International experiments in integrated care for the elderly: a synthesis of the evidence

Johri, Mira; Béland, François; Bergman, Howard

doi:10.1002/gps.819

Cited by 297 publications

(265 citation statements)

References 31 publications

(53 reference statements)

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“…There is evidence that home and community care (H&CC) may be more cost-effective than facility-based LTC except for individuals with unstable care needs (Hollander and Chappell 2007). Reflecting this situation, public policies emphasizing "deinstitutionalization" have been implemented across the developed world ( Johri et al 2003). Nevertheless, in jurisdictions like Ontario, Canada' s most populous province, facilitybased LTC wait lists persist.…”

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confidence: 99%

The Role of Community-Based Care Capacity in Shaping Risk of Long-Term Care Facility Placement

Kuluski

Williams²,

Laporte³

et al. 2012

hcpol

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The Role of Community-Based Care Capacity in Shaping Risk of Long-Term Care Facility Placement AbstractObjectives: Across the developed world, wait lists for facility-based long-term care (LTC) beds continue to grow. Wait lists are primarily driven by the needs of aging populations (demandside factors). Less attention has been given to system capacity to provide community alternatives to LTC (supply-side factors). We examine the role of both demand-and supply-side factors by comparing the characteristics of individuals who have been assessed and deemed eligible for LTC in urban and rural/underserviced parts of northwestern Ontario, Canada.Methods: Home care assessment data were analyzed for all individuals waiting for LTC in northwestern Ontario as of march 2008 (n=858). for the analysis, the sample was separated into urban and rural groups to account for geographical differences in wait list location. Characteristics between these two groups were compared. Results: Individuals on LTC wait lists in the rural areas were significantly less impaired in activities of daily living and cognition than their counterparts in the urban area. However, in both areas, impairments in lighter-care activities appeared to be a key wait list driver, and few people had an informal caregiver living in the home. Conclusions: Our data suggest that LTC wait lists reflect, at least to some extent, insufficient community capacity, not just need for LTC.

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mentioning

confidence: 99%

The Role of Community-Based Care Capacity in Shaping Risk of Long-Term Care Facility Placement

Kuluski

Williams²,

Laporte³

et al. 2012

hcpol

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“…Unlike HICs, we found few examples of integration types focused on professional staff and patient self-management. This does not mean that improved team working was absent from "integration experiments" [12] in these countries, only that this element has formed part of a wider package of activity to achieve a different goal (such as integrated management of childhood diseases). Integration focusing on primary care is more prevalent in LMIC contexts, not unexpected given the weak primary care network in those contexts.…”

Section: Resultsmentioning

confidence: 99%

Can service integration work for universal health coverage? Evidence from around the globe

et al. 2016

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Yours sincerely 2 MANUSCRIPT Highlights: Empirical impacts of past integration experiments were explored through a global review  Positive outcomes for patients and clinicians without incurring additional financial costs were found  Improvements were incremental hence integration should not be considered a fundamental 'game-changer'. AbstractUniversal Health Coverage (UHC) is at the heart of the new 2030 Agenda for Sustainable Development. Health service integration is seen by World Health Organization as an essential requirement to achieve UHC. However, to date the debate on service integration has focused on perceived benefits rather than empirical impact. We conducted a global review in a systematic manner searching for empirical outcomes of service integration experiments in UHC countries and those on the path to UHC. Sixty-seven articles and reports were found. We grouped results into a unique integration typology with six categories -Medical staff from different disciplines; Patients and Medical Staff; Care Package for One Medical Condition; Care Package for Two or More Medical Conditions; Specialist standalone services with GP services; Community locations. We showed that it is possible to integrate services in different human development contexts delivering positive outcomes for patients and clinicians without incurring additional costs. However, the improved outcomes shown were incremental rather than radical and suggest that integration is likely to enhance already well established systems rather than fundamentally changing the outcomes of care.

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“…In Northern Ireland, the absence of intensive care management, evidence of greater integration overall and the discrepancy between old age psychiatry and social care perspectives on integration would together seem to indicate that integration was predominantly occurring between nursing and social care at a primary level, with perhaps poorer linkages with secondary care. For intensive care management to develop within an integrated structure would require closer linkages between care management and secondary care services, such as old age psychiatry and geriatric medicine as demonstrated in the UK and elsewhere (Challis et al, 1995(Challis et al, , 2002aJohri et al, 2003;Howe, 1997). The importance of this is highlighted in the development of services to meet the needs of people with long term conditions in England (Department of Health, 2005;Cm 6737, 2006) Overall, from this study it is possible to conclude that, despite the difficulties in comparing two settings with different structures, it is surprising that there have not been other comparisons of the potential gains associated with the integrated system in Northern Ireland in relation to services in the rest of the UK since developments in the former provide evidence to inform both policy and practice in the latter.…”

Section: Discussionmentioning

confidence: 99%

“…Three main areas were identified where it was considered likely that these differences would be apparent: the process of care, including multidisciplinary working, assessment and care planning; differentiation of care management; and specialist services. A number of broad hypotheses, either implicit or explicit in the literature, about the nature of integrated services may be formulated by which England and Northern Ireland can be compared (SSI/SWSG, 1991;Challis, 1998;Audit Commission, 2000;Johri et al, 2003). These suggest that Northern Ireland compared to England would have:…”

Section: Introductionmentioning

confidence: 99%

Care management for older people: Does integration make a difference?

Challis

Stewart

Donnelly³

et al. 2006

Journal of Interprofessional Care

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England and Northern Ireland provide examples of different degrees of integration of health and social care within broadly similar administrative and funding frameworks. This paper examines whether integrated structures appear to impact upon the operation of care management, a key approach to providing coordinated care for vulnerable older people. There appeared to be more evidence of integrated practice between health and social care in Northern Ireland than England, although some key features, such as intensive care management, were no more evident. It is concluded that further investigation is required as to the extent to which integrated structures have impacted upon patterns of professional working and underlying beliefs about roles.

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International experiments in integrated care for the elderly: a synthesis of the evidence

Cited by 297 publications

References 31 publications

The Role of Community-Based Care Capacity in Shaping Risk of Long-Term Care Facility Placement

The Role of Community-Based Care Capacity in Shaping Risk of Long-Term Care Facility Placement

Can service integration work for universal health coverage? Evidence from around the globe

Care management for older people: Does integration make a difference?

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