' concept, in research and theory development, as well as in practice, especially in high-income countries. The current debate on integrated care is dominated by norms and values of professionals, while most of the care is provided by non-professionals. The paradigms of integrated care for people with complex needs need to be reconsidered. It is argued that non-professional care and care by local communities need to be incorporated as a resource and a co-producer of care. It seems fair to assume that the community as such can take a more prominent role in organising and delivering health and long-term care. This implies redefining professional and non-professional responsibilities and boundaries. The boundary between public and private space is losing its significance, as is the distinction between formal and non-formal care. It also requires renegotiating and transforming organisational boundaries. This has consequences for legislation, funding and professional qualifications, as well as for management and governance. It challenges current professional identities as well as identities of service users, their informal carers and citizens. It may also require new types of funding, including non-monetary currencies, time-sharing and social impact bonds. The challenge is that big, that it needs to be addressed at its smallest scale: the citizen in his social network and local community, being co-producer of really integrated care

  4. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

    Science.gov (United States)

    Lake, James; Turner, Mason Spain

    2017-01-01

    Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. PMID:28898197

  5. Integration of evidence-based and experience-based design: contributions from a study in a health care service

    Directory of Open Access Journals (Sweden)

    Mirela S. da Rosa

    2015-06-01

    Full Text Available The purpose this paper is to present an integrated study of Service Design and the Mechanism of the Production Function (MPF for redesigning the health care services to improve the perceived value of the patient and increase the productivity of hospital operations by eliminating wastes. The method used was action research and applied in an ICU of a private hospital in southern Brazil. The techniques of participant observation, interviews, archival research and meetings co-creation with a team of the hospital were used to collect data. Data were analyzed through content analysis of the interviews and the Design Service and Production Engineering tools. Evidence based approaches tends to contribute to the replication of the project outcomes in future cases. The MPF can support project development in the field of Design, as well the integrated approach developed in the healthcare sector, helped to devote more time to the phases of diagnosis and implementation. The findings are useful to demonstrate that can use simultaneously approaches the Service Design and MPF for the development of more robust solutions in health care environment. Further research could be done in other private or public hospitals as well as in other hospital units besides the ICUs. Limitations include the work done in a single hospital and service unit, data collected from a small group of people in the hospital. Integrating Evidence-Based Design, Experience-Based Design and the MPF can produce a more robust way to justify and define the focus of improvements in health care services.

  6. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    NARCIS (Netherlands)

    Bousquet, J.; Addis, A.; Adcock, I.; Agache, I.; Agusti, A.; Alonso, A.; Annesi-Maesano, I.; Anto, J. M.; Bachert, C.; Baena-Cagnani, C. E.; Bai, C.; Baigenzhin, A.; Barbara, C.; Barnes, P. J.; Bateman, E. D.; Beck, L.; Bedbrook, A.; Bel, E. H.; Benezet, O.; Bennoor, K. S.; Benson, M.; Bernabeu-Wittel, M.; Bewick, M.; Bindslev-Jensen, C.; Blain, H.; Blasi, F.; Bonini, M.; Bonini, S.; Boulet, L. P.; Bourdin, A.; Bourret, R.; Bousquet, P. J.; Brightling, C. E.; Briggs, A.; Brozek, J.; Buhl, R.; Bush, A.; Caimmi, D.; Calderon, M.; Calverley, P.; Camargos, P. A.; Camuzat, T.; Canonica, G. W.; Carlsen, K. H.; Casale, T. B.; Cazzola, M.; Cepeda Sarabia, A. M.; Cesario, A.; Chen, Y. Z.; Chkhartishvili, E.; Chavannes, N. H.; Chiron, R.; Chuchalin, A.; Chung, K. F.; Cox, L.; Crooks, G.; Crooks, M. G.; Cruz, A. A.; Custovic, A.; Dahl, R.; Dahlen, S. E.; de Blay, F.; Dedeu, T.; Deleanu, D.; Demoly, P.; Devillier, P.; Didier, A.; Dinh-Xuan, A. T.; Djukanovic, R.; Dokic, D.; Douagui, H.; Dubakiene, R.; Eglin, S.; Elliot, F.; Emuzyte, R.; Fabbri, L.; Fink Wagner, A.; Fletcher, M.; Fokkens, W. J.; Fonseca, J.; Franco, A.; Frith, P.; Furber, A.; Gaga, M.; Garcés, J.; Garcia-Aymerich, J.; Gamkrelidze, A.; Gonzales-Diaz, S.; Gouzi, F.; Guzmán, M. A.; Haahtela, T.; Harrison, D.; Hayot, M.; Heaney, L. G.; Heinrich, J.; Hellings, P. W.; Hooper, J.; Humbert, M.; Hyland, M.; Iaccarino, G.; Jakovenko, D.; Jardim, J. R.; Jeandel, C.; Jenkins, C.; Johnston, S. L.; Jonquet, O.; Joos, G.; Jung, K. S.; Kalayci, O.; Karunanithi, S.; Keil, T.; Khaltaev, N.; Kolek, V.; Kowalski, M. L.; Kull, I.; Kuna, P.; Kvedariene, V.; Le, L. T.; Lodrup Carlsen, K. C.; Louis, R.; MacNee, W.; Mair, A.; Majer, I.; Manning, P.; de Manuel Keenoy, E.; Masjedi, M. R.; Melen, E.; Melo-Gomes, E.; Menzies-Gow, A.; Mercier, G.; Mercier, J.; Michel, J. P.; Miculinic, N.; Mihaltan, F.; Milenkovic, B.; Molimard, M.; Momas, I.; Montilla-Santana, A.; Morais-Almeida, M.; Morgan, M.; N'Diaye, M.; Nafti, S.; Nekam, K.; Neou, A.; Nicod, L.; O'Hehir, R.; Ohta, K.; Paggiaro, P.; Palkonen, S.; Palmer, S.; Papadopoulos, N. G.; Papi, A.; Passalacqua, G.; Pavord, I.; Pigearias, B.; Plavec, D.; Postma, D. S.; Price, D.; Rabe, K. F.; Radier Pontal, F.; Redon, J.; Rennard, S.; Roberts, J.; Robine, J. M.; Roca, J.; Roche, N.; Rodenas, F.; Roggeri, A.; Rolland, C.; Rosado-Pinto, J.; Ryan, D.; Samolinski, B.; Sanchez-Borges, M.; Schünemann, H. J.; Sheikh, A.; Shields, M.; Siafakas, N.; Sibille, Y.; Similowski, T.; Small, I.; Sola-Morales, O.; Sooronbaev, T.; Stelmach, R.; Sterk, P. J.; Stiris, T.; Sud, P.; Tellier, V.; To, T.; Todo-Bom, A.; Triggiani, M.; Valenta, R.; Valero, A. L.; Valiulis, A.; Valovirta, E.; van Ganse, E.; Vandenplas, O.; Vasankari, T.; Vestbo, J.; Vezzani, G.; Viegi, G.; Visier, L.; Vogelmeier, C.; Vontetsianos, T.; Wagstaff, R.; Wahn, U.; Wallaert, B.; Whalley, B.; Wickman, M.; Williams, D. M.; Wilson, N.; Yawn, B. P.; Yiallouros, P. K.; Yorgancioglu, A.; Yusuf, O. M.; Zar, H. J.; Zhong, N.; Zidarn, M.; Zuberbier, T.

    2014-01-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will

  7. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    NARCIS (Netherlands)

    Bousquet, J.; Addis, A.; Adcock, I.; Agache, I.; Agusti, A.; Alonso, A.; Annesi-Maesano, I.; Anto, J. M.; Bachert, C.; Baena-Cagnani, C. E.; Bai, C.; Baigenzhin, A.; Barbara, C.; Barnes, P. J.; Bateman, E. D.; Beck, L.; Bedbrook, A.; Bel, E. H.; Benezet, O.; Bennoor, K. S.; Benson, M.; Bernabeu-Wittel, M.; Bewick, M.; Bindslev-Jensen, C.; Blain, H.; Blasi, F.; Bonini, M.; Bonini, S.; Boulet, L. P.; Bourdin, A.; Bourret, R.; Bousquet, P. J.; Brightling, C. E.; Briggs, A.; Brozek, J.; Buh, R.; Bush, A.; Caimmi, D.; Calderon, M.; Calverley, P.; Camargos, P. A.; Camuzat, T.; Canonica, G. W.; Carlsen, K. H.; Casale, T. B.; Cazzola, M.; Sarabia, A. M. Cepeda; Cesario, A.; Chen, Y. Z.; Chkhartishvili, E.; Chavannes, N. H.; Chiron, R.; Chuchalin, A.; Chung, K. F.; Cox, L.; Crooks, G.; Crooks, M. G.; Cruz, A. A.; Custovic, A.; Dahl, R.; Dahlen, S. E.; De Blay, F.; Dedeu, T.; Deleanu, D.; Demoly, P.; Devillier, P.; Didier, A.; Dinh-Xuan, A. T.; Djukanovic, R.; Dokic, D.; Douagui, H.; Dubakiene, R.; Eglin, S.; Elliot, F.; Emuzyte, R.; Fabbri, L.; Wagner, A. Fink; Fletcher, M.; Fokkens, W. J.; Fonseca, J.; Franco, A.; Frith, P.; Furber, A.; Gaga, M.; Garces, J.; Garcia-Aymerich, J.; Gamkrelidze, A.; Gonzales-Diaz, S.; Gouzi, F.; Guzman, M. A.; Haahtela, T.; Harrison, D.; Hayot, M.; Heaney, L. G.; Heinrich, J.; Hellings, P. W.; Hooper, J.; Humbert, M.; Hyland, M.; Iaccarino, G.; Jakovenko, D.; Jardim, J. R.; Jeandel, C.; Jenkins, C.; Johnston, S. L.; Jonquet, O.; Joos, G.; Jung, K. S.; Kalayci, O.; Karunanithi, S.; Keil, T.; Khaltaev, N.; Kolek, V.; Kowalski, M. L.; Kull, I.; Kuna, P.; Kvedariene, V.; Le, L. T.; Carlsen, K. C. Lodrup; Louis, R.; MacNee, W.; Mair, A.; Majer, I.; Manning, P.; Keenoy, E. de Manuel; Masjedi, M. R.; Meten, E.; Melo-Gomes, E.; Menzies-Gow, A.; Mercier, G.; Mercier, J.; Michel, J. P.; Miculinic, N.; Mihaltan, F.; Milenkovic, B.; Molimard, M.; Mamas, I.; Montilla-Santana, A.; Morais-Almeida, M.; Morgan, M.; N'Diaye, M.; Nafti, S.; Nekam, K.; Neou, A.; Nicod, L.; O'Hehir, R.; Ohta, K.; Paggiaro, P.; Palkonen, S.; Palmer, S.; Papadopoulos, N. G.; Papi, A.; Passalacqua, G.; Pavord, I.; Pigearias, B.; Plavec, D.; Postma, D. S.; Price, D.; Rabe, K. F.; Pontal, F. Radier; Redon, J.; Rennard, S.; Roberts, J.; Robine, J. M.; Roca, J.; Roche, N.; Rodenas, F.; Roggeri, A.; Rolland, C.; Rosado-Pinto, J.; Ryan, D.; Samolinski, B.; Sanchez-Borges, M.; Schunemann, H. J.; Sheikh, A.; Shields, M.; Siafakas, N.; Sibille, Y.; Similowski, T.; Small, I.; Sola-Morales, O.; Sooronbaev, T.; Stelmach, R.; Sterk, P. J.; Stiris, T.; Sud, P.; Tellier, V.; To, T.; Todo-Bom, A.; Triggiani, M.; Valenta, R.; Valero, A. L.; Valiulis, A.; Valovirta, E.; Van Ganse, E.; Vandenplas, O.; Vasankari, T.; Vestbo, J.; Vezzani, G.; Viegi, G.; Visier, L.; Vogelmeier, C.; Vontetsianos, T.; Wagstaff, R.; Wahn, U.; Wallaert, B.; Whalley, B.; Wickman, M.; Williams, D. M.; Wilson, N.; Yawn, B. P.; Yiallouros, P. K.; Yorgancioglu, A.; Yusuf, O. M.; Zar, H. J.; Zhong, N.; Zidarn, M.; Zuberbier, T.

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will

  8. Integrating a Suicide Prevention Program into the Primary Health Care Network: A Field Trial Study in Iran

    Directory of Open Access Journals (Sweden)

    Seyed Kazem Malakouti

    2015-01-01

    Full Text Available Objective. To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. Methodology. This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. Results. We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ2=14.8, P<0.001. We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. Conclusion. Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas.

  9. Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

    Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector. Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy. Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

  10. Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

    Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector.Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy.Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

  11. Integrated care reform in urban China: a qualitative study on design, supporting environment and implementation.

    Science.gov (United States)

    Qian, Yi; Hou, Zhiyuan; Wang, Wei; Zhang, Donglan; Yan, Fei

    2017-10-25

    Initiatives on integrated care between hospitals and community health centers (CHCs) have been introduced to transform the current fragmented health care delivery system into an integrated system in China. Up to date no research has analyzed in-depth the experiences of these initiatives based on perspectives from various stakeholders. This study analyzed the integrated care pilot in Hangzhou City by investigating stakeholders' perspectives on its design features and supporting environment, their acceptability of this pilot, and further identifying the enabling and constraining factors that may influence the implementation of the integrated care reform. The qualitative study was carried out based on in-depth interviews and focus group discussions with 50 key informants who were involved in the policy-making process and implementation. Relevant policy documents were also collected for analysis. The pilot in Hangzhou was established as a CHC-led delivery system based on cooperation agreement between CHCs and hospitals to deliver primary and specialty care together for patients with chronic diseases. An innovative learning-from-practice mentorship system between specialists and general practitioners was also introduced to solve the poor capacity of general practitioners. The design of the pilot, its governance and organizational structure and human resources were enabling factors, which facilitated the integrated care reform. However, the main constraining factors were a lack of an integrated payment mechanism from health insurance and a lack of tailored information system to ensure its sustainability. The integrated care pilot in Hangzhou enabled CHCs to play as gate-keeper and care coordinator for the full continuum of services across the health care providers. The government put integrated care a priority, and constructed an efficient design, governance and organizational structure to enable its implementation. Health insurance should play a proactive role, and

  12. The Impact of Grid on Health Care Digital Repositories

    CERN Document Server

    Donno, Flavia; CERN. Geneva. IT Department

    2008-01-01

    Grid computing has attracted worldwide attention in a variety of applications like Health Care. In this paper we identified the Grid services that could facilitate the integration and interoperation of Health Care data and frameworks world-wide. While many of the current Health Care Grid projects address issues such as data location and description on the Grid and the security aspects, the problems connected to data storage, integrity, preservation and distribution have been neglected. We describe the currently available Grid storage services and protocols that can come in handy when dealing with those problems. We further describe a Grid infrastructure to build a cooperative Health Care environment based on currently available Grid services and a service able to validate it.

  13. Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs.

    Science.gov (United States)

    Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth

    2012-04-01

    To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide.

  14. Vertical integration and diversification of acute care hospitals: conceptual definitions.

    Science.gov (United States)

    Clement, J P

    1988-01-01

    The terms vertical integration and diversification, although used quite frequently, are ill-defined for use in the health care field. In this article, the concepts are defined--specifically for nonuniversity acute care hospitals. The resulting definitions are more useful than previous ones for predicting the effects of vertical integration and diversification.

  15. Simulation modeling for the health care manager.

    Science.gov (United States)

    Kennedy, Michael H

    2009-01-01

    This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

  16. Integrating complementary and alternative medicine into cancer care: Canadian oncology nurses′ perspectives

    Directory of Open Access Journals (Sweden)

    Tracy L Truant

    2015-01-01

    Full Text Available The integration of complementary and alternative medicine (CAM and conventional cancer care in Canada is in its nascent stages. While most patients use CAM during their cancer experience, the majority does not receive adequate support from their oncology health care professionals (HCPs to integrate CAM safely and effectively into their treatment and care. A variety of factors influence this lack of integration in Canada, such as health care professional(HCP education and attitudes about CAM; variable licensure, credentialing of CAM practitioners, and reimbursement issues across the country; an emerging CAM evidence base; and models of cancer care that privilege diseased-focused care at the expense of whole person care. Oncology nurses are optimally aligned to be leaders in the integration of CAM into cancer care in Canada. Beyond the respect afforded to oncology nurses by patients and family members that support them in broaching the topic of CAM, policies, and position statements exist that allow oncology nurses to include CAM as part of their scope. Oncology nurses have also taken on leadership roles in clinical innovation, research, education, and advocacy that are integral to the safe and informed integration of evidence-based CAM therapies into cancer care settings in Canada.

  17. Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs.

