Models of Integrated Care: The global experience

This Global Experience Paper on Integrated Health Care was developed to provide the Primary Health Care Institute (PHCI) in Libya with insights as it designs and develops its plans to rebuild primary health care (PHC). The findings are informed by a review of recent international literature, and by insights provided by selected international experts. The paper uses the Framework on Integrated, People-Centered Health Services from the World Health Organization to structure the analysis of global experiences. Overall, there is no single model of integration that can or should be adopted in countries seeking to develop primary health care. There is, however, evidence of good practice in designing and developing local, context-specific solutions. Evidence to support effective strategies and policies relevant for conflict-affected situations is scarce. However, there are some common themes and issues relating to the need to rebuild trust in the quality and safety of services; to build from ...

Population health management in primary health care: a proactive approach to improve health and well-being: primary heath care policy paper series

Overview

Population health management can play a critical role in strengthening primary health care (PHC) by providing a data-driven, people-centred and proactive approach to managing the health and well-being of a defined population. By identifying subgroups with similar characteristics and needs, population health management can enable PHC providers to move from a one-size-fits-all approach to targeted and tailored interventions that account for the needs of different groups and individuals. By focusing on the social determinants of health and psychosocial needs, population health management can help PHC providers in adopting a holistic and proportionate universalism approach to address health inequalities at the community level. This publication identifies key success factors at the system, organizational and clinical levels to enable population health management in PHC. It includes 12 country examples from across the WHO European Region showing how population health management is used in PHC. The publication provides a set of 16 ...

Integrated Care for Older People: Theories and Practices

As the first Chinese monograph to explicitly connect the “Yiyang Jiehe” with “integrated care for older people”, this book presents readers with a thorough overview of integrated care for older people, from theoretical content, management tools, to practices in China and international learning.

Transnational Forum on Integrated Community Care (TransForm)

Citizen Leadership & Integrated Care Report

Integrated care is at its heart about health, social care and wider services being better coordinated around people, families, and communities. This requires those who plan, design, and deliver services to understand what is important to people on an individual and collective basis. People’s circumstances and aspirations may change with their health conditions and social situations and through new challenges arising in wider society. It is therefore important that opportunities to influence and co-produce services are not a one-off exercise, but rather are ongoing and responsive to people’s interests and perspectives.

Professor Robin Miller and Dr Caroline Jackson (Social Care theme) have been collaborating with research partners in Europe and Canada to understand how people with lived experience of health and/or social care can influence the development of integrated care.

The first report from the research is now available for download: Citizen Leadership & Integrated Care Report.

IFIC Scotland Integrated Care Matters: Webinar Series 7

IFIC Scotland and partners are delighted to announce the webinars in our Integrated Care Matters Series 7. This series will consider innovations in holistic and personalised approaches to integrated care and support.

Each webinar will be accompanied by a topic resource with links to further information. All who register will receive links to the recordings and topic resources.

Join us @IFICInfo #IFICScotland for #IntegratedCareMatters7

The Lancet Global Health Commission on financing primary health care: putting people at the centre

Person-centred care and measurement: The more one sees, the better one knows where to look

Determining the quality of a health system is a complex and challenging endeavour. The variety of perspectives needed to determine quality means that increasingly complex measurement frameworks are often employed. Providing the best possible health care has always been a priority for health system leaders, individual professions and individual professionals. But the importance and significance of measuring quality has increased since the evolution of quality-improvement methodologies for health-care quality standardisation in the 1990s.

Audit and feedback systems evolved into quality-control methods with the increased industrialisation of health systems. As the patient voice became increasingly important, with the rise in advocacy groups and patient-representative organisations, the focus on controlling the quality of services through a managerialist ideology was challenged. Broader, more inclusive, approaches to quality were embraced. Quality-improvement methodologies aim to adopt an inclusive approach to ongoing quality enhancement, ensuring that services are continuously developed and improved. This evolutionary context is ...

