Great Expectations: The Implementation of Integrated Care and Its Contribution to Improved Outcomes for People with Chronic Conditions

Busetto, Loraine

doi:10.5334/ijic.2555

Cited by 21 publications

(25 citation statements)

References 15 publications

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“…The Dutch case study concerned integrated care for people with type 2 diabetes in the primary care setting, including care groups, bundled payments, patient involvement, health professional cooperation, task substitution, evidence-based care protocols and a shared clinical information system [123536]. The German case study concerned integrated care for geriatric conditions in a secondary care setting.…”

Section: Methodsmentioning

confidence: 99%

“…The German case study concerned integrated care for geriatric conditions in a secondary care setting. Here, integrated care included a specific reimbursement system called “early complex geriatric rehabilitation”, multidisciplinary cooperation and comprehensive geriatric assessments [123537]. Both case reports provided data on barriers and facilitators, but these were not specifically linked to the workforce changes of the integrated care intervention.…”

Section: Methodsmentioning

confidence: 99%

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Barriers and Facilitators to Workforce Changes in Integrated Care

Busetto¹,

Luijkx²,

Calciolari³

et al. 2018

International Journal of Integrated Care

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Introduction:The aim of the study is to investigate the barriers and facilitators to the implementation of workforce changes implemented as part of integrated chronic care interventions.Methods:We used a qualitative multimethod design that combined expert questionnaires, a systematic literature review, and secondary analysis of two case reports. Twenty-five experts, twenty-one studies and two case reports were included in the study.Results:Most barriers related to problematic delivery structures, health professionals’ skills and enthusiasm, IT, funding, culture and cooperation and communication. Most facilitators related to health professionals’ motivation and enthusiasm, good delivery structures, communication and cooperation, IT, patients, leadership and senior management. Overall, similar categories of barriers and facilitators were found.Discussion:We recommend that future research focusses on more complex designs including multiple data sources, as these are better able to capture the complexity of interventions such as integrated care. We recommend that health managers and policy-makers should invest in delivery structures and skills and motivation of health professionals to improve the implementation of workforce changes in integrated chronic care interventions.Conclusion:The added value of the present study lies in its provision of information on which factors might mitigate the success of an intervention, which helps to prevent premature conclusions of ineffectiveness for complex interventions.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Barriers and Facilitators to Workforce Changes in Integrated Care

Busetto¹,

Luijkx²,

Calciolari³

et al. 2018

International Journal of Integrated Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…[10][11][12][13][14][15][16] The strategic directions of national and local healthcare services both identify improvements in technology systems as being key to the improved integration of services, ultimately improving patient experience of health care and leading to better outcomes. 26 As referrals are a central part of the health-care journey, any system aiming to improve referral quality will impact on both health outcomes and patient experience. This audit indicates that the development of systems is important and that the quality of referrals can be improved by better systems, including the use of mental healthspecific referral guidelines.…”

Section: Discussionmentioning

confidence: 99%

Referrals from primary care to community mental health teams: what’s missing?

O’Brien

Glue

2019

J Prim Health Care

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INTRODUCTION:Transfer of care from primary to specialist mental health services almost always requires a referral by hardcopy letter or sent via a structured electronic form. The quality and content of referrals can vary, leading to delays in treatment. AIM:The aim of the research was to explore the quality and content of referral letters received by two urban New Zealand community mental health teams. METHODS:A retrospective audit of 4 months' worth of referrals (n ¼ 92) from primary care to specialist mental health services was undertaken using an audit tool created from a review of literature. RESULTS:The audit identified gaps in the information provided by referrers, including a lack of evidence of treatment in primary care before referral, risk information, information relating to physical health concerns or co-existing problems, evidence of client consent to referral, and recording of ethnicity. Thirty-seven percent of referrals were considered to be of poor quality. Compared to hardcopy letters, referrals generated by an electronic referral system were of a better quality and contained more information. More than 40% of referrals were not accepted, although the reasons for this were not assessed as part of this audit. DISCUSSION:Better integration of primary and secondary mental health care by using electronic referral templates may reduce the number of inappropriate or incomplete referrals. Referrals from primary care to specialist mental health services vary in content and quality, with many falling below a level that specialist services can accept. This impacts on the efficacy of services and ultimately on patients' journeys between primary and secondary care. Development of a standard referral template for use by primary care services may improve the quality of referrals.

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“…However, translating a healthcare innovation into another (cultural) setting may require structural adaptations to the innovation and a variety of implementation strategies [10][11][12]. Here, we will present our experience with the first phase of the implementation of PD network care in California, specifically focusing on the achieved concentration of care among expert allied health professionals, who were trained as part of the Dutch network approach and their training programs.…”

Section: Introductionmentioning

confidence: 99%

Introduction of Network-Based Healthcare at Kaiser Permanente

Rompen¹,

Vries²,

Munneke³

et al. 2020

JPD

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Background: Early 2014, Kaiser Permanente decided to adopt an innovative model for network-based allied healthcare for persons with Parkinson's disease (PD), based on the principles of the Dutch ParkinsonNet. Objective: We present the interventions that were performed to implement this method at Kaiser Permanente and we show the first outcomes based on these interventions. Methods: In this study, 57 physical therapists, 18 speech therapists and 20 occupational therapists, as well as 13 medical centers across the state of California were included. Nine interventions were performed more or less simultaneously, including training and education of healthcare providers and patients, a train the trainer curriculum, organizing IT, streamlining referral processes and building networks. Results: At the start, less than 30% of the patients within the Southern California Region received specialized allied health treatment (consisting of, i.e., gait training, voice training or guidance in activities of daily life). After one year, almost 55% of patients received specialized allied health treatment. In the second year, this number increased to just under 67%, suggesting a sustained concentration of care (the second core component of networked care). This can be seen as a first indicator for successful implementation of the ParkinsonNet network at Kaiser Permanente. Conclusions: The importance of these findings lies in the fact that a healthcare innovation that proved effective in one country can be transferred successfully to another country and to another healthcare system.

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Great Expectations: The Implementation of Integrated Care and Its Contribution to Improved Outcomes for People with Chronic Conditions

Cited by 21 publications

References 15 publications

Barriers and Facilitators to Workforce Changes in Integrated Care

Barriers and Facilitators to Workforce Changes in Integrated Care

Referrals from primary care to community mental health teams: what’s missing?

Introduction of Network-Based Healthcare at Kaiser Permanente

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