    Science.gov (United States)

    Ssonko, Charles; Gonzalez, Lucia; Mesic, Anita; da Fonseca, Marcio Silveira; Achar, Jay; Safar, Nadia; Martin, Beatriz; Wong, Sidney; Casas, Esther C

    2017-07-21

    Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076-16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12-255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and

  18. Neuroeconomics and Integrated Care

    DEFF Research Database (Denmark)

    Larsen, Torben

    2012-01-01

    Background: Fragmented specialized care for the frail elderly as claimed by WHO needs horizontal integration across settings. The home of the patient seems to be a promising place to integrate hospital care, primary care and social services for high-risk discharges where the quality...... of rehabilitation makes a difference. Objective: The study aims to reveal how integrated home care may be organised to improve quality of care as compared to usual hospital care. Method: A qualitative case study of the use of a neuroeconomic model in relation to multidisciplianry collaboration on a RCT...... of integrated home care for stroke patients. Results: (1) The classical understanding of CNS is that of a dual system of ANS and Cortex. The new neuroeconomic understanding is that of a reciprocal balance of Limbic System (LS) and Neocortex (NC). This applies directly in favour of integrated homecare compared...

  19. Could local integration of health and social care finally overcome the pull to the centre?

    Science.gov (United States)

    Dixon, Anna

    2018-04-25

    There are several advantages of Bevan's design, such as progressive funding through taxation and equity of access regardless of income, that we must not lose sight of as we celebrate the NHS's (National Health Service) 70th birthday. However, there remain historical fault-lines dividing health and social care. The challenge is how to preserve equity if a more radical reform were implemented to fully integrate both the funding and delivery of health and social care. Funding from national taxation with defined entitlements could preserve both equity in funding and geographical equity. This does not solve the issue of the pull to the centre, which has been a feature of the NHS throughout its history, according to Klein. This will require a fundamental shift in the use of data. Data must be wrenched from the hands of the regulators and put back in the hands of those who generate them for the purposes of improvement.

  20. Instruments Measuring Integrated Care: A Systematic Review of Measurement Properties.

    Science.gov (United States)

    Bautista, Mary Ann C; Nurjono, Milawaty; Lim, Yee Wei; Dessers, Ezra; Vrijhoef, Hubertus Jm

    2016-12-01

    Policy Points: Investigations on systematic methodologies for measuring integrated care should coincide with the growing interest in this field of research. A systematic review of instruments provides insights into integrated care measurement, including setting the research agenda for validating available instruments and informing the decision to develop new ones. This study is the first systematic review of instruments measuring integrated care with an evidence synthesis of the measurement properties. We found 209 index instruments measuring different constructs related to integrated care; the strength of evidence on the adequacy of the majority of their measurement properties remained largely unassessed. Integrated care is an important strategy for increasing health system performance. Despite its growing significance, detailed evidence on the measurement properties of integrated care instruments remains vague and limited. Our systematic review aims to provide evidence on the state of the art in measuring integrated care. Our comprehensive systematic review framework builds on the Rainbow Model for Integrated Care (RMIC). We searched MEDLINE/PubMed for published articles on the measurement properties of instruments measuring integrated care and identified eligible articles using a standard set of selection criteria. We assessed the methodological quality of every validation study reported using the COSMIN checklist and extracted data on study and instrument characteristics. We also evaluated the measurement properties of each examined instrument per validation study and provided a best evidence synthesis on the adequacy of measurement properties of the index instruments. From the 300 eligible articles, we assessed the methodological quality of 379 validation studies from which we identified 209 index instruments measuring integrated care constructs. The majority of studies reported on instruments measuring constructs related to care integration (33%) and patient

  1. Instruments Measuring Integrated Care: A Systematic Review of Measurement Properties

    Science.gov (United States)

    BAUTISTA, MARY ANN C.; NURJONO, MILAWATY; DESSERS, EZRA; VRIJHOEF, HUBERTUS JM

    2016-01-01

    Policy Points: Investigations on systematic methodologies for measuring integrated care should coincide with the growing interest in this field of research.A systematic review of instruments provides insights into integrated care measurement, including setting the research agenda for validating available instruments and informing the decision to develop new ones.This study is the first systematic review of instruments measuring integrated care with an evidence synthesis of the measurement properties.We found 209 index instruments measuring different constructs related to integrated care; the strength of evidence on the adequacy of the majority of their measurement properties remained largely unassessed. Context Integrated care is an important strategy for increasing health system performance. Despite its growing significance, detailed evidence on the measurement properties of integrated care instruments remains vague and limited. Our systematic review aims to provide evidence on the state of the art in measuring integrated care. Methods Our comprehensive systematic review framework builds on the Rainbow Model for Integrated Care (RMIC). We searched MEDLINE/PubMed for published articles on the measurement properties of instruments measuring integrated care and identified eligible articles using a standard set of selection criteria. We assessed the methodological quality of every validation study reported using the COSMIN checklist and extracted data on study and instrument characteristics. We also evaluated the measurement properties of each examined instrument per validation study and provided a best evidence synthesis on the adequacy of measurement properties of the index instruments. Findings From the 300 eligible articles, we assessed the methodological quality of 379 validation studies from which we identified 209 index instruments measuring integrated care constructs. The majority of studies reported on instruments measuring constructs related to care

  2. Proposals for enhanced health risk assessment and stratification in an integrated care scenario

    Science.gov (United States)

    Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep

    2016-01-01

    Objectives Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. Settings The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Participants Responsible teams for regional data management in the five ACT regions. Primary and secondary outcome measures We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. Results There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. Conclusions The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches

  3. Bringing Wellness to Schools: Opportunities for and Challenges to Mental Health Integration in School-Based Health Centers.

    Science.gov (United States)

    Lai, Karen; Guo, Sisi; Ijadi-Maghsoodi, Roya; Puffer, Maryjane; Kataoka, Sheryl H

    2016-12-01

    School-based health centers (SBHCs) reduce access barriers to mental health care and improve educational outcomes for youths. This qualitative study evaluated the innovations and challenges of a unique network of SBHCs in a large, urban school district as the centers attempted to integrate health, mental health, and educational services. The 43 participants sampled included mental health providers, primary care providers, and care coordinators at 14 SBHCs. Semistructured interviews with each participant were audio recorded and transcribed. Themes were identified and coded by using Atlas.ti 5.1 and collapsed into three domains: operations, partnership, and engagement. Interviews revealed provider models ranging from single agencies offering both primary care and mental health services to colocated services. Sites where the health agency provided at least some mental health services reported more mental health screenings. Many sites used SBHC wellness coordinators and coordination team meetings to facilitate relationships between schools and health agency and community mental health clinic providers. Partnership challenges included confidentiality policies and staff turnover. Participants also highlighted student and parent engagement through culturally sensitive services, peer health advocates, and "drop-in" lunches. Staffing and operational models are critical in the success of integrating primary care, mental health care, and education. Among the provider models observed, the combined primary care and mental health provider model offered the most integrated services. Despite barriers, providers and schools have begun to implement novel solutions to operational problems and family engagement in mental health services.

  4. Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

    Science.gov (United States)

    McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

    2018-01-01

    Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

  5. Channel leadership in health care marketing: a natural role for hospitals.

    Science.gov (United States)

    Fugate, D L; Decker, P J

    1990-01-01

    Health care has entered an era of rapid change. Most observers agree that important long-term changes will fundamentally reshape health care as we know it. To that end, health care providers should consider the benefits of operating vertically integrated marketing system with hospitals as the channel leader. Whether an administered VMS (hospitals have the power to gain compliance) or a corporate VMS (hospitals own successive levels of care providers), integrated channel management holds the promise of cost containment and quality patient care for the future. However, a great deal of integrating work must be done before VMSs will become a practical solution. Research studies are needed on each of the issues just discussed. As marketers, it is time we make a transition from treating health care marketing as a disjointed entity and instead treat it as an industry where all marketing principles are considered including channel management.

  6. Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations

    Directory of Open Access Journals (Sweden)

    Jenkins Rachel

    2010-06-01

    Full Text Available Abstract Background Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. Results The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines

  7. A Policy Guide on Integrated Care (PGIC: Lessons Learned from EU Project INTEGRATE and Beyond

    Directory of Open Access Journals (Sweden)

    Liesbeth Borgermans

    2017-09-01

    Full Text Available Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012–2016 and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

  8. A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond.

    Science.gov (United States)

    Borgermans, Liesbeth; Devroey, Dirk

    2017-09-25

    Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012-2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

  9. Social care informatics as an essential part of holistic health care: a call for action.

    Science.gov (United States)

    Rigby, Michael; Hill, Penny; Koch, Sabine; Keeling, Debbie

    2011-08-01

    The authors identified the need for a cross-disciplinary research view of issues to ensure an integrated citizen-centric support to achieve optimal health of individual citizens and, in particular, the role of informatics to inform and coordinate support towards integrated and holistic care. An Exploratory Workshop was approved and sponsored by the European Science Foundation. Twenty-three participants from 15 countries attended, covering a full range of health, social care and informatics professions and disciplines. The participants found strong common ground in identifying key issues to be addressed if citizens with compromised health are to receive integrated and coordinated support to a common set of objectives, while also ensuring appropriate choice and support for citizen, family and other informal carers. At the same time, optimal health was identified as a fundamental human right, and that achieving this is a necessary priority of a caring society. Moreover, Europe has a commitment to researching and developing health informatics (e-health), though not yet giving a priority to this integration of health and social care. Specifically the following main informatics challenges to be addressed were identified: (1) to identify available information and communication needs related to different scenarios of use in the intersection between health and social care, (2) to develop and map shared ontologies, and standards for integration and/or brokerage, (3) to enable planned information access and sharing, shaping a system of trust where the patient is an active partner and policies are established considering all partners/interests, (4) to investigate the use of automatic/intelligent knowledge based and context-relevant services, and (5) empowering the citizen (or their selected agent) as co-producer through modern informatics tools, while carefully avoiding selective disempowerment of the most vulnerable. The Exploratory Workshop resulted in a unanimous

  10. Health information technology: integration of clinical workflow into meaningful use of electronic health records.

    Science.gov (United States)

    Bowens, Felicia M; Frye, Patricia A; Jones, Warren A

    2010-10-01

    This article examines the role that clinical workflow plays in successful implementation and meaningful use of electronic health record (EHR) technology in ambulatory care. The benefits and barriers of implementing EHRs in ambulatory care settings are discussed. The researchers conclude that widespread adoption and meaningful use of EHR technology rely on the successful integration of health information technology (HIT) into clinical workflow. Without successful integration of HIT into clinical workflow, clinicians in today's ambulatory care settings will continue to resist adoption and implementation of EHR technology.

  11. Integrated mental health care and vocational rehabilitation to improve return to work rates for people on sick leave because of depression and anxiety (the Danish IBBIS trial)

    DEFF Research Database (Denmark)

    Poulsen, Rie; Hoff, Andreas; Fisker, Jonas

    2017-01-01

    have depression and/or anxiety. There is no clear evidence that treatment alone will provide sufficient support for vocational recovery in this group. Integrated vocational and health care services have shown good effects on return to work in other, similar welfare contexts. The purpose of the IBBIS...... (Integrated Mental Health Care and Vocational Rehabilitation to Individuals on Sick Leave Due to Anxiety and Depression) interventions is to improve and hasten the process of return to employment for people in Denmark on sick leave because of depression and anxiety. METHODS/DESIGN: This three-arm, parallel......-group, randomized superiority trial has been set up to investigate the effectiveness of the IBBIS mental health care intervention and the integrated IBBIS mental health care and IBBIS vocational rehabilitation intervention for people on sick leave because of depression and/or anxiety in Denmark. The trial has...

  12. Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review.

    Science.gov (United States)

    Sangaleti, Carine; Schveitzer, Mariana Cabral; Peduzzi, Marina; Zoboli, Elma Lourdes Campos Pavone; Soares, Cassia Baldini

    2017-11-01

    During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration have been pointed out as astrategy for effective organization of health care services as the complexity of healthcare requires integration of knowledge and practices from differente professional groups. This integration has a qualitative dimension that can be identified through the experiences of health professionals and to the meaning they give to teamwork. The objective of this systematic review was to synthesize the best available evidence on the experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. The populations included were all officially regulated health professionals that work in primary health settings: dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work and speech therapy. In addition to these professionals, community health workers, nursing assistants, licensed practical nurses and other allied health workers were also included. The phenomena of interest were experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. The context was primary health care settings that included health care centers, health maintenance organizations, integrative medicine practices, integrative health care, family practices, primary care organizations and family medical clinics. National health surgery as a setting was excluded. The qualitative component of the review considered studies that

  13. Multidisciplinary integration in the context of integrated care – results from the North West London Integrated Care Pilot

    Directory of Open Access Journals (Sweden)

    Matthew Harris

    2013-10-01

    Full Text Available Background: In the context of integrated care, Multidisciplinary Group (MDG meetings involve participants from diverse professional groups and organizations and are potential vehicles to advance efficiency improvements within the local health economy.  We advance a novel method to evaluate the effectiveness of MDGs by measuring the extent to which participants integrate within MDG meetings and whether this integration leads to improved working. Methods: We purposively selected four MDG meetings, and conducted a content analysis of audio-recorded and transcribed case discussions. Two coders independently coded utterances according to their ‘integrative intensity’ which was defined against three a priori independent domains – the Level (i.e. Individual, Collective and Systems; the Valence (Problem, Information and Solution; the Focus (Concrete and Abstract. Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discussion.  Standardized weighted mean integration scores were calculated for Case Discussions across utterance deciles, indicating how integrative intensity changed during the conversations. Results: Twenty-three Case Discussions in four different MDG groups were transcribed and coded. Inter- and intra-rater reliability was good as shown by the Prevalence and Bias Adjusted Kappa Scores for one randomly selected Case Discussion.  There were differences in the proportion of utterances per participant type (Consultant 14.6%; Presenting GP 38.75%; Chair 7.8%; Non-Presenting GP 2.25%; Allied Health Professional 4.8%. Utterances were predominantly coded at low levels of integrative intensity; however there was a gradual increase (R2=0.66 in integrative intensity during the Case Discussions.  Based on analysis of the minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving forward. Interpretation: We characterize the MDGs as

  14. Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI).

    Science.gov (United States)

    Vasan, Ashwin; Ellner, Andrew; Lawn, Stephen D; Gove, Sandy; Anatole, Manzi; Gupta, Neil; Drobac, Peter; Nicholson, Tom; Seung, Kwonjune; Mabey, David C; Farmer, Paul E

    2014-01-14

    More than three decades after the 1978 Declaration of Alma-Ata enshrined the goal of 'health for all', high-quality primary care services remain undelivered to the great majority of the world's poor. This failure to effectively reach the most vulnerable populations has been, in part, a failure to develop and implement appropriate and effective primary care delivery models. This paper examines a root cause of these failures, namely that the inability to achieve clear and practical consensus around the scope and aims of primary care may be contributing to ongoing operational inertia. The present work also examines integrated models of care as a strategy to move beyond conceptual dissonance in primary care and toward implementation. Finally, this paper examines the strengths and weaknesses of a particular model, the World Health Organization's Integrated Management of Adolescent and Adult Illness (IMAI), and its potential as a guidepost toward improving the quality of primary care delivery in poor settings. Integration and integrated care may be an important approach in establishing a new paradigm of primary care delivery, though overall, current evidence is mixed. However, a number of successful specific examples illustrate the potential for clinical and service integration to positively impact patient care in primary care settings. One example deserving of further examination is the IMAI, developed by the World Health Organization as an operational model that integrates discrete vertical interventions into a comprehensive delivery system encompassing triage and screening, basic acute and chronic disease care, basic prevention and treatment services, and follow-up and referral guidelines. IMAI is an integrated model delivered at a single point-of-care using a standard approach to each patient based on the universal patient history and physical examination. The evidence base on IMAI is currently weak, but whether or not IMAI itself ultimately proves useful in

  15. Community mental health care in India.

    Science.gov (United States)

    Padmavati, R

    2005-04-01

    Recent times are witnessing methods in the various forms of community care for the mentally ill in India. Non-governmental organizations (NGO) play a pivotal role in filling the gap in the existing mental health services in India and the substantial need for these services. Various strategies that have been employed in community care have attempted to utilize existing community resources for implementation. Informal manpower resources incorporated with specialist psychiatric care and integrated with existing health care facilities have been general strategies. While the feasibility and cost-effectiveness of the NGO operated community outreach programs for the mentally ill have been demonstrated, various factors are seen to influence the planning and execution of such programs. This paper elucidates some critical factors that would need to be considered in community mental health care in India.

  16. Health information systems to improve health care: A telemedicine case study

    Directory of Open Access Journals (Sweden)

    Liezel Cilliers

    2013-03-01

    Full Text Available Background: E-health has been identified as an integral part of the future of South African public healthcare. Telemedicine was first introduced in South Africa in 1997 and since then the cost of running the Telemedicine projects has increased substantially. Despite these efforts to introduce the system, only 34% of the Telemedicine sites in South Africa are functional at present. Objectives: Literature has suggested that one of the barriers to the successful implementation of health information systems is the user acceptance by health care workers of systems such as Telemedicine. This study investigated the user acceptance of Telemedicine in the public health care system in the Eastern Cape Province, making use of the Unified Theory of the Use and Acceptance of Technology. Method: The study employed a quantitative survey approach. A questionnaire was developed making use of existing literature and was distributed to various clinics around the province where Telemedicine has been implemented. Statistics were produced making use of Statistical Package for the Social Sciences (SPSS. Results: In general, the health care workers did understand the value and benefit of health information systems to improve the effectiveness and efficiency of the health care system. The barriers to the effective implementation of a health information system include the lack of knowledge and the lack of awareness regarding the Telemedicine system. This in turn means that the user is apprehensive when making use of the system thus contributing to less frequent usage. Conclusion: Health care workers do acknowledge that information systems can help to increase the effectiveness of the health care system. In general, the acceptance of Telemedicine in the Eastern Cape Department of Health is positive, but in order to integrate it into standard work practices, more must be done with regards to the promotion and education of telemedicine.