Developing New Methods for Person-Centred Approaches to Adjudicate Context–Mechanism–Outcome Configurations in Realist Evaluation

Realist evaluation provides a general method of evaluating the application of interventions including policy, legislation, projects, and new processes in social settings such as law enforcement, healthcare and education. Realist evaluation focuses on what about interventions works, for whom, and in what circumstances, and there is a growing body of work using realist evaluation to analyse interventions in healthcare organizations, including those using Lean Six Sigma improvement methodologies.

Whilst realist evaluation facilitates the analysis of interventions using both qualitative and quantitative research, there is little guidance given on methods of data collection and analysis.

The purpose of this study is to address this lack of guidance through detailing the use of innovative person-centred methods of data collection and analysis in a realist evaluation that enabled us to understand the contribution of Lean Six Sigma to person-centred care and cultures.

This use of person-centred principles in the adjudication of identified program ...

The Leadership of Co-Production in Health and Social Care Integration in Scotland: A Qualitative Study

The involvement of citizens in the production and creation of public services has become a central tenet for administrations internationally. In Scotland, co-production has underpinned the integration of health and social care via the Public Bodies (Joint Working) (Scotland) Act 2014. We report on a qualitative study that examined the experiences and perspectives of local and national leaders in Scotland on undertaking and sustaining co-production in public services. By adopting a meso and macro perspective, we interviewed senior planning officers from eight health and social care partnership areas in Scotland and key actors in national agencies. The findings suggest that an overly complex Scottish governance landscape undermines the sustainability of co-production efforts. As part of a COVID-19 recovery, both the implementation of meaningful co-production and coordinated leadership for health and social care in Scotland need to be addressed, as should the development of evaluation capacities of those working across health ...

The state of integrated care systems 2021/22

An assessment of integrated care systems' progress in 2021/22, based on the views of system leaders across England

Though they have been in operation for several years in many parts of the country, integrated care systems (ICSs) across England are set to become new statutory bodies from July 2022. This will represent a significant shift in how health and care services are planned and delivered – away from the model of fragmentation and competition followed in previous decades (and reinforced through the Health and Social Care Act 2012), and towards one of collaboration between services.

“ICSs are a revolution in the mindset, not just a reorganisation of services.” A system leader

As we look ahead to July, this report seeks to assess the progress made so far. It presents the views of system leaders in autumn 2021, both on where they feel they have progressed well and where improvements are ...

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Measuring Older Peoples’ Experiences of Person-Centred Coordinated Care: Experience and Methodological Reflections from Applying a Patient Reported Experience Measure in SUSTAIN

While several evaluation studies on (cost-)effectiveness of integrated care have been conducted in recent years, more insight is deemed necessary into integrated care from the perspective of service users.

In the context of a European project on integrated care for older people living at home (SUSTAIN), this paper shares the experience and methodological reflections from applying a Patient Reported Experience Measure (PREM) on person-centred coordinated care -the P3CEQ- among this population.

Exploring the Quality Paradigms in Integrated Care: The Need for Emergence and Reflection

There are four quality paradigms, of which the Empirical and Reference paradigm fit best in stable circumstances, and the Reflective and Emergence paradigms, which fit best in unstable circumstances.

This study aims to explore the use of the four quality paradigms in integrated care, and to shed light on the different paradigmatic commitments and different perspectives on quality.

Co-Design for People-Centred Care Digital Solutions: A Literature Review

The implementation of people-centred care requires strategies that respond to local conditions and contexts, with the participation of local stakeholders in collaborative approaches such as co-design. Within this framework, the authors performed a literature review to identify the most implemented practices in health and social care services for co-designing digital solutions.

Nothing for us, without us: opportunities for meaningful engagement of people living with NCDs

People living with NCDs (PLWNCDs) are experts in their own right and if meaningfully engaged can be key partners and drivers in the co-creation, implementation and evaluation of NCD policies, programs, and services. 

This report is a result of the WHO Informal Consultation on PLWNCDs and outlines the participatory methods, main themes discussed and key next steps to further support meaningful engagement.

