Feb. 14, 2016 Europe

Personalised Integrated Care Programme

All too often older people living with long-term conditions do not have a sustainable care plan to keep them out of the hospital. Launched in Cornwall in 2013, Age UK’s Personalised Integrated Care programme uses risk stratification to both identify those older people who are at risk of recurring hospital admissions and provide a combination of medical and non-medical support. This support starts with a 'guided conversation' between the older person and an Age UK Personal Independence Co-ordinator. In this conversation they outline the goals that the older person identifies as most important to him or her and they ...

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Feb. 12, 2016 Americas Europe Western Pacific

How High-Need Patients Experience the Health Care System in Nine Countries

In this study, high-need patients are defined as those aged 65 and older with at least three chronic conditions or a functional limitation in activities of daily living. The brief analyses data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults to investigate health care use, quality, and experiences among high-need patients in nine countries (Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United States) compared with other older adults. The study found that high-need adults use more health care – especially avoidable Emergency Department visits –, experience more cost-related barriers to care, and poorly coordinated ...

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Feb. 11, 2016 Europe

From integrated care towards DIY Health - Combining person-centered health care delivery, mobile technology and entrepreneurship

Introduction and objectives:

To achieve the level of impact necessary to reverse current trends of rising incidence and costs of multimorbidity and enabling healthy ageing will require new health care policy and practices. Notwithstanding integrated care receiving worldwide attention in improving healthcare delivery, the value of data driven and mobile technology for integration of health and care services remains unclear. Nevertheless, person-centered and data driven mobile health (mHealth) has the potential to evolve integrated care from business process re-design towards a new digital health ecosystem that is truly centered around a person facing health challenges. The objective of our study ...

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Feb. 7, 2016 Europe

I’m Still Me: A Narrative For Coordinated Support For Older People

Care coordination should be a means to achieving specific outcomes, rather than an end in itself. In turn, it is important that these outcomes reflect what patients want. In December 2014, National Voices, Age UK and UCLPartners jointly published I’m Still Me, a document that focuses on what older people consider to be the most important outcomes of coordinated support. The report is based on a variety of research methods, including 74 semi-structured interviews with older individuals. The research identifies a number of outcomes which are key to older people, such as maintaining their independence and retaining their own ...

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Feb. 2, 2016 Europe

Integrated care: the importance of ICT in data sharing

In this post by Health IT Central it is analyzed how different experiences regarding people centered and integrated health systems have been developed across the world. Some studies have been able to identify what are the key elements to succeed when performing integrated health care; these factors are rethinking clinical models, achieving a cultural change, enforcing collaborative multidisciplinary working and improving the way patient information is shared. In this post, the author focuses on how important patient information sharing is to make integrated services experiences succeed, being a core factor in continuity of care and becoming a barrier when data ...

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Feb. 1, 2016 Europe

Evaluation of health care delivery integration: The case of the Russian Federation

This case study explores the current state of affairs within Russia's health system providing care for increasingly complex chronic conditions from the perspective of providers, namely physicians. A survey was developed by a group of experts and later distributed by the Russian center for public opinion research in August 2012. It focused on the interactions between providers at different levels of the health system often working in different organizational models such as primary care offices, polyspecialty clinics as well as hospitals. The survey focused on three areas crucial to integration, namely: teamwork, coordination and continuity of care. The results ...

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Jan. 9, 2016 Europe

Older people with social care needs and multiple long-term conditions

In November 2015, the National Institute for Health and Care Excellence (NICE) in the UK published a guideline on care and support for older people with social care needs and multiple long-term conditions. The guideline recommends that care should be integrated and person-centred, while at present “some people are still being treated as a collection of conditions or symptoms, rather than as a whole person”. NICE calls for a designated care coordinator who would serve as the older person’s first point of contact as well as communicate with all health and social care services, including those provided by non-governmental ...

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Jan. 9, 2016 Europe

What does it take to make integrated care work?: A ‘cookbook’ for large-scale deployment of coordinated care and telehealth. A personalised approach that will benefit patients in your organisation.

Evidence on integrated care is not only needed to show which interventions work, but also to understand how organisational processes affect these interventions. Therefore, evidence from large-scale implementations is especially important. In October 2015, the consortium of the EU-funded programme 'Advancing Care Coordination and Telehealth Deployment' (ACT) published a ‘cookbook’ of good practices, focusing on the structural and organisational drivers as well as barriers to large-scale deployment of care coordination and telehealth in five European regions. The report centres on chronic patients and elderly people, giving recommendations regarding staff engagement,  patient adherence, risk stratification and programme assessment. The report does ...

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Jan. 9, 2016 Europe

Acute hospitals and integrated care

In March 2015, the King’s Fund published a report regarding the progress made by five acute hospital providers in England towards developing more integrated models of care. According to the report, becoming more closely integrated with primary care has proved a considerable challenge for these hospitals. This is partly due to the lack of alternatives to building relationships on a practice-by-practice basis. As the report explains, GP provider groups or federations “are still at an early stage of development in many areas of the country, and where they do exist it is not always clear that they are sufficiently ...

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Jan. 9, 2016 Europe

Local leadership, new approaches: improving the health of local communities

In February 2015, Public Health England and the Local Government Association published a report on how local authorities and the health sector have worked together to improve the health of communities through prevention and early intervention.

An example of this coordination is highlighted in a case study on the new Integrated Wellbeing Service in Blackburn with Darwen. The service has been developed in a joint effort by the borough council and the local GP-led Clinical Commissioning Group (CCG). It combines CCG-funded projects concerning specific long-term conditions (e.g. COPD or stroke), together with public health-funded services (e.g. tobacco cessation ...

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