  17. Integrating the Fundamentals of Care framework in baccalaureate nursing education

    DEFF Research Database (Denmark)

    Voldbjerg, Siri; Laugesen, Britt; Bahnsen, Iben Bøgh

    2018-01-01

    AIM AND OBJECTIVES: To describe and discuss the process of integrating the Fundamentals of Care framework in a baccalaureate nursing education at a School of Nursing in Denmark. BACKGROUND: Nursing education plays an essential role in educating nurses to work within health care systems in which...... Fundamentals of Care framework has been integrated in nursing education at a School of Nursing in Denmark. DESIGN AND METHODS: Discursive paper using an adjusted descriptive case study design for describing and discussing the process of integrating the conceptual Fundamentals of Care Framework in nursing...... education. RESULTS: The process of integrating the Fundamentals of Care framework is illuminated through a description of the context, in which the process occurs including the faculty members, lectures, case-based work and simulation lab in nursing education. Based on this description, opportunities...

  18. Exploring Integration of Care for Children Living with Complex Care Needs across the European Union and European Economic Area.

    Science.gov (United States)

    Brenner, Maria; O'Shea, Miriam; J Larkin, Philip; Kamionka, Stine Lundstroem; Berry, Jay; Hiscock, Harriet; Rigby, Michael; Blair, Mitch

    2017-04-24

    The aim of this paper is to report on the development of surveys to explore integration of care for children living with complex care needs across the European Union (EU) and European Economic Area (EEA). Each survey consists of a vignette and questions adapted from the Standards for Systems of Care for Children and Youth with Special Health Care Needs and the Eurobarometer Survey . A Country Agent in each country, a local expert in child health services, will obtain data from indigenous sources. We identified 'in-principle' complex problems and adapted surveys to capture care integration. We expect to get rich data to understand perceptions and to inform actions for a number of complex health issues. The study has the potential to make a wide contribution to individual countries of the EU/EEA to understand their own integration of services mapped against responses from other member states. Early results are expected in Spring 2017.

  19. Integration of oncology and palliative care: setting a benchmark.

    Science.gov (United States)

    Vayne-Bossert, P; Richard, E; Good, P; Sullivan, K; Hardy, J R

    2017-10-01

    Integration of oncology and palliative care (PC) should be the standard model of care for patients with advanced cancer. An expert panel developed criteria that constitute integration. This study determined whether the PC service within this Health Service, which is considered to be fully "integrated", could be benchmarked against these criteria. A survey was undertaken to determine the perceived level of integration of oncology and palliative care by all health care professionals (HCPs) within our cancer centre. An objective determination of integration was obtained from chart reviews of deceased patients. Integration was defined as >70% of all respondents answered "agree" or "strongly agree" to each indicator and >70% of patient charts supported each criteria. Thirty-four HCPs participated in the survey (response rate 69%). Over 90% were aware of the outpatient PC clinic, interdisciplinary and consultation team, PC senior leadership, and the acceptance of concurrent anticancer therapy. None of the other criteria met the 70% agreement mark but many respondents lacked the necessary knowledge to respond. The chart review included 67 patients, 92% of whom were seen by the PC team prior to death. The median time from referral to death was 103 days (range 0-1347). The level of agreement across all criteria was below our predefined definition of integration. The integration criteria relating to service delivery are medically focused and do not lend themselves to interdisciplinary review. The objective criteria can be audited and serve both as a benchmark and a basis for improvement activities.

  20. Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System.

    Science.gov (United States)

    Psek, Wayne; Davis, F Daniel; Gerrity, Gloria; Stametz, Rebecca; Bailey-Davis, Lisa; Henninger, Debra; Sellers, Dorothy; Darer, Jonathan

    2016-01-01

    Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders' perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders' perspectives on the LHS and learning activities in an integrated delivery system. A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders' responses were categorized into themes. Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals. Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed. Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery.

  1. Integrative health care method based on combined complementary ...

    African Journals Online (AJOL)

    Background: There are various models of health care, such as the ... sociological, economic, systemic of Neuman, cognitive medicine or ecological, ayurvedic, ... 2013, with a comprehensive approach in 64 patients using the clinical method.

  2. Integration of early specialist palliative care in cancer care: Survey of oncologists, oncology nurses, and patients

    Directory of Open Access Journals (Sweden)

    Naveen Salins

    2016-01-01

    Conclusion: Oncologists, oncology nurses, and patients felt that integration of early specialist palliative care in cancer improves symptom control, end-of-life care, health-related communication, and continuity of care. The perceptions of benefit of the palliative care intervention in the components surveyed, differed among the three groups.

  3. The maze and the minotaur: mental health in primary health care.

    Science.gov (United States)

    Hirdes, Alice; Scarparo, Helena Beatriz Kochenborger

    2015-02-01

    The article aims to discuss the issue of integration of mental health in primary care by matrix support in mental health. We point out the main barriers in the use of this work method, as well as the facilitating factors of the matrix support of mental health in primary care. The first are within the scope of epistemological specificities, professional issues and management in the political and ideological dimensions. Among the second, we highlight: the care for people with mental disorders in the territory; the reduction of stigma and discrimination; the development of new skills for professionals in primary care; reduction of costs; simultaneous treatment of physical and mental illness, which often overlap; the possibility of incorporating mental health care in a perspective of extended clinical service using an inter/transdisciplinary approach.

  4. Quality health care in the European Union thanks to competition law.

    Science.gov (United States)

    Fornaciari, Diego

    2010-01-01

    There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institutions that have expertise in the field of health care quality measurement in order to integrate these dimensions in competition practice.

  5. Quality Health Care in the European Union Thanks to Competition Law

    Science.gov (United States)

    Fornaciari, Diego

    2010-01-01

    There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institutions that have expertise in the field of health care quality measurement in order to integrate these dimensions in competition practice. PMID:20195428

  6. The utah beacon experience: integrating quality improvement, health information technology, and practice facilitation to improve diabetes outcomes in small health care facilities.

    Science.gov (United States)

    Tennison, Janet; Rajeev, Deepthi; Woolsey, Sarah; Black, Jeff; Oostema, Steven J; North, Christie

    2014-01-01

    The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010-2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC(3) was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients' diabetes outcomes at 21 participating smaller, independent clinics. Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC(3) helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients' diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources. Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC(3) Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow. Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC(3) Beacon practices are currently smoothly transitioning to new models of care such as Patient

  7. Promoting coordination in Norwegian health care

    Directory of Open Access Journals (Sweden)

    Tor I. Romøren

    2011-10-01

    Full Text Available   Introduction: The Norwegian health care system is well organized within its two main sectors - primary health and long term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures.Policy practice: Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented.Discussion: The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.

  8. A revisionist view of the integrated academic health center.

    Science.gov (United States)

    Rodin, Judith

    2004-02-01

    Like many academic health centers that had expanded aggressively during the 1990s, the nation's first vertically integrated academic health center, the University of Pennsylvania Health System, was profoundly challenged by the dramatic and unanticipated financial impacts of the Balanced Budget Act of 1997. The author explains why-although Penn's Health System had lost $300 million over two years and its debts threatened to cause serious financial and educational damage to the rest of the University-Penn chose to manage its way out of the financial crisis (instead of selling or spinning off its four hospitals, clinical practices, and possibly even its medical school). A strategy of comprehensive integration has not only stabilized Penn's Health System financially, but strengthened its position of leadership in medical education, research, and health care delivery. The author argues that a strategy of greater horizontal integration offers important strategic advantages to academic health centers. In an era when major social and scientific problems demand broadly multidisciplinary and highly-integrated approaches, such horizontally integrated institutions will be better able to educate citizens and train physicians, develop new approaches to health care policy, and answer pressing biomedical research questions. Institutional cultural integration is also crucial to create new, innovative organizational structures that bridge traditional disciplinary, school, and clinical boundaries.

  9. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  10. Health care needs of children with Tourette syndrome.

    Science.gov (United States)

    Bitsko, Rebecca H; Danielson, Melissa; King, Michael; Visser, Susanna N; Scahill, Lawrence; Perou, Ruth

    2013-12-01

    To document the impact of Tourette syndrome on the health care needs of children and access to health care among youth with Tourette syndrome, parent-reported data from the 2007-2008 National Survey of Children's Health were analyzed. Children with Tourette syndrome had more co-occurring mental disorders than children with asthma or children without Tourette syndrome or asthma and had health care needs that were equal to or greater than children with asthma (no Tourette syndrome) or children with neither asthma nor Tourette syndrome. Health care needs were greatest among children with Tourette syndrome and co-occurring mental disorders, and these children were least likely to receive effective care coordination. Addressing co-occurring conditions may improve the health and well-being of children with Tourette syndrome. Strategies such as integration of behavioral health and primary care may be needed to improve care coordination.

  11. Integrated care organizations in Switzerland.

    Science.gov (United States)

    Berchtold, Peter; Peytremann-Bridevaux, Isabelle

    2011-01-01

    The Swiss health care system is characterized by its decentralized structure and high degree of local autonomy. Ambulatory care is provided by physicians working mainly independently in individual private practices. However, a growing part of primary care is provided by networks of physicians and health maintenance organizations (HMOs) acting on the principles of gatekeeping. The share of insured choosing an alternative (managed care) type of basic health insurance and therefore restrict their choice of doctors in return for lower premiums increased continuously since 1990. To date, an average of one out of eight insured person in Switzerland, and one out of three in the regions in north-eastern Switzerland, opted for the provision of care by general practitioners in one of the 86 physician networks or HMOs. About 50% of all general practitioners and more than 400 other specialists have joined a physician networks. Seventy-three of the 86 networks (84%) have contracts with the healthcare insurance companies in which they agree to assume budgetary co-responsibility, i.e., to adhere to set cost targets for particular groups of patients. Within and outside the physician networks, at regional and/or cantonal levels, several initiatives targeting chronic diseases have been developed, such as clinical pathways for heart failure and breast cancer patients or chronic disease management programs for patients with diabetes. Swiss physician networks and HMOs were all established solely by initiatives of physicians and health insurance companies on the sole basis of a healthcare legislation (Swiss Health Insurance Law, KVG) which allows for such initiatives and developments. The relevance of these developments towards more integration of healthcare as well as their implications for the future are discussed.

  12. Integrated complex care model: lessons learned from inter-organizational partnership.

    Science.gov (United States)

    Cohen, Eyal; Bruce-Barrett, Cindy; Kingsnorth, Shauna; Keilty, Krista; Cooper, Anna; Daub, Stacey

    2011-01-01

    Providing integrated care for children with medical complexity in Canada is challenging as these children are, by definition, in need of coordinated care from disparate providers, organizations and funders across the continuum in order to optimize health outcomes. We describe the development of an inter-organizational team constructed as a unique tripartite partnership of an acute care hospital, a children's rehabilitation hospital and a home/community health organization focused on children who frequently use services across these three organizations. Model building and operationalization within the Canadian healthcare system is emphasized. Key challenges identified to date include communication and policy barriers as well as optimizing interactions with families; critical enablers have been alignment with policy trends in healthcare and inter-organizational commitment to integrate at the point of care. Considerations for policy developments supporting full integration across service sectors are raised. Early indicators of success include the enrolment of 34 clients and patients and the securing of funds to evaluate and expand the model to serve more children.

  13. How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review.

    Science.gov (United States)

    Rolls, Kaye; Hansen, Margaret; Jackson, Debra; Elliott, Doug

    2016-06-16

    Prevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines. This study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice. An integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used. Overall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the target group ranged from 1.6% to 29% (n

  14. Wearable Sensors Integrated with Internet of Things for Advancing eHealth Care

    Directory of Open Access Journals (Sweden)

    Jose-Luis Bayo-Monton

    2018-06-01

    Full Text Available Health and sociological indicators alert that life expectancy is increasing, hence so are the years that patients have to live with chronic diseases and co-morbidities. With the advancement in ICT, new tools and paradigms are been explored to provide effective and efficient health care. Telemedicine and health sensors stand as indispensable tools for promoting patient engagement, self-management of diseases and assist doctors to remotely follow up patients. In this paper, we evaluate a rapid prototyping solution for information merging based on five health sensors and two low-cost ubiquitous computing components: Arduino and Raspberry Pi. Our study, which is entirely described with the purpose of reproducibility, aimed to evaluate the extent to which portable technologies are capable of integrating wearable sensors by comparing two deployment scenarios: Raspberry Pi 3 and Personal Computer. The integration is implemented using a choreography engine to transmit data from sensors to a display unit using web services and a simple communication protocol with two modes of data retrieval. Performance of the two set-ups is compared by means of the latency in the wearable data transmission and data loss. PC has a delay of 0.051 ± 0.0035 s (max = 0.2504 s, whereas the Raspberry Pi yields a delay of 0.0175 ± 0.149 s (max = 0.294 s for N = 300. Our analysis confirms that portable devices ( p < < 0 . 01 are suitable to support the transmission and analysis of biometric signals into scalable telemedicine systems.

  15. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System

    Science.gov (United States)

    Durant, Anne Foss; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California’s Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes. PMID:26828076

  16. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

    Science.gov (United States)

    Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

  17. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program

    Science.gov (United States)

    Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-01-01

    Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a “homeless medical home” initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. Results More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Conclusion Integrating social determinants of health into clinical care can be effective for high

  18. Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial.

    Science.gov (United States)

    Bruce, Martha L; Lohman, Matthew C; Greenberg, Rebecca L; Bao, Yuhua; Raue, Patrick J

    2016-11-01

    To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  19. Integrating care for individuals with FASD: results from a multi-stakeholder symposium.

    Science.gov (United States)

    Masotti, Paul; Longstaffe, Sally; Gammon, Holly; Isbister, Jill; Maxwell, Breann; Hanlon-Dearman, Ana

    2015-10-05

    Fetal Alcohol Spectrum Disorder (FASD) has a significant impact on communities and systems such as health, education, justice and social services. FASD is a complex neurodevelopmental disorder that results in permanent disabilities and associated service needs that change across affected individuals' lifespans. There is a degree of interdependency among medical and non-medical providers across these systems that do not frequently meet or plan a coordinated continuum of care. Improving overall care integration will increase provider-specific and system capacity, satisfaction, quality of life and outcomes. We conducted a consensus generating symposium comprised of 60 experts from different stakeholder groups: Allied & Mental Health, Education, First Nations & Métis Health, Advocates, Primary Care, Government Health Policy, Regional FASD Coordinators, Social Services, and Youth Justice. Research questions addressed barriers and solutions to integration across systems and group-specific and system-wide research priorities. Solutions and consensus on prioritized lists were generated by combining the Electronic Meeting System approach with a modified 'Nominal Group Technique'. FASD capacity (e.g., training, education, awareness) needs to be increased in both medical and non-medical providers. Outcomes and integration will be improved by implementing: multidisciplinary primary care group practice models, FASD system navigators/advocates, and patient centred medical homes. Electronic medical records that are accessible to multiple medical and non-medical providers are a key tool to enhancing integration and quality. Eligibility criteria for services are a main barrier to integration across systems. There is a need for culturally and community-specific approaches for First Nations communities. There is a need to better integrate care for individuals and families living with FASD. Primary Care is well positioned to play a central and important role in facilitating and

  20. Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model.

    Science.gov (United States)

    Sandoval, Brian E; Bell, Jennifer; Khatri, Parinda; Robinson, Patricia J

    2017-12-12

    Primary care continues to be at the center of health care transformation. The Primary Care Behavioral Health (PCBH) model of service delivery includes patient-centered care delivery strategies that can improve clinical outcomes, cost, and patient and primary care provider satisfaction with services. This article reviews the link between the PCBH model of service delivery and health care services quality improvement, and provides guidance for initiating PCBH model clinical pathways for patients facing depression, chronic pain, alcohol misuse, obesity, insomnia, and social barriers to health.

