SUSTAIN: Sustainable tailored integrated care for older people in Europe

Problem: The project started from their observation that in all European countries, care for older people is often poorly coordinated. This prevents care from adequately meeting the needs of older adults, and it shows that quality of care and outcomes could be much improved.

Solutions:  SUSTAIN will in particular aim to support and improve what we call ‘integrated care’. By a better ‘integration’ of care, it means that: care for older people is better organised, and professionals coordinate the care they deliver; older persons’ health and social care needs are well assessed; care services listen carefully to older persons and informal carers, seek to involve them in the decisions affecting them and deliver care in line with their needs and preferences as much as they can (‘person-centred care’); professionals from different disciplines (prevention, healthcare, social care) are included in the care team, and different types of support are offered (including ...

The integration of health and social care services

The Government is committed to the introduction of a single-tier health service, supported by universal health insurance (UHI). Under UHI, everyone will be insured for a standard package of primary and hospital care services, including mental health services. It is understood that primary and hospital care will be funded mainly via the UHI system and social care services and public health services will be funded by general taxation. While funded separately, these services will need to be delivered in an integrated manner around the needs of the person. This review considers the international evidence in relation to mechanisms and structures used to integrate health services (provided under UHI) and social care services.

The theory and practice of integrative health care governance: the case of New Zealand´s alliances

The purpose of this paper is to outline the theory and practice of governance for integrated care, using the case of New Zealand´s healthcare alliances.

This paper argued that the new "experimental" governance models are needed for effective development of integrated care, illustrated through the example of alliance governance in New Zealand. While the alliances are in a relatively incipient state, they hold considerable promise when compared with the alternatives: corporate, democratic or clinical governance. Alliance governance provides for a different way of working, and for boldstering clinical leadership as central to this. 

The Effective Use of Psychiatric Mental Health Nurses in Integrated Care: Policy Implications for Increasing Quality and Access to Care

In the last ten years primary care providers have been encouraged to implement integrated models of care where individuals' medical and mental health needs are addressed holistically. Many integrated models use Psychiatric Mental Health (PMH) nurses as case managers and select exemplars use PMH Advanced Practice Nurses (APNs) as providers. However, the potential value of PMH nurses in integrated health care remains unrealized by health care planners and payers, limiting access to services for the populations most in need of comprehensive care approaches. This current situation is partially fueled by insufficient knowledge of the roles and skill sets of PMH nurses. In this paper, the PMH RN and APN skill sets are detailed, demonstrating how effective use of these nurses can further the aims of integrated care models. Finally, outlined are barriers and enabling factors to effective use of PMH RNs and APNs and attendant policy implications.

Integrated team working: a literature review

This literature review was conducted to provide a background understanding of the literature around integrated health and social care prior to a research proyect evaluating two integrated health and social care teams in England, UK. 

Harnessing the Electronic Health Record to Advance Integrated Care

Integrated health care is utilized in primary care clinics to meet patients' physical, behavioral, and social needs. Current methods to collect and evaluate the effectiveness of integrated care require refinement. Using informatics and electronic health records (EHR) to distill large amounts of clinical data may help researchers measure the impact of integrated care more efficiently. This exploratory pilot study aimed to (a) determine the feasibility of using EHR documentation to identify behavioral health and social care components of integrated care, using social work as a use case, and (b) develop a lexicon to inform future research using natural language processing.