Service Delivery Reforms for Asian Ageing Societies: A Cross-Country Study Between Japan, South Korea, China, Thailand, Indonesia, and the Philippines

Japan’s health policies to address the most advanced-aged society have been the target of focus in Asia, but no studies have investigated this issue using tools for cross-country comparisons.

A cross-country study design was used to compare healthcare reform policies with a framework in Japan, Korea, Thailand, China, Indonesia, and the Philippines. Data were collected via document reviews and key informant interviews.

Three distinctions were identified. First, all countries except for the Philippines have policy decisions regarding reforms for the existing service delivery systems for healthcare, long-term care and welfare. Second, the most extensive service delivery reform is currently being implemented in Japan, whose system is shifting to primary health care. Third, the direction of the transformation of service delivery system is different between Thailand and China despite a similar level of ageing society. China has made progress on facility-based care integration between health and social care, whereas Thailand ...

Co-Creating Descriptors and a Definition for Person-Centred Coordinated Health Care: An Action Research Study

The aim of this study was to co-create a definition and generic descriptors for person-centred coordinated care for Ireland generated from service users’ narratives.

An overarching action research approach was used to engage and empower people to tangibly impact health policy and practice. Through focus groups and a qualitative survey, primary data were collected from a national sample of health services users, caregivers and health care service users’ representative groups. Thematic analysis was used to analyse the data. Three major themes were co-produced as essential care elements. These were: ‘My experience of healthcare’, ‘Care that I am confident in’ and ‘My journey through healthcare’. Through an IPPOSI partner project steering group and their membership groups’ contribution, these themes were further refined into a definition of person-centred coordinated care and nineteen related generic descriptors.

Key findings demonstrate that within complex, fragmented healthcare systems, the subjective expectations of service users should be ...

Applying Elinor Ostrom’s Design Principles to Guide Co-Design in Health(care) Improvement: A Case Study with Citizens Returning to the Community from Jail in Los Angeles County

Increased interest in collaborative and inclusive approaches to healthcare improvement makes revisiting Elinor Ostrom’s ‘design principles’ for enabling collective management of common pool resources (CPR) in polycentric systems a timely endeavour.

Ostrom proposed a generalisable set of eight core design principles for the efficacy of groups. To consider the utility of Ostrom’s principles for the planning, delivery, and evaluation of future health(care) improvement, the autors retrospectively applied them to a recent co-design project.

Three distinct aspects of co-design were identified through consideration of the principles. These related to: (1) understanding and mapping the system (2) upholding democratic values and (3) regulating participation. Within these aspects, four of Ostrom’s eight principles were inherently observed. Consideration of the remaining four principles could have enhanced the systemic impact of the co-design process.

Reconceptualising co-design through the lens of CPR offers new insights into the successful system-wide application of such ...

Person-centred care 4 sustainable health systems - How to transform health care in the post-pandemic era

This virtual conference, organised by the European Project COSTCARES (www.costcares.eu), a European network for improved quality of care and cost containment, will focus on the implementation of person-centred care from different European perspectives.

Your are welcome to participate in this free event. Registration deadline:10 March 2021

Further information, panelists and programme

Registration

JICA Special Issue: Integrated Palliative and End of Life Care for People with Advanced Dementia or Frailty

This special issue now seems uncannily prescient in view of the devastating impact of COVID-19 on people with advanced dementia or severe frailty, particularly in care homes.

The pandemic has heightened awareness of the possibility of a sudden and rapid transition from relative health to a palliative or end of life stage. This has opened up conversations about the potential burden from intensive treatments that are likely to be futile and the benefits of advance care planning.

The collection of papers in this special issue will be of interest to readers involved in planning, commissioning or delivering palliative and end of life care services for our most vulnerable citizens at this time, whether at home or in a hospital, care home or hospice.