  1. Primary health care in India.

    Science.gov (United States)

    Deodhar, N S

    1982-03-01

    Concurrently with the development of the general health services infrastructure in India, serveral special health programs were instituted at the national level to provide a massive and concentrated assault on the major public health problems of malaria, smallpox, cholera, trachoma, tuberculosis, leprosy, filariasis, and the rapid population growth. These vertical programs were expected to reduce the heavy morbidity and mortality within the shortest possible time to where they were no longer major public health problems. The impact was variable. Major steps toward providing integrated health care were taken during the first 5-year plan. Emphasis was on the provision of a packet of inttegrated health, family planning, and nutrition services to the vulnerable groups, i.e., children, pregnant women, and nursing mothers. To rectify past shortcomings ssuch as the failures of the national health programs, ineffective coordination in the nutrition programs, and slow rate of development as a result of interdependence of different sectors, it was necessary to improve the health infrastructure and to launch a frontal attack on poverty. The Multipurpose Health Workers Scheme was planned to rationalize the organization and use of available manpower to reduce the area and population covered by each of the field staff in order to reduce travel time and to make services more effective and more satisfactory. Each multipurpose health worker was entrusted with the task of providing comprehensive health care to about 5000 people. Communicable diseases were the main public health problems, and many specific control/eradication programs were launched. the immunization programs against common childhood diseases have not taken deep roots and coverage continues to be poor. The adoption of the Western model of medical services has resulted in emphasis on "cure" rather than on "care". Another problem is maldistribution of the facilities. Overemphasis on medical education has resulted in the

  2. Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

    Directory of Open Access Journals (Sweden)

    Janya McCalman

    2018-03-01

    Full Text Available Continuous quality improvement (CQI processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

  3. Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

    Science.gov (United States)

    McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

    2018-01-01

    Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

  4. Factors affecting rural volunteering in palliative care - an integrated review.

    Science.gov (United States)

    Whittall, Dawn; Lee, Susan; O'Connor, Margaret

    2016-12-01

    To review factors shaping volunteering in palliative care in Australian rural communities using Australian and International literature. Identify gaps in the palliative care literature and make recommendations for future research. A comprehensive literature search was conducted using Proquest, Scopus, Sage Premier, Wiley online, Ovid, Cochran, Google Scholar, CINAHL and Informit Health Collection. The literature was synthesised and presented in an integrated thematic narrative. Australian Rural communities. While Australia, Canada, the United States (US) and the United Kingdom (UK) are leaders in palliative care volunteer research, limited research specifically focuses on volunteers in rural communities with the least occurring in Australia. Several interrelated factors influence rural palliative care provision, in particular an increasingly ageing population which includes an ageing volunteer and health professional workforce. Also current and models of palliative care practice fail to recognise the innumerable variables between and within rural communities such as distance, isolation, lack of privacy, limited health care services and infrastructure, and workforce shortages. These issues impact palliative care provision and are significant for health professionals, volunteers, patients and caregivers. The three key themes of this integrated review include: (i) Geography, ageing rural populations in palliative care practice, (ii) Psychosocial impact of end-end-of life care in rural communities and (iii) Palliative care models of practice and volunteering in rural communities. The invisibility of volunteers in rural palliative care research is a concern in understanding the issues affecting the sustainability of quality palliative care provision in rural communities. Recommendations for future Australian research includes examination of the suitability of current models of palliative care practice in addressing the needs of rural communities; the recruitment

  5. Extended applications with smart cards for integration of health care and health insurance services.

    Science.gov (United States)

    Sucholotiuc, M; Stefan, L; Dobre, I; Teseleanu, M

    2000-01-01

    In 1999 in Romania has initiated the reformation of the national health care system based on health insurance. In 1998 we analyzed this system from the point of view of its IT support and we studied methods of optimisation with relational, distributed databases and new technologies such as Our objectives were to make a model of the information and services flow in a modern health insurance system, to study the smart card technology and to demonstrate how smart card can improve health care services. The paper presents only the smart cards implementations.

  6. A Research Program on Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH: An International Collaboration

    Directory of Open Access Journals (Sweden)

    Walter P. Wodchis

    2018-05-01

    Full Text Available Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC has been associated with more equitable access to services, better population level outcomes and lower system level costs. Itmay be well suited to the increasingly complex needs of populations; however the implementation of CBPHC models of care faces many challenges. This paper describes a program of research by an international, multi-university, multidisciplinary research team who are seeking to understand how to scale up and spread models of Integrated CBPHC (ICBPHC. The key question being addressed is “What are the steps to implementing innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs?” and will be answered in three phases. In the first phase we identify and describe exemplar models of ICBPHC and their context in relation to relevant policies and performance across the three jurisdictions (New Zealand, Ontario and Québec, Canada. The second phase involves a series of theory-informed, mixed methods case studies from which we shall develop a conceptual framework that captures not only the attributes of successful innovative ICBPHC models, but also how these models are being implemented. In the third phase, we aim to translate our research into practice by identifying emerging models of ICBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction. The final output of the program will be a comprehensive guide to the design, implementation and scaling-up of innovative models of ICBPHC.

  7. Education, implementation, and policy barriers to greater integration of palliative care: A literature review.

    Science.gov (United States)

    Aldridge, Melissa D; Hasselaar, Jeroen; Garralda, Eduardo; van der Eerden, Marlieke; Stevenson, David; McKendrick, Karen; Centeno, Carlos; Meier, Diane E

    2016-03-01

    Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. To provide an overview of the barriers to more widespread palliative care integration in the United States. A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness. © The Author(s) 2015.

  8. Integrating Behavioral Health into Pediatric Primary Care: Implications for Provider Time and Cost.

    Science.gov (United States)

    Gouge, Natasha; Polaha, Jodi; Rogers, Rachel; Harden, Amy

    2016-12-01

    Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not. Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers' direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated. On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected $1142 more revenue than on days when no consultant was present. The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.

  9. The influence of nursing care integration services on nurses' work satisfaction and quality of nursing care.

    Science.gov (United States)

    Ryu, Jeong-Im; Kim, Kisook

    2018-06-20

    To investigate differences in work satisfaction and quality of nursing services between nurses from the nursing care integration service and general nursing units in Korea. The nursing care integration service was recently introduced in Korea to improve patient health outcomes through the provision of high quality nursing services and to relieve the caregiving burden of patients' families. In this cross-sectional study, data were collected from a convenience sample of 116 and 156 nurses working in nursing care integration service and general units, respectively. The data were analysed using descriptive statistics, t tests and one-way analysis of variance. Regarding work satisfaction, nursing care integration service nurses scored higher than general unit nurses on professional status, autonomy and task requirements, but the overall scores showed no significant differences. Scores on overall quality of nursing services, responsiveness and assurance were higher for nursing care integration service nurses than for general unit nurses. Nursing care integration service nurses scored higher than general unit nurses on some aspects of work satisfaction and quality of nursing services. Further studies with larger sample sizes will contribute to improving the quality of nursing care integration service units. These findings can help to establish strategies for the implementation and efficient operation of the nursing care integration service system, for the improvement of the quality of nursing services, and for successfully implementing and expanding nursing care integration service services in other countries. © 2018 John Wiley & Sons Ltd.

  10. Clustering and inertia: structural integration of home care in Swedish elderly care

    Directory of Open Access Journals (Sweden)

    Nils Olof Hedman

    2007-09-01

    Full Text Available Purpose: To study the design and distribution of different organizational solutions regarding the responsibility for and provision of home care for elderly in Swedish municipalities. Method: Directors of the social welfare services in all Swedish municipalities received a questionnaire about old-age care organization, especially home care services and related activities. Rate of response was 73% (211/289. Results: Three different organizational models of home care were identified. The models represented different degrees of integration of home care, i.e. health and social aspects of home care were to varying degrees integrated in the same organization. The county councils (i.e. large sub-national political-administrative units tended to contain clusters of municipalities (smaller sub-national units with the same organizational characteristics. Thus, municipalities' home care organization followed a county council pattern. In spite of a general tendency for Swedish municipalities to reorganize their activities, only 1% of them had changed their home care services organization in relation to the county council since the reform. Conclusion: The decentralist intention of the reform—to give actors at the sub-national levels freedom to integrate home care according to varying local circumstances—has resulted in a sub-national inter-organizational network structure at the county council, rather than municipal, level, which is highly inert and difficult to change.

  11. Care coordination in bone health screening between individual behaviors and health care services among Korean-American women across three age groups

    OpenAIRE

    Young-Shin Lee

    2017-01-01

    Integrated continuous care is important to prevent and treat brittle bone status in the aging process; however, minority groups often have limited access to health services. The purpose of this study was to identify the care coordination among women’s perceptions about their bone health, information from health care providers, and the results of Bone Mineral Density (BMD) tests across three age groups. The study was a cross-sectional comparative design. A total of 63 Korean American women com...

  12. [Ethical problems experienced by nurses in primary health care: integrative literature review].

    Science.gov (United States)

    Nora, Carlise Rigon Dalla; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida

    2015-03-01

    The aim of this study is to identify ethical problems experienced by nurses in primary health care and resources for coping based on publications on the subject. An integrative literature review was performed between the months of October and November 2013, using the databases: BDTD, CINAHL, LILACS, MEDLINE, Biblioteca Cochrane, PubMed, RCAAP and SciELO. Articles, dissertations and theses published in Portuguese, English and Spanish were included, totalling 31 studies published from 1992 to 2013. This analysis resulted in four categories: ethical problems in the relationship between team members, ethical problems in the relationship with the user, ethical problems in health services management and resources for coping with ethical problems. Results showed that nurses need to be prepared to face ethical problems, emphasizing the importance of ethics education during the education process before and during professional practice to enhance the development of ethical sensitivity and competence for problem resolution.

  13. Diagnoses, Intervention Strategies, and Rates of Functional Improvement in Integrated Behavioral Health Care Patients

    Science.gov (United States)

    Bridges, Ana J.; Gregus, Samantha J.; Rodriguez, Juventino Hernandez; Andrews, Arthur R.; Villalobos, Bianca T.; Pastrana, Freddie A.; Cavell, Timothy A.

    2016-01-01

    Objective Compared with more traditional mental health care, integrated behavioral health care (IBHC) offers greater access to services and earlier identification and intervention of behavioral and mental health difficulties. The current study examined demographic, diagnostic, and intervention factors that predict positive changes for IBHC patients. Method Participants were 1,150 consecutive patients (mean age = 30.10 years, 66.6% female, 60.1% Hispanic, 47.9% uninsured) seen for IBHC services at 2 primary care clinics over a 34-month period. Patients presented with depressive (23.2%), anxiety (18.6%), adjustment (11.3%), and childhood externalizing (7.6%) disorders, with 25.7% of patients receiving no diagnosis. Results The most commonly delivered interventions included behavioral activation (26.1%), behavioral medicine-specific consultation (14.6%), relaxation training (10.3%), and parent-management training (8.5%). There was high concordance between diagnoses and evidence-based intervention selection. We used latent growth curve modeling to explore predictors of baseline global assessment of functioning (GAF) and improvements in GAF across sessions, utilizing data from a subset of 117 patients who attended at least 3 behavioral health visits. Hispanic ethnicity and being insured predicted higher baseline GAF, while patients with an anxiety disorder had lower baseline GAF than patients with other diagnoses. Controlling for primary diagnosis, patients receiving behavioral activation or exposure therapy improved at faster rates than patients receiving other interventions. Demographic variables did not relate to rates of improvement. Conclusion Results suggest even brief IBHC interventions can be focused, targeting specific patient concerns with evidence-based treatment components. PMID:25774786

  14. The integration of the treatment for common mental disorders in primary care: experiences of health care providers in the MANAS trial in Goa, India

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    Kirkwood Betty R

    2011-10-01

    Full Text Available Abstract Background The MANAS trial reported that a Lay Health Counsellor (LHC led collaborative stepped care intervention (the "MANAS intervention" for Common Mental Disorders (CMD was effective in public sector primary care clinics but private sector General Practitioners (GPs did as well with or without the additional counsellor. This paper aims to describe the experiences of integrating the MANAS intervention in primary care. Methods Qualitative semi-structured interviews with key members (n = 119 of the primary health care teams upon completion of the trial and additional interviews with control arm GPs upon completion of the outcome analyses which revealed non-inferiority of this arm. Results Several components of the MANAS intervention were reported to have been critically important for facilitating integration, notably: screening and the categorization of the severity of CMD; provision of psychosocial treatments and adherence management; and the support of the visiting psychiatrist. Non-adherence was common, often because symptoms had been controlled or because of doubt that health care interventions could address one's 'life difficulties'. Interpersonal therapy was intended to be provided face to face by the LHC; however it could not be delivered for most eligible patients due to the cost implications related to travel to the clinic and the time lost from work. The LHCs had particular difficulty in working with patients with extreme social difficulties or alcohol related problems, and elderly patients, as the intervention seemed unable to address their specific needs. The control arm GPs adopted practices similar to the principles of the MANAS intervention; GPs routinely diagnosed CMD and provided psychoeducation, advice on life style changes and problem solving, prescribed antidepressants, and referred to specialists as appropriate. Conclusion The key factors which enhance the acceptability and integration of a LHC in primary care are

  15. Reframing the challenges to integrated care: a complex-adaptive systems perspective

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    Peter Tsasis

    2012-09-01

    Full Text Available Introduction: Despite over two decades of international experience and research on health systems integration, integrated care has not developed widely. We hypothesized that part of the problem may lie in how we conceptualize the integration process and the complex systems within which integrated care is enacted. This study aims to contribute to discourse regarding the relevance and utility of a complex-adaptive systems (CAS perspective on integrated care.Methods: In the Canadian province of Ontario, government mandated the development of fourteen Local Health Integration Networks in 2006. Against the backdrop of these efforts to integrate care, we collected focus group data from a diverse sample of healthcare professionals in the Greater Toronto Area using convenience and snowball sampling. A semi-structured interview guide was used to elicit participant views and experiences of health systems integration. We use a CAS framework to describe and analyze the data, and to assess the theoretical fit of a CAS perspective with the dominant themes in participant responses.Results: Our findings indicate that integration is challenged by system complexity, weak ties and poor alignment among professionals and organizations, a lack of funding incentives to support collaborative work, and a bureaucratic environment based on a command and control approach to management. Using a CAS framework, we identified several characteristics of CAS in our data, including diverse, interdependent and semi-autonomous actors; embedded co-evolutionary systems; emergent behaviours and non-linearity; and self-organizing capacity. Discussion and Conclusion: One possible explanation for the lack of systems change towards integration is that we have failed to treat the healthcare system as complex-adaptive. The data suggest that future integration initiatives must be anchored in a CAS perspective, and focus on building the system's capacity to self-organize. We conclude that

  16. Reframing the challenges to integrated care: a complex-adaptive systems perspective

    Directory of Open Access Journals (Sweden)

    Peter Tsasis

    2012-09-01

    Full Text Available Introduction: Despite over two decades of international experience and research on health systems integration, integrated care has not developed widely. We hypothesized that part of the problem may lie in how we conceptualize the integration process and the complex systems within which integrated care is enacted. This study aims to contribute to discourse regarding the relevance and utility of a complex-adaptive systems (CAS perspective on integrated care. Methods: In the Canadian province of Ontario, government mandated the development of fourteen Local Health Integration Networks in 2006. Against the backdrop of these efforts to integrate care, we collected focus group data from a diverse sample of healthcare professionals in the Greater Toronto Area using convenience and snowball sampling. A semi-structured interview guide was used to elicit participant views and experiences of health systems integration. We use a CAS framework to describe and analyze the data, and to assess the theoretical fit of a CAS perspective with the dominant themes in participant responses. Results: Our findings indicate that integration is challenged by system complexity, weak ties and poor alignment among professionals and organizations, a lack of funding incentives to support collaborative work, and a bureaucratic environment based on a command and control approach to management. Using a CAS framework, we identified several characteristics of CAS in our data, including diverse, interdependent and semi-autonomous actors; embedded co-evolutionary systems; emergent behaviours and non-linearity; and self-organizing capacity.  Discussion and Conclusion: One possible explanation for the lack of systems change towards integration is that we have failed to treat the healthcare system as complex-adaptive. The data suggest that future integration initiatives must be anchored in a CAS perspective, and focus on building the system's capacity to self-organize. We conclude that

  17. The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems

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    Menizibeya Osain Welcome

    2011-01-01

    Full Text Available Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine

  18. Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses.

    Science.gov (United States)

    Maurits, Erica E M; de Veer, Anke J E; Groenewegen, Peter P; Francke, Anneke L

    2018-03-05

    The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people-centred and integrated health services. This includes providing integrated care around people's needs that is effectively co-ordinated across providers and co-produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home-care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people-centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home-care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people-centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home-care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people-centred, integrated home care as attractive. Specific aspects that home-care nurses find attractive are promoting the patient's self-reliance and having a network in the community. Hospital nurses are mainly attracted to health-related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home-care nurses and a minority of hospital nurses feel attracted to people-centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home-care organisations who aim to expand the home-care nursing workforce. © 2018 John Wiley & Sons Ltd.

  19. A Comparison of Medical Birth Register Outcomes between Maternity Health Clinics and Integrated Maternity and Child Health Clinics in Southwest Finland.

    Science.gov (United States)

    Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Mäkinen, Juha; Rautava, Päivi

    2016-07-08

    Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.

