The impact of integrated care on direct nursing home care

Paulus, Aggie; Raak, A.J.A. van

doi:10.1016/j.healthpol.2007.05.014

Cited by 5 publications

(5 citation statements)

References 41 publications

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“…233 No significant impact on costs was reported in nine papers (seven studies). 195,209,217,231,232,235,240,241,306 The patient groups and services included dermatology, neurology, general populations, older adults, asthma, COPD, cardiac and diabetes mellitus. Initiatives included integrated home care, case management, integrated nursing home care, an accountable care model and multidisciplinary care.…”

Section: Resultsmentioning

confidence: 99%

“…However, Beacon et al 37 reported that a multidisciplinary primary care team reduced secondary care activity and the number of emergency admissions. The only non-UK study 231 to report on MDT care in isolation found higher total mean costs relative to traditional care in a nursing home setting. In contrast, a number of UK studies reported positive outcomes from more-complex initiatives involving MDTs, including reductions in length of stay and hospital costs; 36 reduced length of stay; 46 reduced numbers of admissions and readmissions; 66 reduced waiting times; 75 reductions in the numbers of inappropriate referrals; 76 and perceived improvements in care and access to services.…”

Section: Elements Of the Interventionsmentioning

confidence: 94%

“…Fifteen UK intervention studies [39][40][41]44,49,59,61,62,64,65,68,70,71,78,85 were carried out solely in hospital settings, together with nine non-UK studies. 204,212,216,222,228,229,[238][239][240] One UK intervention study 53 and one non-UK intervention study 231 were carried out solely in nursing homes. The other included studies examined initiatives across a range of contexts, or the setting was unclear.…”

Section: The Location Of the Initiativementioning

confidence: 99%

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Understanding new models of integrated care in developed countries: a systematic review

Baxter

Johnson

Chambers

et al. 2018

Health Serv Deliv Res

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BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Resultsmentioning

confidence: 99%

Section: Elements Of the Interventionsmentioning

confidence: 94%

Section: The Location Of the Initiativementioning

confidence: 99%

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Understanding new models of integrated care in developed countries: a systematic review

Baxter

Johnson

Chambers

et al. 2018

Health Serv Deliv Res

View full text Add to dashboard Cite

show abstract

“…The observations were conducted over a three‐month period. Directly assessed, observed activities were defined as those that were patient‐centred and occurred in the presence of the patient and/or family as appropriate . Direct observation can be biased by the Hawthorne effect and the Pygmalion effect , whereby participants modify their behaviour and performance because of awareness of being observed.…”

Section: Methodsmentioning

confidence: 99%

“…Apart from costs, dependency assessments can be used to inform discharge (packages of care), workforce skill mix planning and resource allocation. Quantifying number of health professionals undertaking activities of measured duration can also be used to inform new management approaches designed to evaluate quality of care and cost‐efficiency savings . This study reports on the preliminary development, validation and reliability testing of a comprehensive multidisciplinary assessment (MEND) designed to be used in very severely disabled adult populations to assess dependency, monitor changes in status and inform workforce planning and the direct costs of care.…”

Section: Introductionmentioning

confidence: 99%