Read the full Guest Editorial and the collection of papers of this special issue

Emerging Researchers and Professionals in Integrated Care (ERPIC) to launch a Journal Club

In 2021, Emerging Researchers and Professionals in Integrated Care (ERPIC) is preparing to launch a new networking activity: ERPIC Journal Club! Beginning in February, every 2 months the ERPIC Journal Club will host discussion sessions with the author(s) of foundational academic articles on integrated care. Details will follow.

In March 2021, the second round of the ERPIC Mentorship Program will commence. A call will be advertised for Mentors and Mentees in January.

Book reviews are still open! In collaboration with the International Journal of Integrated Care (IJIC), a list of books on integrated care to be reviewed is available. ERPIC members are invited to choose a book to review (a free copy will be sent to you) and your review will be published in IJIC.

Join ERPIC today!   Link (https://integratedcarefoundation.org/emerging-researchers-professionals-in-integrated-care)

Integrating patient complexity into health policy: a conceptual framework

Clinicians across all health professions increasingly strive to add value to the care they deliver through the application of the central tenets of people-centred care (PCC), namely the ‘right care’, in the ‘right place’, at the ‘right time’ and ‘tailored to the needs of communities’.

This ideal is being hampered by a lack of a structured, evidence-based means to formulate policy and value the commissioning of services in an environment of increasing appreciation for the complex health needs of communities. This creates significant challenges for policy makers, commissioners and providers of health services. Communities face a complex intersection of challenges when engaging with healthcare. Increasingly, complexity is gaining prominence as a significant factor in the delivery of PCC.

Based on the World Health Organization (WHO) components of health policy, this paper proposes a policy framework that enables policy makers, commissioners and providers of health care to integrate a model of ...

26th WONCA Europe Conference

The 26th WONCA Europe Conference, Europe’s Top Conference for General Practitioners, organised by the Dutch College of General Practitioners, will be held virtual on 6-10 July 2021!

The theme of our conference is “Practising Person Centred Care”. We will elaborate on this theme in cohesive sets of plenary presentations, round table sessions and workshops, covering aspects of patient care, research, and education, that will be organised by WONCA Special Interest Groups and WONCA Networks. The cohesive sessions will be built around clinical topics that are linked to non-clinical topics such as cardiovascular risk management and shared decision making, respiratory diseases and health skills, or elderly care and prevention of overdiagnosis. The impact of COVID-19 on GP health and primary care services will also receive ample attention.

Attend this conference to enhance your knowledge and practice with Europe’s family physicians’ community. Why not upgrade your network, learn from the ...

Achieving patient priorities: an alternative to patient-reported outcome measures (PROMs) for promoting patient-centred care

For the past two decades, patient-centredness has served as one of six acknowledged dimensions of healthcare quality. Initially, healthcare institutions described patient centredness superficially—clean waiting rooms, hotel-like bed and board, access to innovative medical technology—and measured it with crude satisfaction scales. The concept of patient-centred care evolved into a model attuned to the patient experience of care, defined by the interactions between patients and providers and the care environment.This patient experience model of patient-centred care has deep normative roots around principles of the patient as the locus of control and a demand for individualisation and customisation of care based on the patient rather than clinician.

Towards an Integrated Care Organisation from a CEO Perspective

Many experimental projects towards Person-Centred Care (PCC) are successful in the early stages, but founder when the attempt is made to scale them up to encompass the whole organisation. This case study therefore focusses on one manager’s attempts to extend the successes of a preliminary project ‘Etxean Ondo’ that aimed to provide adequate support for the elderly living at home or in nursing homes, as well as for their families and care professionals. Through in-depth interviews with stakeholders, this qualitative study, based on Grounded Theory, sets out to analyse which behaviours, attitudes and values on the part of management appeared to favour full-integration of PCC in this wider context. Analysis of the data gathered allowed the researcher to generate an experimental case model which suggests how the extrinsic, intrinsic and transcendent motivation of stakeholders can be aligned with the goals of upper management to promote full-integration of PCC in ...