  20. Severe hypertriglyceridemia and factors associated with acute pancreatitis in an integrated health care system.

    Science.gov (United States)

    Rashid, Nazia; Sharma, Puza P; Scott, Ronald D; Lin, Kathy J; Toth, Peter P

    2016-01-01

    To evaluate patient characteristics, treatment patterns, comorbidities, and risk factors associated with the development of acute pancreatitis (AP) in patients with severe hypertriglyceridemia (HTG) in an integrated health care delivery system. We identified a retrospective cohort of severe HTG patients with a fasting triglyceride level ≥ 1000 mg/dL during January 1, 2007 to June 30, 2013 (index date) in an integrated health care delivery system. Patients were aged ≥18 years on index date and had 12 months of continuous membership and drug eligibility before the index date and during postindex including index date. Baseline patient characteristics, comorbidities, and risk factors were evaluated during 12-month preindex. Outcomes such as development of AP, treatment patterns, adherence to index therapy, and change in triglyceride (TG) laboratory levels were evaluated during postindex. Descriptive statistics were used to identify differences between patients developing AP vs no development of AP. A stepwise multivariate logistic regression and backward elimination method were used to assess statistically significant predictive factors associated with development of AP vs no AP. We identified 5550 patients with severe HTG, and 5.4% of these patients developed AP during postindex. Patients were mostly male (≥70%) in both groups; however, younger in the AP group (45 years ± 10.6) vs no AP group (50 years ± 11.4) with P value severe HTG are at a higher risk of developing AP. A number of comorbidities, risk factors, and baseline TG levels are associated with an increased incidence of AP. Patients with severe HTG are underdiagnosed, undertreated and are nonadherent to their index lipid therapy. There is a need to better define optimal approaches to treating severe HTG so as to reduce the incidence of AP. Economic studies are also needed to evaluate the burden of AP on various health care systems. Copyright © 2016 National Lipid Association. Published by

  1. Bringing Wellness to Schools: Opportunities and Challenges to Mental Health Integration in School Health Centers

    Science.gov (United States)

    Lai, Karen; Guo, Sisi; Ijadi-Maghsoodi, Roya; Puffer, Maryjane; Kataoka, Sheryl H.

    2016-01-01

    Objective School-based health centers (SBHCs) reduce mental health access-to-care barriers and improve educational outcomes for youth. This qualitative study evaluates the innovations and challenges of a unique network of SBHCs in a large, urban school district, as they attempt to integrate health, mental health, and educational services. Methods The 43 participants sampled included mental health providers, primary care providers, and care coordinators at 14 SBHCs. Semi-structured interviews with each participant were audio-recorded and transcribed. Themes were identified and coded using Atlas.ti 5.1, and collapsed into three domains: Operations, Partnership, and Engagement. Results Interviews revealed provider models ranging from single agencies offering both health and mental health services to co-located services. Sites with the Health Agency providing at least some mental health services reported more mental health screenings. Many sites utilized SBHC coordinators and coordination team meetings to facilitate relationships between schools and Health Agency and Community Mental Health Clinic providers. Partnership challenges included confidentiality policies and staff turnover. Participants also highlighted student and parent engagement, through culturally sensitive services, peer health advocates, and “drop-in” lunches. Conclusions Staffing and operational models are critical in the success of health-mental health-education integration. Among the provider models observed, the combined health and mental health provider model offered the most integrated services. Despite barriers, providers and schools have begun to implement novel solutions for operational problems and family engagement in mental health services. Implications for future SBHCs as an integrated model are described. PMID:27417895

  2. Proposals for enhanced health risk assessment and stratification in an integrated care scenario.

    Science.gov (United States)

    Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep

    2016-04-15

    Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Responsible teams for regional data management in the five ACT regions. We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. Applicability and impact of the proposals for enhanced clinical risk assessment require

  3. Economic evaluation of integrated care: an introduction

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    Hindrik Vondeling

    2004-03-01

    Full Text Available 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.

  4. Creating an integrated public sector? Labour's plans for the modernisation of the English health care system

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    Nick Goodwin

    2002-03-01

    Full Text Available The current Labour Government has embarked on radical public sector reform in England. A so-called ‘Modernisation Agenda’ has been developed that is encapsulated in the NHS Plan—a document that details a long-term vision for health care. This plan involves a five-fold strategy: investment through greater public funding; quality assurance; improving access; service integration and inter-professional working; and providing a public health focus. The principles of Labour's vision have been broadly supported. However, achieving its aims appears reliant on two key factors. First, appropriate resources are required to create capacity, particularly management capacity, to enable new functions to develop. Second, promoting access and service integration requires the development of significant co-ordination, collaboration and networking between agencies and individuals. This is particularly important for health and social care professionals. Their historically separate professions suggest that a significant period of change management is required to allow new roles and partnerships to evolve. In an attempt to secure delivery of its goals, however, the Government has placed the emphasis on further organisational restructuring. In doing so, the Government may have missed the key challenges faced in delivering its NHS Plan. As this paper argues, cultural and behavioural change is probably a far more appropriate and important requirement for success than a centrally directed approach that emphasises the rearrangement of structural furniture.

  5. Practical Steps to Integrate Family Voice in Organization, Policy, Planning, and Decision-Making for Socio-Emotional Trauma-Informed Integrated Pediatric Care.

    Science.gov (United States)

    Dayton, Lauren; Buttress, Amelia; Agosti, Jen; Aceves, Javier; Kieschnick, Meredith; Popejoy, Agatha; Robbins, Robyn; Farinholt, Kate

    2016-12-01

    This article explores barriers and strategies to achieving family-driven integrated child health care. Family involvement in health system design and reform has become a guiding principle in national and local efforts to improve children's mental health services. In practice, primary care clinicians, staff, and families continue to describe common barriers to integrating family voice. Drawing from the collective knowledge of the Pediatric Integrated Care Collaborative (PICC) and the National Alliance on Mental Illness (NAMI), we present strategies to overcome these barriers to successfully recruit, sustain, and expand family influence on health systems. Family advocates and clinical leaders from two clinic sites in Albuquerque, New Mexico and Santa Rosa, California share challenges and strategies for building family involvement in system design. Copyright © 2016. Published by Elsevier Inc.

  6. Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations.

    Science.gov (United States)

    Rodgers, Mark; Dalton, Jane; Harden, Melissa; Street, Andrew; Parker, Gillian; Eastwood, Alison

    2018-01-25

    People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings. Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services. Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.

  7. Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations

    Directory of Open Access Journals (Sweden)

    Mark Rodgers

    2018-01-01

    Full Text Available People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings. Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI. We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services. Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.

  8. How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review

    Science.gov (United States)

    2016-01-01

    Background Prevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines. Objectives This study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice. Methods An integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used. Results Overall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the

  9. Statement of the American Psychological Association in response to the "joint principles: integrating behavioral health care into the patient-centered medical home".

    Science.gov (United States)

    Anderson, Norman B; Belar, Cynthia D; Cubic, Barbara A; Garrison, Ellen G; Johnson, Suzanne Bennett; Kaslow, Nadine J

    2014-06-01

    Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011), presented by the Working Party Group on Integrated Behavioral Healthcare. The American Psychological Association (APA) shares concerns about the lack of reference to behavioral health care in the original 2007 Joint Principles of the Patient-Centered Medical Home for which this new document is intended to supplement but not replace. The decision to support the supplemental Joint Principles was not an easy one for APA, as there is one area of significant concern. That concern is related to the use of the term "physician-directed medical practice"

  10. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

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    Norbert eMayer-Amberg

    2016-01-01

    Full Text Available The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various healthcare service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The current work is a quality monitoring report of a novel care setting, called Integrated Care Initiative Schizophrenia. It has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialised nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient’s departments and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarised in a quality monitoring report. In addition, standardised patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented integrated care initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia.

  11. Can banks offer digital keys for health care?

    Science.gov (United States)

    Casillas, John

    2013-01-01

    In the quest to implement electronic health care records, health care stakeholders have uncovered an elephant in the room - how to implement patient identity and integrity solutions. Without this, linking the unique records of an individual is impossible. An inaccurate record can be dangerous for prescribing treatment. Yet many consider a unique patient identifier as an unacceptable privacy risk. Medical banking, or the convergence of banking and heath IT systems, is spawning new ideas that could impact on this difficult area. This article suggests that new forms of efficiency in payment processing may yield a common, cross-industry technology platform for managing digital identity by banks. Redefining a bank based on core competencies, the article looks at three areas: (1) the "identity theft arms race"; (2) innovations in payment processing; and (3) consumer engagement, and suggests that, as banking and health care systems converge, digital identity may become the new money. This realization may find banks fully engaged in helping health care to overcome the challenge of patient identity and integrity.

  12. Combined horizontal and vertical integration of care: a goal of practice-based commissioning.

    Science.gov (United States)

    Thomas, Paul; Meads, Geoffrey; Moustafa, Ahmet; Nazareth, Irwin; Stange, Kurt C; Donnelly Hess, Gertrude

    2008-01-01

    Practice-based commissioning (PBC) in the UK is intended to improve both the vertical and horizontal integration of health care, in order to avoid escalating costs and enhance population health. Vertical integration involves patient pathways to treat named medical conditions that transcend organisational boundaries and connect community-based generalists with largely hospital-sited specialists, whereas horizontal integration involves peer-based and cross-sectoral collaboration to improve overall health. Effective mechanisms are now needed to permit ongoing dialogue between the vertical and horizontal dimensions to ensure that medical and nonmedical care are both used to their best advantage. This paper proposes three different models for combining vertical and horizontal integration - each is a hybrid of internationally recognised ideal types of primary care organisation. Leaders of PBC should consider a range of models and apply them in ways that are relevant to the local context. General practitioners, policy makers and others whose job it is to facilitate horizontal and vertical integration must learn to lead such combined approaches to integration if the UK is to avoid the mistakes of the USA in over-medicalising health issues.

  13. The diagnosis and management of progressive dysfunction of health care organizations.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B

    2005-04-01

    This paper presents an ethically justified approach to the diagnosis and management of progressive dysfunction of health care organizational cultures. We explain the concept of professional integrity in terms of the ethical concept of the cofiduciary responsibility of physicians and health care organizations. We identify the ethical features of a healthy health care organization and the spectrum of progressive dysfunction of organizational cultures from cynical through wonderland and Kafkaesque to postmodern. Physicians should respond to cynical health care organizations by creating moral enclaves of professional integrity for the main purpose of confrontation and reform, to wonderland organizations by strengthening moral enclaves for the main purpose of resisting self-deception, to Kafkaesque organizations by strengthening moral enclaves still further for the main purpose of defending professional integrity (adopting a Machiavellian appearance of virtue as necessary), and to postmodern organizations by creating moral fortresses and, should these fail, quitting.

  14. Do governance choices matter in health care networks?: an exploratory configuration study of health care networks

    Science.gov (United States)

    2013-01-01

    Background Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. Methods The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. Results Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. Conclusions Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness. PMID:23800334

  15. Ethical problems experienced by nurses in primary health care: integrative literature review

    Directory of Open Access Journals (Sweden)

    Carlise Rigon Dalla Nora

    Full Text Available The aim of this study is to identify ethical problems experienced by nurses in primary health care and resources for coping based on publications on the subject. An integrative literature review was performed between the months of October and November 2013, using the databases: BDTD, CINAHL, LILACS, MEDLINE, Biblioteca Cochrane, PubMed, RCAAP and SciELO. Articles, dissertations and theses published in Portuguese, English and Spanish were included, totalling 31 studies published from 1992 to 2013. This analysis resulted in four categories: ethical problems in the relationship between team members, ethical problems in the relationship with the user, ethical problems in health services management and resources for coping with ethical problems. Results showed that nurses need to be prepared to face ethical problems, emphasizing the importance of ethics education during the education process before and during professional practice to enhance the development of ethical sensitivity and competence for problem resolution.

  16. Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care.

    Science.gov (United States)

    Rajkumar, Rajasekaran; Sriman Narayana Iyengar, Nallani Chackravatula

    2013-10-01

    The existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventative medicine, to help promote a healthy rural community. We investigate the approaches of patient health monitoring, emergency care, and an ambulance alert alarm (AAA) under mobile cloud-based telecare or community cloud controller systems. Considering permanent mobile users, an efficient health promotion method is proposed. Experiments were conducted to verify the effectiveness of the method. The performance was evaluated from September 2011 to July 2012. A total of 1,856,454 cases were transported and referred to hospital, identified with health problems, and were monitored. We selected all the peer groups and the control server N0 which controls N1, N2, and N3 proxied peer groups. The hospital cloud controller maintains the database of the patients through a JXTA network. Among 1,856,454 transported cases with beneficiaries of 1,712,877 cases there were 1,662,834 lives saved and 8,500 cases transported per day with 104,530 transported cases found to be registered in a JXTA network. The registered case histories were referred from the Hospital community cloud (HCC). SMS messages were sent from node N0 to the relay peers which connected to the N1, N2, and N3 nodes, controlled by the cloud controller through a JXTA network.

  17. Personal health systems and value creation mechanisms in occupational health care.

    Science.gov (United States)

    Auvinen, Ari-Matti

    2007-01-01

    Personal Health Systems are believed to have great business potential among citizens, but they might reach also an important market in occupational health care. However, in reaching the occupational health care market, it is important to understand the value creation and value configuration mechanisms of this particular market. This paper also claims that in such a business-to-business market service integrators are needed to compose for the various customers specific offerings combing a tailored variety of products and services to suit their specific needs.

  18. Care and pedagogical production: integration of Public Health System scenarios

    Directory of Open Access Journals (Sweden)

    Túlio Batista Franco

    2007-01-01

    Full Text Available Throughout Brazilian Public Health System's (Centralized Health System - SUS construction history there has been a reasonable investment in the education for the sector. However, it has been frequently noticed by health professionals and managers the fact that this investment in educational programs has not converted into change of healthcare practices. Assuming that education can be used as a tool for changes in health, the text suggests that the pedagogical practices should be directed towards the production of individuals implied with the care production. Hence it proposes to work on a field of subjectivity in addition to cognition. This work reveals the management of the Brazilian public health system and its flows of permanent education, focusing "micromanagement" to think about the context on which they structuralize the diverse scenarios of care production, treating them as Pedagogical Production Units where it would be possible to develop entailed educational methodologies to a general idea of permanent education in health.

  19. Integrating GDM management in public health: Pakistan perspective.

    Science.gov (United States)

    Riaz, Musarrat; Basit, Abdul

    2016-09-01

    Pakistan is a developing country with diverse social, economic and cultural dimensions along with limited resources. Non communicable diseases (NCDS) including diabetes are highly prevalent compromising the already challenged health care system. Gestational diabetes mellitus (GDM) with its associated maternal and foetal complications is increasing with rapidly changing lifestyle pattern. Since Pakistan has limited resources and other health issues compete strongly with gestational diabetes initiatives, the most feasible strategy will be the horizontal integration. This will work with the existing primary health care system integrating NCD control programmes with Maternal and Child health (MCH) programmes. Utilizing the existing health care system is the only implementable cost effective strategy. Antenatal screening and treatment of GDM alone is not sufficient but Post-partum screening (PPS) of women with GDM is an important strategy for prevention of diabetes as the conversion rates of GDM to type 2 diabetes are high. Furthermore, instead of perceiving GDM as a temporary reversible clinical entity, it should be considered as a trans-generational prevention of diabetes that needs to be addressed as a public health issue in order to improve maternal and foetal health.

  20. [Comparison of level of satisfaction of users of home care: integrated model vs. dispensaries model].

    Science.gov (United States)

    Gorina, Marta; Limonero, Joaquín T; Peñart, Xavier; Jiménez, Jordi; Gassó, Javier

    2014-01-01

    To determine the level of satisfaction of users that receive home health care through two different models of primary health care: integrated model and dispensaries model. cross-sectional, observational study. Two primary care centers in the province of Barcelona. The questionnaire was administered to 158 chronic patients over 65 years old, of whom 67 were receiving health care from the integrated model, and 91 from the dispensaries model. The Evaluation of Satisfaction with Home Health Care (SATISFAD12) questionnaire was, together with other complementary questions about service satisfaction of home health care, as well as social demographic questions (age, sex, disease, etc). The patients of the dispensaries model showed more satisfaction than the users receiving care from the integrated model. There was a greater healthcare continuity for those patients from the dispensaries model, and a lower percentage of hospitalizations during the last year. The satisfaction of the users from both models was not associated to gender, the health perception,or independence of the The user satisfaction rate of the home care by primary health care seems to depend of the typical characteristics of each organisational model. The dispensaries model shows a higher rate of satisfaction or perceived quality of care in all the aspects analysed. More studies are neede to extrapolate these results to other primary care centers belonging to other institutions. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  1. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

    Science.gov (United States)

    Roberts, James R.; McCurdy, Leyla Erk

    2005-01-01

    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

  2. Unregulated health care workers in the care of aging populations: Similarities and differences between Brazil and Canada

    Directory of Open Access Journals (Sweden)

    Mirella Veras

    2016-02-01

    Full Text Available Introduction: The world’s population is rapidly aging. Unregulated health care workers (UHCWs are emerging as a potentially important workforce in the care of older adults. Objective: A review was conducted to identify the activities of UHCWs with respect to contributions and limitations. Methods: A systematic integrative literature review was conducted using online databases (LILACS, PubMed, EMBASE, CINAHL, and grey literature. The inclusion criteria were as follows: (i description of UHCW activities related to older adults; and (ii description of UHCW activities performed in Brazil or Canada. Results: Eleven papers were included in this review. In both countries, UHCW activities included health promotion, mental health care, and rehabilitation. In Brazil, UHCWs performed integrated care, while in Canada UHCWs performed personal care and housekeeping. Conclusion: These results highlight the potential and limits of UHCWs who provide care for the aging population. Such information is important to health and social policy making and household decision making.

  3. 'Trust and teamwork matter': community health workers' experiences in integrated service delivery in India.

    Science.gov (United States)

    Mishra, Arima

    2014-01-01

    A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011-2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive 'teamwork' and 'building trust with the community' (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology - which the health workers espouse - is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration.

  4. Integrating mental health and social development in theory and practice.

    Science.gov (United States)

    Plagerson, Sophie

    2015-03-01

    In many low and middle income countries, attention to mental illness remains compartmentalized and consigned as a matter for specialist policy. Despite great advances in global mental health, mental health policy and practice dovetail only to a limited degree with social development efforts. They often lag behind broader approaches to health and development. This gap ignores the small but growing evidence that social development unavoidably impacts the mental health of those affected, and that this influence can be both positive and negative. This article examines the theoretical and practical challenges that need to be overcome for a more effective integration of social development and mental health policy. From a theoretical perspective, this article demonstrates compatibility between social development and mental health paradigms. In particular, the capability approach is shown to provide a strong framework for integrating mental health and development. Yet, capability-oriented critiques on 'happiness' have recently been applied to mental health with potentially detrimental outcomes. With regard to policy and practice, horizontal and vertical integration strategies are suggested. Horizontal strategies require stronger devolution of mental health care to the primary care level, more unified messages regarding mental health care provision and the gradual expansion of mental health packages of care. Vertical integration refers to the alignment of mental health with related policy domains (particularly the social, economic and political domains). Evidence from mental health research reinforces aspects of social development theory in a way that can have tangible implications on practice. First, it encourages a focus on avoiding exclusion of those affected by or at risk of mental illness. Secondly, it underscores the importance of the process of implementation as an integral component of successful policies. Finally, by retaining a focus on the individual, it seeks to

  5. Identification and Management of Eating Disorders in Integrated Primary Care: Recommendations for Psychologists in Integrated Care Settings.

    Science.gov (United States)

    Buchholz, Laura J; King, Paul R; Wray, Laura O

    2017-06-01

    Eating disorders are associated with deleterious health consequences, increased risk of mortality, and psychosocial impairment. Although individuals with eating disorders are likely to seek treatment in general medical settings such as primary care (PC), these conditions are often under-detected by PC providers. However, psychologists in integrated PC settings are likely to see patients with eating disorders because of the mental health comorbidities associated with these conditions. Further, due to their training in identifying risk factors associated with eating disorders (i.e., comorbid mental health and medical disorders) and opportunities for collaboration with PC providers, psychologists are well-positioned to improve the detection and management of eating disorders in PC. This paper provides a brief overview of eating disorders and practical guidance for psychologists working in integrated PC settings to facilitate the identification and management of these conditions.

  6. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    DEFF Research Database (Denmark)

    Bousquet, J; Addis, A; Adcock, I

    2014-01-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy...... and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking...... and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5...

  7. Value-based integrated (renal) care: setting a development agenda for research and implementation strategies.

    Science.gov (United States)

    Valentijn, Pim P; Biermann, Claus; Bruijnzeels, Marc A

    2016-08-02

    Integrated care services are considered a vital strategy for improving the Triple Aim values for people with chronic kidney disease. However, a solid scholarly explanation of how to develop, implement and evaluate such value-based integrated renal care services is limited. The aim of this study was to develop a framework to identify the strategies and outcomes for the implementation of value-based integrated renal care. First, the theoretical foundations of the Rainbow Model of Integrated Care and the Triple Aim were united into one overarching framework through an iterative process of key-informant consultations. Second, a rapid review approach was conducted to identify the published research on integrated renal care, and the Cochrane Library, Medline, Scopus, and Business Source Premier databases were searched for pertinent articles published between 2000 and 2015. Based on the framework, a coding schema was developed to synthesis the included articles. The overarching framework distinguishes the integrated care domains: 1) type of integration, 2) enablers of integration and the interrelated outcome domains, 3) experience of care, 4) population health and 5) costs. The literature synthesis indicated that integrated renal care implementation strategies have particularly focused on micro clinical processes and physical outcomes, while little emphasis has been placed on meso organisational as well as macro system integration processes. In addition, evidence regarding patients' perceived outcomes and economic outcomes has been weak. These results underscore that the future challenge for researchers is to explore which integrated care implementation strategies achieve better health and improved experience of care at a lower cost within a specific context. For this purpose, this study's framework and evidence synthesis have set a developmental agenda for both integrated renal care practice and research. Accordingly, we plan further work to develop an implementation

  8. An Integrated Model of Co-ordinated Community-Based Care.

    Science.gov (United States)

    Scharlach, Andrew E; Graham, Carrie L; Berridge, Clara

    2015-08-01

    Co-ordinated approaches to community-based care are a central component of current and proposed efforts to help vulnerable older adults obtain needed services and supports and reduce unnecessary use of health care resources. This study examines ElderHelp Concierge Club, an integrated community-based care model that includes comprehensive personal and environmental assessment, multilevel care co-ordination, a mix of professional and volunteer service providers, and a capitated, income-adjusted fee model. Evaluation includes a retrospective study (n = 96) of service use and perceived program impact, and a prospective study (n = 21) of changes in participant physical and social well-being and health services utilization. Over the period of this study, participants showed greater mobility, greater ability to meet household needs, greater access to health care, reduced social isolation, reduced home hazards, fewer falls, and greater perceived ability to obtain assistance needed to age in place. This study provides preliminary evidence that an integrated multilevel care co-ordination approach may be an effective and efficient model for serving vulnerable community-based elders, especially low and moderate-income elders who otherwise could not afford the cost of care. The findings suggest the need for multisite controlled studies to more rigorously evaluate program impacts and the optimal mix of various program components. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Evaluation of primary mental health care in North West province – a ...

    African Journals Online (AJOL)

    Background. Owing to many complaints by health care workers and patients and a perceived poor standard of care, the mental health care services in North West province were assessed using quantitative and qualitative methods. The Mental Health Care Act of 2002 makes provision for the integration of services into ...

  10. Integrating Social Services and Home-Based Primary Care for High-Risk Patients.

    Science.gov (United States)

    Feinglass, Joe; Norman, Greg; Golden, Robyn L; Muramatsu, Naoko; Gelder, Michael; Cornwell, Thomas

    2018-04-01

    There is a consensus that our current hospital-intensive approach to care is deeply flawed. This review article describes the research evidence for developing a better system of care for high-cost, high-risk patients. It reviews the evidence that home-centered care and integration of health care with social services are the cornerstones of a more humane and efficient system. The article describes the strengths and weaknesses of research evaluating the effects of social services in addressing social determinants of health, and how social support is critical to successful acute care transition programs. It reviews the history of incorporating social services into care management, and the prospects that recent payment reforms and regulatory initiatives can succeed in stimulating the financial integration of social services into new care coordination initiatives. The article reviews the literature on home-based primary care for the chronically ill and disabled, and suggests that it is the emergence of this care modality that holds the greatest promise for delivery system reform. In the hope of stimulating further discussion and debate, the authors summarize existing viewpoints on how a home-centered system, which integrates social and medical services, might emerge in the next few years.

  11. A Gap Analysis Needs Assessment Tool to Drive a Care Delivery and Research Agenda for Integration of Care and Sharing of Best Practices Across a Health System.

    Science.gov (United States)

    Golden, Sherita Hill; Hager, Daniel; Gould, Lois J; Mathioudakis, Nestoras; Pronovost, Peter J

    2017-01-01

    In a complex health system, it is important to establish a systematic and data-driven approach to identifying needs. The Diabetes Clinical Community (DCC) of Johns Hopkins Medicine's Armstrong Institute for Patient Safety and Quality developed a gap analysis tool and process to establish the system's current state of inpatient diabetes care. The collectively developed tool assessed the following areas: program infrastructure; protocols, policies, and order sets; patient and health care professional education; and automated data access. For the purposes of this analysis, gaps were defined as those instances in which local resources, infrastructure, or processes demonstrated a variance against the current national evidence base or institutionally defined best practices. Following the gap analysis, members of the DCC, in collaboration with health system leadership, met to identify priority areas in order to integrate and synergize diabetes care resources and efforts to enhance quality and reduce disparities in care across the system. Key gaps in care identified included lack of standardized glucose management policies, lack of standardized training of health care professionals in inpatient diabetes management, and lack of access to automated data collection and analysis. These results were used to gain resources to support collaborative diabetes health system initiatives and to successfully obtain federal research funding to develop and pilot a pragmatic diabetes educational intervention. At a health system level, the summary format of this gap analysis tool is an effective method to clearly identify disparities in care to focus efforts and resources to improve care delivery. Copyright © 2016 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  12. The effects of integrated care: a systematic review of UK and international evidence.

    Science.gov (United States)

    Baxter, Susan; Johnson, Maxine; Chambers, Duncan; Sutton, Anthea; Goyder, Elizabeth; Booth, Andrew

    2018-05-10

    Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. Models of

  13. Requirements for a text that integrates the oncological pharmacy into the Cuban national health care system

    International Nuclear Information System (INIS)

    Arbesú Michelena, Ma Antonieta; Sedeño Argilagos, C. Caridad; Fernández Argüelles, Rogelio Alberto

    2015-01-01

    Introduction: oncological patients are cared for at all health care system levels. The pharmaceutical professional requires unifying instructions for his/her work in order to be part of the health team. Currently, there is no domestic literature for the pharmaceutical services, mainly that one devoted to oncological area, which comprises in just one text all the functional requirements and directs his/her professional daily work. Objective: to verify the requirement for national integral literature for the development of the oncological pharmaceutical service work. Methods: one two-question questionnaire was designed to assess the knowledge of experts and another with eight questions to learn about the requirement for literature on oncological pharmaceutical service adapted to the conditions of the Cuban health system. The questionnaires were e-mailed to 15 pharmacists who had an outstanding experience in several activities of the oncological pharmacy. Results: ten university experts, with 14.5 years of work experience as average in assistance activities from three provinces, responded. Two were excluded because their low level of information on oncological activity; poor incorporation of the pharmacist involved in services to activities inherent to his/her formation. All the experts believed that it was necessary to have a comprehensive text on the tasks, functions and activities linked to the oncological patient care, and to use the formal learning pathways for updating. A positive association with the favorable answers (1.40) was noticed. Conclusions: there exists a need for a text as a guide of the oncological pharmaceutical services according to the demands of the Cuban health care system. (author) 1

  14. Knowledge about complementary, alternative and integrative medicine (CAM) among registered health care providers in Swedish surgical care: a national survey among university hospitals.

    Science.gov (United States)

    Bjerså, Kristofer; Stener Victorin, Elisabet; Fagevik Olsén, Monika

    2012-04-12

    Previous studies show an increased interest and usage of complementary and alternative medicine (CAM) in the general population and among health care workers both internationally and nationally. CAM usage is also reported to be common among surgical patients. Earlier international studies have reported that a large amount of surgical patients use it prior to and after surgery. Recent publications indicate a weak knowledge about CAM among health care workers. However the current situation in Sweden is unknown. The aim of this study was therefore to explore perceived knowledge about CAM among registered healthcare professions in surgical departments at Swedish university hospitals. A questionnaire was distributed to 1757 registered physicians, nurses and physiotherapists in surgical wards at the seven university hospitals in Sweden from spring 2010 to spring 2011. The questionnaire included classification of 21 therapies into conventional, complementary, alternative and integrative, and whether patients were recommended these therapies. Questions concerning knowledge, research, and patient communication about CAM were also included. A total of 737 (42.0%) questionnaires were returned. Therapies classified as complementary; were massage, manual therapies, yoga and acupuncture. Alternative therapies; were herbal medicine, dietary supplements, homeopathy and healing. Classification to integrative therapy was low, and unfamiliar therapies were Bowen therapy, iridology and Rosen method. Therapies recommended by > 40% off the participants were massage and acupuncture. Knowledge and research about CAM was valued as minor or none at all by 95.7% respectively 99.2%. Importance of possessing knowledge about it was valued as important by 80.9%. It was believed by 61.2% that more research funding should be addressed to CAM research, 72.8% were interested in reading CAM-research results, and 27.8% would consider taking part in such research. Half of the participants (55.8%) were

  15. Knowledge about complementary, alternative and integrative medicine (CAM among registered health care providers in Swedish surgical care: a national survey among university hospitals

    Directory of Open Access Journals (Sweden)

    Bjerså Kristofer

    2012-04-01

    Full Text Available Abstract Background Previous studies show an increased interest and usage of complementary and alternative medicine (CAM in the general population and among health care workers both internationally and nationally. CAM usage is also reported to be common among surgical patients. Earlier international studies have reported that a large amount of surgical patients use it prior to and after surgery. Recent publications indicate a weak knowledge about CAM among health care workers. However the current situation in Sweden is unknown. The aim of this study was therefore to explore perceived knowledge about CAM among registered healthcare professions in surgical departments at Swedish university hospitals. Method A questionnaire was distributed to 1757 registered physicians, nurses and physiotherapists in surgical wards at the seven university hospitals in Sweden from spring 2010 to spring 2011. The questionnaire included classification of 21 therapies into conventional, complementary, alternative and integrative, and whether patients were recommended these therapies. Questions concerning knowledge, research, and patient communication about CAM were also included. Result A total of 737 (42.0% questionnaires were returned. Therapies classified as complementary; were massage, manual therapies, yoga and acupuncture. Alternative therapies; were herbal medicine, dietary supplements, homeopathy and healing. Classification to integrative therapy was low, and unfamiliar therapies were Bowen therapy, iridology and Rosen method. Therapies recommended by > 40% off the participants were massage and acupuncture. Knowledge and research about CAM was valued as minor or none at all by 95.7% respectively 99.2%. Importance of possessing knowledge about it was valued as important by 80.9%. It was believed by 61.2% that more research funding should be addressed to CAM research, 72.8% were interested in reading CAM-research results, and 27.8% would consider taking part in

  16. The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

    Directory of Open Access Journals (Sweden)

    Sina Waibel

    2015-07-01

    Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

  17. Patient's and health care provider's perspectives on music therapy in palliative care - an integrative review.

    Science.gov (United States)

    Schmid, W; Rosland, J H; von Hofacker, S; Hunskår, I; Bruvik, F

    2018-02-20

    The use of music as therapy in multidisciplinary end-of-life care dates back to the 1970s and nowadays music therapy (MT) is one of the most frequently used complementary therapy in in-patient palliative care in the US. However existing research investigated music therapy's potential impact mainly from one perspective, referring to either a quantitative or qualitative paradigm. The aim of this review is to provide an overview of the users' and providers' perspectives on music therapy in palliative care within one research article. A systematic literature search was conducted using several databases supplemented with a hand-search of journals between November 1978 and December 2016. Inclusion criteria were: Music therapy with adults in palliative care conducted by a certified music therapist. Both quantitative and qualitative studies in English, German or a Scandinavian language published in peer reviewed journals were included. We aimed to identify and discuss the perspectives of both patients and health care providers on music therapy's impact in palliative care to forward a comprehensive understanding of it's effectiveness, benefits and limitations. We investigated themes mentioned by patients within qualitative studies, as well as commonly chosen outcome measures in quantitative research. A qualitative approach utilizing inductive content analysis was carried out to analyze and categorize the data. Twelve articles, reporting on nine quantitative and three qualitative research studies were included. Seven out of the nine quantitative studies investigated pain as an outcome. All of the included quantitative studies reported positive effects of the music therapy. Patients themselves associated MT with the expression of positive as well as challenging emotions and increased well-being. An overarching theme in both types of research is a psycho-physiological change through music therapy. Both quantitative as well as qualitative research showed positive changes in

  18. Point-of-care technology: integration for improved delivery of care.

    Science.gov (United States)

    Gregory, Debbie; Buckner, Martha

    2014-01-01

    The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"?

  19. Organizational economics and health care markets.

    Science.gov (United States)

    Robinson, J C

    2001-04-01

    As health policy emphasizes the use of private sector mechanisms to pursue public sector goals, health services research needs to develop stronger conceptual frameworks for the interpretation of empirical studies of health care markets and organizations. Organizational relationships should not be interpreted exclusively in terms of competition among providers of similar services but also in terms of relationships among providers of substitute and complementary services and in terms of upstream suppliers and downstream distributors. This article illustrates the potential applicability of transactions cost economics, agency theory, and organizational economics more broadly to horizontal and vertical markets in health care. Examples are derived from organizational integration between physicians and hospitals and organizational conversions from nonprofit to for-profit ownership.