Project INTEGRATE: Developing a Framework to Guide Design, Implementation and Evaluation of People-centred Integrated Care Processes

People-centred integrated care is an acknowledged approach to improve the quality and effectiveness of health systems in delivering care around people’s needs and preferences. Nevertheless, more guidance on how to effectively design, implement and evaluate the care process of people-centred integrated care services is needed. Under Project INTEGRATE, a framework was developed to guide managers in the assessment, transformation and delivery of these health service innovations.

4th International Congress of Person Centered Medicine

The 4th International Congress of Person Centered Medicine will be held in Madrid, Spain, from the 7-9 of November 2016, in Campus of the Francisco de Vitoria University. 

The main topics for this congress are:

• Person Centered Medical Education: Need for a new Model
• Role of Humanities and Humanism in Medical Education
• Doctor – Patient Clinical Communication as “core theme” in Humanizing Clinical Practice
• Humanism and Bioethics in Medical Education
• Clinical Simulation in Medical Education
• Person Centered Medicine: Perspective from Healthcare Systems
• Person Centered Medicine: Perspective from Perspective from patients

Deadline for abstracts: September 15, 2016

Preliminary Scientific Program

For more information: Website

ICIC16 – 16th International Conference on Integrated Care

The conference will be held in Barcelona from the 23th to the 25th of May and will bring together researchers, clinicians and managers from around the world who are engaged in the design and delivery of integrated health and social care. They will share experience and the latest evidence about integrating Public Health, Health and Social Care and the New roles and Possibilities for Hospitals, producing Positive and Curative Integrated Mental and Physical Care, mobilising key enablers like policy making and Mobile and Digital Health Solutions, and investment in an Integrated Care Workforce, clinical leadership and coproduction with individuals, careers, communities and populations.

The conference can follow with the hashtag #ICIC16 and will be streaming live to the global audience in English and Spanish. It is possible to take part in the discussions and ask questions to the speakers from your own home or from your institution as an individual ...

Using patient feedback to drive improvement

Increasing amount of information is being collected from patients after they are discharged in a hospital; this information can be used mainly in three ways: (I) to analyse how care is being performed, (II) to publish data in order to share information with general public and to enhance government’s accountability, and (III) to implement reforms in hospital activities and way of working.

In this post, the author defends the idea that not enough information is being used to make patient experience have actual influence at changing how health care organization work at a local level. Organizational leadership and patient-centered culture are said to be critical to use patient feedback to drive improvement.

The author, Joni Jabal, ends this post urging NHS to use its “NHS inpatient survey” to make NHS become an actual people-centered organization.

Learning about patients’ experiences of care in their own homes

Patient’s experiences are a main factor in order to design how health care services should work. Many different ways of measuring these experiences have been developed; in this post hosted by the King’s Fund Blog, Jo Maybin explains how they have used face-to-face interviews in patient’s home, what difficulties they have found and what they have been able to investigate thanks to this kind of methodology.

As it is said in the post, patient’s own homes interviews enabled the interviewers to get in contact with external carers, to analyze their point of view in relation to health care coordination and integration, and to identify what aspects should be improved in order to increase patient’s satisfaction with the care provided.

On the other hand, this post lists some of the difficulties found when doing face-to-face interviews, specially in what concerns to the amount of resources or ...

Age UK’s Personalised Integrated Care Programme: where are we now?

Age UK launched its personalised integrated care programme in 2012 in Cornwall. In this post, published in its blog, some data about its evaluation are shown and discussed.

The main objectives of this programme are to improve health and wellbeing of older people by tailoring services to meet their needs, improve the experience and quality of care received, and to reduce unplanned hospital admissions amongst older people with multiple long-term conditions.

The evaluation showed a 31% reduction in all hospital admissions, a 26% reduction in emergency ones, and a 20% improvement in older people’s health and wellbeing. In addition, one fifth of aged people participating in the programme became volunteers in order to be able to improve other people’s health and wellbeing.

In 2015, this programme expanded to nine more places across the United Kingdom, a substantial challenge because, as it is said in the post, the needs ...

People-centred and integrated care: what the evidence may look like

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