  20. Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

    Directory of Open Access Journals (Sweden)

    Cohen Eyal

    2012-10-01

    Full Text Available Abstract Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN, by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC. Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™], and family-centered care (MPOC-20®. Comparisons were made in equal (up to 1 year pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR $244 (981 per patient per month (PPPM pre-enrolment to $131 (355 PPPM post-enrolment (p=.007, driven primarily by fewer inpatient days in the tertiary care center (p=.006. Parents reported decreased out of pocket expenses (p© domains [Health Standardization Section (p=.04; Comfort and Emotions (p=.03], while total CPCHILD© score decreased between baseline and 1 year (p=.003. Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex

  1. Where the Mind Meets the Mouth – an integrated and collaborative health care approach

    OpenAIRE

    Martin, Rachel Ellen; Calache, Hanny; Richardson, Jessie; Krouskos, Demos; Hall, Martin; Bettega, Alyson; Chalmers-Robinson, Emily; Christian, Bradley

    2018-01-01

    Background: The majority of the cost of oral health care in Australia is borne by individuals, hence many miss out on early, cost-effective care. 63,000 Australians are hospitalised annually for preventable oral conditions. Current approaches separate the provision of oral from general health care. Australia’s National Oral Health Plan recognises oral health as everyone’s business and a role for health care workers and carers to intervene early in oral disease.Objectives: To present an innova...

  2. Population aging and its impacts: strategies of the health-care system in Taipei.

    Science.gov (United States)

    Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung

    2010-11-01

    Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.

  3. Accountable Care Organizations: Integrated Care Meets Market Power.

    Science.gov (United States)

    Scheffler, Richard M

    2015-08-01

    Will accountable care organizations (ACOs) deliver high-quality care at lower costs? Or will their potential market power lead to higher prices and lower quality? ACOs appear in various forms and structures with financial and clinical integration at their core; however, the tools to assess their quality and the incentive structures that will determine their success are still evolving. Both market forces and regulatory structures will determine how these outcomes emerge. This introduction reviews the evidence presented in this special issue to tackle this thorny trade-off. In general the evidence is promising, but the full potential of ACOs to improve the health care delivery system is still uncertain. This introductory review concludes that the current consensus is to let ACOs grow, anticipating that they will make a contribution to improve our poor-quality and high-cost delivery system. Copyright © 2015 by Duke University Press.

  4. The need for consumer behavior analysis in health care coverage decisions.

    Science.gov (United States)

    Thompson, A M; Rao, C P

    1990-01-01

    Demographic analysis has been the primary form of analysis connected with health care coverage decisions. This paper reviews past demographic research and shows the need to use behavioral analyses for health care coverage policy decisions. A behavioral model based research study is presented and a case is made for integrated study into why consumers make health care coverage decisions.

  5. Economic evaluation of integrated new technologies for health and social care: Suggestions for policy makers, users and evaluators.

    Science.gov (United States)

    Wildman, John; McMeekin, Peter; Grieve, Eleanor; Briggs, Andrew

    2016-11-01

    With an ageing population there is a move towards the use of assisted living technologies (ALTs) to provide social care and health care services, and to improve service processes. These technologies are at the forefront of the integration of health and social care. However, economic evaluations of ALTs, and indeed economic evaluations of any interventions providing both health benefits and benefits beyond health are complex. This paper considers the challenges faced by evaluators and presents a method of economic evaluation for use with interventions where traditional methods may not be suitable for informing funders and decision makers. We propose a method, combining economic evaluation techniques, that can accommodate health outcomes and outcomes beyond health through the use of a common numeraire. Such economic evaluations can benefit both the public and private sector, firstly by ensuring the efficient allocation of resources. And secondly, by providing information for individuals who, in the market for ALTs, face consumption decisions that are infrequent and for which there may be no other sources of information. We consider these issues in the welfarist, extra-welfarist and capabilities frameworks, which we link to attributes in an individual production model. This approach allows for the valuation of the health component of any such intervention and the valuation of key social care attributes and processes. Finally, we present a set of considerations for evaluators highlighting the key issues that need to be considered in this type of economic evaluation. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  6. Integrating a pharmacist into the general practice environment: opinions of pharmacist’s, general practitioner’s, health care consumer’s, and practice manager’s

    Directory of Open Access Journals (Sweden)

    Freeman Christopher

    2012-08-01

    Full Text Available Abstract Background Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment. Methods A sample of general practitioners, health care consumers, pharmacists and practice managers in South-East Queensland were invited to participate in focus groups or semi-structured interviews. Seeding questions common to all sessions were used to facilitate discussion. Sessions were audio recorded and transcribed verbatim. Leximancer software was used to qualitatively analyse responses. Results A total of 58 participants took part in five focus groups and eighteen semi-structured interviews. Concepts relating to six themes based on the seeding questions were identified. These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient’s medical file, and potential funding models. Conclusions These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners.

  7. Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

    Science.gov (United States)

    Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

    2018-04-16

    Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

  8. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

    Science.gov (United States)

    Bauer, M; Bach, A

    1998-06-01

    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law.

  9. A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.

    Science.gov (United States)

    Machta, Rachel M; Maurer, Kristin A; Jones, David J; Furukawa, Michael F; Rich, Eugene C

    2018-04-02

    Small independent practices are increasingly giving way to more complex affiliations between provider organizations and hospital systems. There are several ways in which vertically integrated health systems could improve quality and lower the costs of care. But there are also concerns that integrated systems may increase the price and costs of care without commensurate improvements in quality and outcomes. Despite a growing body of research on vertically integrated health systems, no systematic review that we know of compares vertically integrated health systems (defined as shared ownership or joint management of hospitals and physician practices) to nonintegrated hospitals or physician practices. We conducted a systematic search of the literature published from January 1996 to November 2016. We considered articles for review if they compared the performance of a vertically integrated health system and examined an outcome related to quality of care, efficiency, or patient-centered outcomes. Database searches generated 7,559 articles, with 29 articles included in this review. Vertical integration was associated with better quality, often measured as optimal care for specific conditions, but showed either no differences or lower efficiency as measured by utilization, spending, and prices. Few studies evaluated a patient-centered outcome; among those, most examined mortality and did not identify any effects. Across domains, most studies were observational and did not address the issue of selection bias. Recent evidence suggests the trend toward vertical integration will likely continue as providers respond to changing payment models and market factors. A growing body of research on comparative health system performance suggests that integration of physician practices with hospitals might not be enough to achieve higher-value care. More information is needed to identify the health system attributes that contribute to improved outcomes, as well as which policy levers

  10. Information Technology Adoption and Procedural Performance in Health Care

    Science.gov (United States)

    Shi, Yunfeng

    2010-01-01

    This dissertation studies two specific topics on information technologies in health care industry. (1) The status and change of integrated health care delivery system level IT spending and hospital level IT adoption between 1999 and 2006. (2) The potential link between hospital level IT adoptions and quality as quantified by procedural performance…

  11. Psychiatry's Role in the Management of Human Trafficking Victims: An Integrated Care Approach.

    Science.gov (United States)

    Gordon, Mollie; Salami, Temilola; Coverdale, John; Nguyen, Phuong T

    2018-03-01

    Human trafficking is an outrageous human rights violation with potentially devastating consequences to individuals and the public health. Victims are often underrecognized and there are few guidelines for how best to identify, care for, and safely reintegrate victims back into the community. The purpose of this paper is to propose a multifaceted, interdisciplinary, and interprofessional guideline for providing care and services to human trafficking victims. Databases such as PubMed and PsycINFO were searched for papers outlining human trafficking programs with a primary psychiatric focus. No integrated care models that provide decisional guidelines at different points of intervention for human trafficking patients and that highlight the important role of psychiatric consultation were found. Psychiatrists and psychologists are pivotal to an integrated care approach in health care settings. The provision of such a comprehensive and integrated model of care should facilitate the identification of victims, promote their recovery, and reduce the possibility of retraumatization.

  12. Organizational determinants of interprofessional collaboration in integrative health care: systematic review of qualitative studies.

    Directory of Open Access Journals (Sweden)

    Vincent C H Chung

    Full Text Available CONTEXT: Inteprofessional collaboration (IPC between biomedically trained doctors (BMD and traditional, complementary and alternative medicine practitioners (TCAMP is an essential element in the development of successful integrative healthcare (IHC services. This systematic review aims to identify organizational strategies that would facilitate this process. METHODS: We searched 4 international databases for qualitative studies on the theme of BMD-TCAMP IPC, supplemented with a purposive search of 31 health services and TCAM journals. Methodological quality of included studies was assessed using published checklist. Results of each included study were synthesized using a framework approach, with reference to the Structuration Model of Collaboration. FINDINGS: Thirty-seven studies of acceptable quality were included. The main driver for developing integrative healthcare was the demand for holistic care from patients. Integration can best be led by those trained in both paradigms. Bridge-building activities, positive promotion of partnership and co-location of practices are also beneficial for creating bonding between team members. In order to empower the participation of TCAMP, the perceived power differentials need to be reduced. Also, resources should be committed to supporting team building, collaborative initiatives and greater patient access. Leadership and funding from central authorities are needed to promote the use of condition-specific referral protocols and shared electronic health records. More mature IHC programs usually formalize their evaluation process around outcomes that are recognized both by BMD and TCAMP. CONCLUSIONS: The major themes emerging from our review suggest that successful collaborative relationships between BMD and TCAMP are similar to those between other health professionals, and interventions which improve the effectiveness of joint working in other healthcare teams with may well be transferable to promote better

  13. The Integrality of Situated Caring in Nursing and the Environment

    OpenAIRE

    Jarrin, Olga F.

    2012-01-01

    Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative-caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry.

  14. Integrative holism in psychiatric-mental health nursing.

    Science.gov (United States)

    Zahourek, Rothlyn P

    2008-10-01

    In this era of high-tech care, many Americans seek more holistic approaches and alternative and complementary treatments for health problems, including mental illness. Psychiatric-mental health (PMH) nurses need to be aware of these approaches as they assess clients, maintain a holistic approach, and in some cases, provide skilled, specific modalities. This article reviews holistic philosophy and integrative approaches relevant to PMH nurses. The emphasis is that whichever modality PMH nurses practice, a holistic framework is essential for providing optimal PMH care.

  15. Mental Health Nurse Incentive Program: facilitating physical health care for people with mental illness?

    Science.gov (United States)

    Happell, Brenda; Platania-Phung, Chris; Scott, David

    2013-10-01

    People with serious mental illness have increased rates of physical ill-health and reduced contact with primary care services. In Australia, the Mental Health Nurse Incentive Program (MHNIP) was developed to facilitate access to mental health services. However, as a primary care service, the contribution to physical health care is worthy of consideration. Thirty-eight nurses who were part of the MHNIP participated in a national survey of nurses working in mental health about physical health care. The survey invited nurses to report their views on the physical health of consumers and the regularity of physical health care they provide. Physical health-care provision in collaboration with general practitioners (GPs) and other health-care professionals was reported as common. The findings suggest that the MHNIP provides integrated care, where nurses and GPs work in collaboration, allowing enough time to discuss physical health or share physical health activities. Consumers of this service appeared to have good access to physical and mental health services, and nurses had access to primary care professionals to discuss consumers' physical health and develop their clinical skills in the physical domain. The MHNIP has an important role in addressing physical health concerns, in addition to the mental health issues of people accessing this service. © 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  16. [Implementing population-based integrated care for a region: a work-in-progress report on the project "Gesundes Kinzigtal"].

    Science.gov (United States)

    Hildebrandt, Helmut; Schmitt, Gwendolyn; Roth, Monika; Stunder, Brigitte

    2011-01-01

    The regional integrated care model "Gesundes Kinzigtal" pursues the idea of integrated health care with special focus on increasing the health gain of the served population. Physicians (general practitioners) and psychotherapists, physiotherapists, hospitals, nursing services, non-profit associations, fitness centers, and health insurance companies work closely together with a regional management company and its programs on prevention and care coordination and enhancement. The 10 year-project is run by a company that was founded by the physician network "MQNK" and "OptiMedis AG", a corporation with public health background specialising in integrated health care. The aim of this project is to enhance prevention and quality of health care for a whole region in a sustainable way, and to decrease costs of care. The article describes the special funding model of the project, the engagement of patients, and the different health and prevention programmes. The programmes and projects are developed, implemented, and evaluated by multidisciplinary teams. Copyright © 2011. Published by Elsevier GmbH.

  17. Deinstitutionalisation of mental health care in the Netherlands: towards an integrative approach

    Directory of Open Access Journals (Sweden)

    Dick P. Ravelli

    2006-03-01

    relation to building mental health care centres. Compared to other countries the bed rate in the Netherlands is still among the highest, although it is rapidly decreasing. Lessons from psychiatric reform in other countries emphasise the counterpart of deinstitutionalisation, especially issues such as the quality of alternative community treatment and increasing compulsory admission, while the closing down of old mental hospitals has caused a decrease in the availability of beds. In the Netherlands less attention has been paid to legislation, societal attitudes towards psychiatry, the roles of other care suppliers, the balancing and financing of care, the fate of psychiatric patients from old hospitals, the way to cope with the ever-increasing demand for psychiatric help and the actual quality of psychiatric help. A more integrative policy that includes all these aspects is desirable.

  18. Deinstitutionalisation of mental health care in the Netherlands: towards an integrative approach

    Science.gov (United States)

    Ravelli, Dick P.

    2006-01-01

    building mental health care centres. Compared to other countries the bed rate in the Netherlands is still among the highest, although it is rapidly decreasing. Lessons from psychiatric reform in other countries emphasise the counterpart of deinstitutionalisation, especially issues such as the quality of alternative community treatment and increasing compulsory admission, while the closing down of old mental hospitals has caused a decrease in the availability of beds. In the Netherlands less attention has been paid to legislation, societal attitudes towards psychiatry, the roles of other care suppliers, the balancing and financing of care, the fate of psychiatric patients from old hospitals, the way to cope with the ever-increasing demand for psychiatric help and the actual quality of psychiatric help. A more integrative policy that includes all these aspects is desirable. PMID:16896384

  19. Mandates for Collaboration: Health Care and Child Welfare Policy and Practice Reforms Create the Platform for Improved Health for Children in Foster Care.

    Science.gov (United States)

    Zlotnik, Sarah; Wilson, Leigh; Scribano, Philip; Wood, Joanne N; Noonan, Kathleen

    2015-10-01

    Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare. Copyright © 2015. Published by Elsevier Inc.

  20. [The elderly care practices of indigenous-performance of health].

    Science.gov (United States)

    Rissardo, Leidyani Karina; Alvim, Neide Aparecida Titonelli; Marcon, Sonia Silva; Carreira, Lígia

    2014-01-01

    This research aims to understand the care practices of health professionals who assist the elderly Kaingang. It is a qualitative study, supported in ethnography, conducted by ten professionals working in primary health care in the indigenous land of Faxinal, Paraná, Brazil. The data was collected from November 2010 to February 2012 by participant observation and interviews, and analyzed based on the Transcultural Care Theory. Was identified the preoccupation of the carers practices with the medication and immunization, as well as traditional medical care. To achieve these, care professionals had strategies that implemented maintenance of older people in care. We conclude that cultural values and integrate scientific need assistance to improve the health of elderly indigenous.

  1. Integrating the Integrated Care Organisation – Optimising Resources, Operations, and Services to Create Real Value

    OpenAIRE

    Yap, Jason

    2018-01-01

    Introduction: Implementing Integrated Care to promote and protect the health of organisations is massively complex. Historically, healthcare practitioners thought in terms of single patient acute care encounters within healthcare facilities, and seek to help the patient become “apparently well” again. With an ageing population, multiple morbidities, complex socioeconomic factors, and increasing costs, we must now reconsider our paradigms.In Singapore, the focus has been on our “models of care...

  2. Mental health service users' experiences of diabetes care by Mental Health Nurses: an exploratory study.

    Science.gov (United States)

    Nash, M

    2014-10-01

    This paper is a report of a study exploring mental health service users' (MHSUs') experiences of diabetes care. Diabetes is a growing clinical concern in mental health nursing practice. However, little is known about MHSUs' experience of diabetes care. This is a descriptive qualitative study. Semi-structured telephone interviews were held between June and October 2011, with seven MHSUs who had diabetes. Participants reported experiences of stigma and diagnostic overshadowing (DO) when reporting symptoms of diabetes or when feeling unwell. Participants also encountered a split between their mental health and diabetes care needs, which resulted in a lack of holistic or integrated care. All participants mentioned experiencing complications of diabetes even to the extent of diabetic ketoacidosis. Mental health nurses (MHNs) must critically reflect on their attitudes towards service users that report physical symptoms to ensure that stigma and DO do not constitute barriers to appropriate screening and treatment. The complex relationship that exists between mental illness and diabetes requires MHNs to ensure physical and mental health care are wholly integrated and not split. Education needs are apparent so that symptoms and complications can be recognized and treated accordingly. © 2014 John Wiley & Sons Ltd.

  3. Quality Improvement in Health Care: The Role of Psychologists and Psychology.

    Science.gov (United States)

    Bonin, Liza

    2018-02-21

    Quality Improvement (QI) is a health care interprofessional team activity wherein psychology as a field and individual psychologists in health care settings can and should adopt a more robust presence. The current article makes the argument for why psychology's participation in QI is good for health care, is good for our profession, and is the right thing to do for the patients and families we serve. It reviews the varied ways individual psychologists and our profession can integrate quality processes and improve health care through: (1) our approach to our daily work; (2) our roles on health care teams and involvement in organizational initiatives; (3) opportunities for teaching and scholarship; and (4) system redesign and advocacy within our health care organizations and health care environment.

  4. Integrated care for diabetes - The Singapore Approach

    Directory of Open Access Journals (Sweden)

    Su Qian Yeo

    2012-03-01

    Full Text Available Background The prevalence of diabetes mellitus is 12.7% in Singapore. Managing people with diabetes in the community may be needed to reduce unnecessary utilisation of expensive specialist resources and to reduce hospital waiting times for patients with complications. Care Practice The Singapore General Hospital (SGH Delivering on Target (DOT Programme was launched in 2005 to right-site clinically stable diabetic patients from the hospital to private DOT GPs. The Chronic Disease Management Office (CDMO was established and a fully customised DOT information technology (IT system was developed. Three initiatives were implemented: (i Subsidised Drug Delivery Programme, (ii Diagnostic Tests Incentive Programme, and (iii Allied Healthcare Incentive Programme. Discussion Right-siting was enabled through patient incentives that eased the burden of out-of-pocket expenditure. Right Siting Officers (RSOs maintained a general oversight of the patient pathway. The integrated system supported shared care follow-up by enabling DOT GPs to share updates on the patients' health status with the referring specialists. Conclusion A coherent process across all healthcare providers similar to the SGH DOT Programme may facilitate efforts to shift the care for people with diabetes to the community and to provide integrated care. Successful integration may require incentives for institutional partners and patients.

  5. Cross-Cultural Validation of the Patient Perception of Integrated Care Survey.

    Science.gov (United States)

    Tietschert, Maike V; Angeli, Federica; van Raak, Arno J A; Ruwaard, Dirk; Singer, Sara J

    2017-07-20

    To test the cross-cultural validity of the U.S. Patient Perception of Integrated Care (PPIC) Survey in a Dutch sample using a standardized procedure. Primary data collected from patients of five primary care centers in the south of the Netherlands, through survey research from 2014 to 2015. Cross-sectional data collected from patients who saw multiple health care providers during 6 months preceding data collection. The PPIC survey includes 59 questions that measure patient perceived care integration across providers, settings, and time. Data analysis followed a standardized procedure guiding data preparation, psychometric analysis, and included invariance testing with the U.S. dataset. Latent scale structures of the Dutch and U.S. survey were highly comparable. Factor "Integration with specialist" had lower reliability scores and noninvariance. For the remaining factors, internal consistency and invariance estimates were strong. The standardized cross-cultural validation procedure produced strong support for comparable psychometric characteristics of the Dutch and U.S. surveys. Future research should examine the usability of the proposed procedure for contexts with greater cultural differences. © Health Research and Educational Trust.

  6. Integration of Massage Therapy in Outpatient Cancer Care.

    Science.gov (United States)

    Cowen, Virginia S; Tafuto, Barbara

    2018-03-01

    Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care. The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers. This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62). Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis. The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally. The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all-not even provision of information about massage to patients through the center website. The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care.

  7. Ethical thinking and discrimination in health care

    Directory of Open Access Journals (Sweden)

    Aleksander Mlinšek

    2012-02-01

    Full Text Available RQ: Personal excellence of nursing focusing on self-transcendence and achievements is crucial for achieving excellence in health care. The question is whether there is unequal treatment of patients despite high ethical standards placed in health care.Purpose: Professional nurses code is a guide in assessing their ethical performance. People are different amongst each other, but have the same rights in the health system, which should be provided by health care services. The need to overcome inequalities has become a cornerstone of excellence in health care.Method: A small quantitative survey of nurses was conducted in one of the departments in a Slovenian hospital. To analyse the results, we used frequency statistics, Spearman's rank correlation test and chi-square test. Results: Providers of health care services are aware of the importance of ethics in its formation. Professional Code is relatively well known; 8.4 % of the respondents were not sure if they clearly define the principles of respect for equality. Discrimination, caused by providers of health care, is of a less extent. Ethical awareness among health care providers does not affect identification with the profession. The education level ofnursing personnel and the perception of discrimination based on religious affiliation influenced one another. Education has no influence on the perception of discrimination based on other circumstances.Organization: Health care organizations should integrate hygieneethical thinking among its strategic goals. Quality is not only quantifying the data. Personal excellence of health care providers, which is difficult to measure, is the basic building block of organizational excellence and patient satisfaction.Originality: There are not many research studies on perceptionsof discrimination in health care. The article raises the sensitive issue that we should talk more about.Limitations: The survey was conducted on a small sample size. Further research

  8. Patient Segmentation Analysis Offers Significant Benefits For Integrated Care And Support.

    Science.gov (United States)

    Vuik, Sabine I; Mayer, Erik K; Darzi, Ara

    2016-05-01

    Integrated care aims to organize care around the patient instead of the provider. It is therefore crucial to understand differences across patients and their needs. Segmentation analysis that uses big data can help divide a patient population into distinct groups, which can then be targeted with care models and intervention programs tailored to their needs. In this article we explore the potential applications of patient segmentation in integrated care. We propose a framework for population strategies in integrated care-whole populations, subpopulations, and high-risk populations-and show how patient segmentation can support these strategies. Through international case examples, we illustrate practical considerations such as choosing a segmentation logic, accessing data, and tailoring care models. Important issues for policy makers to consider are trade-offs between simplicity and precision, trade-offs between customized and off-the-shelf solutions, and the availability of linked data sets. We conclude that segmentation can provide many benefits to integrated care, and we encourage policy makers to support its use. Project HOPE—The People-to-People Health Foundation, Inc.

  9. What can a participatory approach to evaluation contribute to the field of integrated care?

    Science.gov (United States)

    Eyre, Laura; Farrelly, Michael; Marshall, Martin

    2017-07-01

    Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge. Participatory approaches are characterised by a desire to use social science methods to solve practical problems and a commitment on the part of researchers to substantive and sustained collaboration with relevant stakeholders. We describe how we applied an emerging practical model of participatory research, the researcher-in-residence model, to evaluate a large-scale integrated care programme in the UK. We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms. While there is still much to learn about the benefits and challenges of applying participatory approaches in the health sector, we demonstrate how using such approaches have the potential to help practitioners integrate care more effectively in their daily practice and help progress the academic study of integrated care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Integrating mHealth at point of care in low- and middle-income settings: the system perspective.

    Science.gov (United States)

    Wallis, Lee; Blessing, Paul; Dalwai, Mohammed; Shin, Sang Do

    2017-06-01

    While the field represents a wide spectrum of products and services, many aspects of mHealth have great promise within resource-poor settings: there is an extensive range of cheap, widely available tools which can be used at the point of care delivery. However, there are a number of conditions which need to be met if such solutions are to be adequately integrated into existing health systems; we consider these from regulatory, technological and user perspectives. We explore the need for an appropriate legislative and regulatory framework, to avoid 'work around' solutions, which threaten patient confidentiality (such as the extensive use of instant messaging services to deliver sensitive clinical information and seek diagnostic and management advice). In addition, we will look at other confidentiality issues such as the need for applications to remove identifiable information (such as photos) from users' devices. Integration is dependent upon multiple technological factors, and we illustrate these using examples such as products made available specifically for adoption in low- and middle-income countries. Issues such as usability of the application, signal loss, data volume utilization, need to enter passwords, and the availability of automated or in-app context-relevant clinical advice will be discussed. From a user perspective, there are three groups to consider: experts, front-line clinicians, and patients. Each will accept, to different degrees, the use of technology in care - often with cultural or regional variation - and this is central to integration and uptake. For clinicians, ease of integration into daily work flow is critical, as are familiarity and acceptability of other technology in the workplace. Front-line staff tend to work in areas with more challenges around cell phone signal coverage and data availability than 'back-end' experts, and the effect of this is discussed.

  11. The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home

    Science.gov (United States)

    Stoop, Annerieke; Billings, Jenny; Leichsenring, Kai; Ruppe, Georg; Tram, Nhu; Barbaglia, María Gabriela; Ambugo, Eliva A.; Zonneveld, Nick; Paat-Ahi, Gerli; Hoffmann, Henrik; Khan, Usman; Stein, Viktoria; Wistow, Gerald; Lette, Manon; Jansen, Aaltje P.D.; Nijpels, Giel; Baan, Caroline A.

    2018-01-01

    Introduction: Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project. Methods: SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans, evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap. Discussion: SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home. PMID:29632456

  12. Interpretations of integration in early accountable care organizations.

    Science.gov (United States)

    Kreindler, Sara A; Larson, Bridget K; Wu, Frances M; Carluzzo, Kathleen L; Gbemudu, Josette N; Struthers, Ashley; VAN Citters, Aricca D; Shortell, Stephen M; Nelson, Eugene C; Fisher, Elliott S

    2012-09-01

    It is widely hoped that accountable care organizations (ACOs) will improve health care quality and reduce costs by fostering integration among diverse provider groups. But how do implementers actually envision integration, and what will integration mean in terms of managing the many social identities that ACOs bring together? Using the lens of the social identity approach, this qualitative study examined how four nascent ACOs engaged with the concept of integration. During multiday site visits, we conducted interviews (114 managers and physicians), observations, and document reviews. In no case was the ACO interpreted as a new, overarching entity uniting disparate groups; rather, each site offered a unique interpretation that flowed from its existing strategies for social-identity management: An independent practice association preserved members' cherished value of autonomy by emphasizing coordination, not "integration"; a medical group promoted integration within its employed core, but not with affiliates; a hospital, engaging community physicians who mistrusted integrated systems, reimagined integration as an equal partnership; an integrated delivery system advanced its careful journey towards intergroup consensus by presenting the ACO as a cultural, not structural, change. The ACO appears to be a model flexible enough to work in synchrony with whatever social strategies are most context appropriate, with the potential to promote alignment and functional integration without demanding common identification with a superordinate group. "Soft integration" may be a promising alternative to the vertically integrated model that, though widely assumed to be ideal, has remained unattainable for most organizations. © 2012 Milbank Memorial Fund.

  13. Systematic Review of Integrative Health Care Research: Randomized Control Trials, Clinical Controlled Trials, and Meta-Analysis

    OpenAIRE

    Khorsan, Raheleh; Coulter, Ian D.; Crawford, Cindy; Hsiao, An-Fu

    2010-01-01

    A systematic review was conducted to assess the level of evidence for integrative health care research. We searched PubMed, Allied and Complementary Medicine (AMED), BIOSIS Previews, EMBASE, the entire Cochrane Library, MANTIS, Social SciSearch, SciSearch Cited Ref Sci, PsychInfo, CINAHL, and NCCAM grantee publications listings, from database inception to May 2009, as well as searches of the “gray literature.” Available studies published in English language were included. Three independent re...

  14. Proposal to integrate the service on radiation hygiene at the primary health care services for workers exposed to ionizing radiation

    International Nuclear Information System (INIS)

    Frometa Suarez, Ileana; Lopez Pumar, Georgina; Gonzalez Amil, Melva

    1998-01-01

    The National Health System implemented in the last few years a new pattern of primary attention for workers by creating doctors offices in work centers. At the same time, the Ministry of Public Health (MINSAP) carries the medical surveillance of the staff exposed to ionizing radiation. This work proposes a program to integrate the consulting room on radiation hygiene to primary health care services for workers that work with ionizing radiation sources, aiming to ameliorate and improve them

  15. Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Myers, Bronwyn; Lund, Crick; Lombard, Carl; Joska, John; Levitt, Naomi; Butler, Christopher; Cleary, Susan; Naledi, Tracey; Milligan, Peter; Stein, Dan J; Sorsdahl, Katherine

    2018-03-16

    In low- and middle-income countries (LMIC), it is uncertain whether a "dedicated" approach to integrating mental health care (wherein a community health worker (CHW) has the sole responsibility of delivering mental health care) or a "designated" approach (wherein a CHW provides this service in addition to usual responsibilities) is most effective and cost-effective. This study aims to compare the effectiveness and cost-effectiveness of these two models of service integration relative to treatment as usual (TAU) for improving mental health and chronic disease outcomes among patients with HIV or diabetes. This is a cluster randomised trial. We will randomise 24 primary health care facilities in the Western Cape Province of South Africa to one of three study arms. Within each cluster, we will recruit 25 patients from HIV and 25 from diabetes services for a total sample of 1200 participants. Eligible patients will be aged 18 years or older, take medication for HIV or diabetes, and screen positive on the Alcohol Use Disorder Identification Test for hazardous/harmful alcohol use or depression on the Centre for Epidemiology Scale on Depression. Participants recruited in clinics assigned to the designated or dedicated approach will receive three sessions of motivational interviewing and problem-solving therapy, while those recruited at TAU-assigned clinics will be referred for further assessment. Participants will complete an interviewer-administered questionnaire at baseline, and at 6 and 12 months post-enrolment to assess change in self-reported outcomes. At these end points, we will test HIV RNA viral load for participants with HIV and HbA1c levels for participants with diabetes. Primary outcomes are reductions in self-reported hazardous/harmful alcohol use and risk of depression. Secondary outcomes are improvements in adherence to chronic disease treatment, biomarkers of chronic disease outcomes, and health-related quality of life. Mixed-effect linear regression models

  16. Co-Creating an Expansive Health Care Learning System.

    Science.gov (United States)

    Cribb, Alan; Owens, John; Singh, Guddi

    2017-11-01

    How should practices of co-creation be integrated into health professions education? Although co-creation permits a variety of interpretations, we argue that realizing a transformative vision of co-creation-one that invites professionals to genuinely reconsider the purposes, relationships, norms, and priorities of health care systems through new forms of collaborative thought and practice-will require radically rethinking existing approaches to professional education. The meaningful enactment of co-creative roles and practices requires health professionals and students to negotiate competing traditions, pressures, and expectations. We therefore suggest that the development of what we call an "expansive health care learning system" is crucial for supporting learners in meeting the challenges of establishing genuinely co-creative health care systems. © 2017 American Medical Association. All Rights Reserved.

  17. The development of an integrated Indonesian health care model using Kano's model, quality function deployment and balanced scorecard

    Science.gov (United States)

    Jonny, Zagloed, Teuku Yuri M.

    2017-11-01

    This paper aims to present an integrated health care model for Indonesian health care industry. Based on previous researches, there are two health care models in the industry such as decease- and patient-centered care models. In their developments, the patient-centered care model is widely applied due to its capability in reducing cost and improving quality simultaneously. However, there is still no comprehensive model resulting in cost reduction, quality improvement, patient satisfaction and hospital profitability simultaneously. Therefore, this research is intended to develop that model. In doing so, first, a conceptual model using Kano's Model, Quality Function Deployment (QFD) and Balanced Scorecard (BSC) is developed to generate several important elements of the model as required by stakeholders. Then, a case study of an Indonesian hospital is presented to evaluate the validity of the model using correlation analysis. As a result, it can be concluded that the model is validated implying several managerial insights among its elements such as l) leadership (r=0.85) and context of the organization (r=0.77) improve operations; 2) planning (r=0.96), support process (r=0.87) and continual improvement (r=0.95) also improve operations; 3) operations improve customer satisfaction (r=0.89) and financial performance (r=0.93) and 4) customer satisfaction improves the financial performance (0.98).

  18. The Integrality of Situated Caring in Nursing and the Environment

    Science.gov (United States)

    Jarrin, Olga F.

    2012-01-01

    Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative-caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry. PMID:22222236

  19. Integrated care in the daily work: coordination beyond organisational boundaries.

    Science.gov (United States)

    Petrakou, Alexandra

    2009-07-09

    In this paper, integrated care in an inter-organisational cooperative setting of in-home elderly care is studied. The aim is to explore how home care workers coordinate their daily work, identify coordination issues in situ and discuss possible actions for supporting seamless and integrated elderly care at home. The empirical findings are drawn from an ethnographic workplace study of the cooperation and coordination taking place between home care workers in a Swedish county. Data were collected through observational studies, interviews and group discussions. The paper identifies a need to support two core issues. Firstly, it must be made clear how the care interventions that are currently defined as 'self-treatment' by the home health care should be divided. Secondly, the distributed and asynchronous coordination between all care workers involved, regardless of organisational belonging must be better supported. Integrated care needs to be developed between organisations as well as within each organisation. As a matter of fact, integrated care needs to be built up beyond organisational boundaries. Organisational boundaries affect the planning of the division of care interventions, but not the coordination during the home care process. During the home care process, the main challenge is the coordination difficulties that arise from the fact that workers are distributed in time and/or space, regardless of organisational belonging. A core subject for future practice and research is to develop IT tools that reach beyond formal organisational boundaries and processes while remaining adaptable in view of future structure changes.

  20. Evidence on the Efficacy of Integrated Care

    DEFF Research Database (Denmark)

    Larsen, Torben

    to European health regions. Method Systematic review of the literature on clinical continuity as complemented by trials and surveys within this project. Preliminary results 1. Integrated home care (IHC) is the most promising approach to better clinical continuity from the point of view of cost...... million new patients per year in EU might benefit from IHC. 3. As IHC improves activities of daily living (ADL) which implicates long term savings in social care services the working hypothesis is that IHC is a health economic dominant intervention. This enables a meso-strategy of dissemination focusing......  Purpose The fragmented delivery of health and social services for large groups of patients with chronic conditions was put on the research agenda in 2002 by WHO. The FP7-IHC-project ( http://www.integratedhomecare.eu/ ) aims to develop a turn-key-solution for better clinical continuity...