Objective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identifi ed. Methods: Systematic search of Medline and Cochrane databases for evaluations of multicomponent disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized. Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for signifi cant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specifi c knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing Ն3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money. Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate signifi cant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specifi c programs illustrated in this paper can, in the absence of 'perfect data', support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision uncertainty.

Person-centered integrated care may have little effect on mortality or quality of life. The effects on serum creatinine, eGFR, and RRT are uncertain, although person-centered integrated care may lead to fewer hospitalizations and improved BP control.

Introduction:In a previous rapid realist review (RRR), an initial programme theory (PT) was established giving insight into the interrelatedness of context items, mechanisms, programme-activities, and outcomes that influence integrated care programmes (ICPs) for community-dwelling frail older people. As ICPs need to be tailored to their local setting, the objective of this study is to assess consensus on the relevance of the items identified in the RRR for the Dutch setting, and refine the PT, where appropriate. Methods:A two-round e-Delphi study was carried out among Dutch experts to determine the relevance of 71 items.Results: Consensus on relevance was reached on 57 out of 71 items (80%). Items added to refine the PT included: increasing number of older people, decreasing access to hospital beds, well-designed ICP implementation processes, case management, having a clear portfolio of patients, the role of the government, aligning existing health and social care systems, management and monitoring of care activities, strong relationship between older person and healthcare providers (HCP), and providing continuous feedback to HCPs. Conclusion and discussion:The initial PT was refined for the Dutch setting. Items on which no consensus was found, need to be further investigated on the reason behind it.

Task shifting in healthcare has mainly been initiated and studied as a way to react to/or mitigate workforce shortages. Here, we define task shifting as the structural redistribution of tasks, usually including responsibilities and competencies between different professions. As such, task shifting is commonly focused on highly specialised and trained professionals who hand-over specific, standardised tasks to professionals with lower levels of education. It is expected that this type of task shifting will lead to efficiency and cost savings to healthcare organisations. Yet, there are more benefits to task shifting, in particular its contribution to integrated patient-centred quality of care and a tailored system that meets the changing care demands in society. Hence the importance to broaden the scope of task shifting, its goals, manifestations and how task shifting plays a role in addressing both the strengths and weaknesses in the healthcare system. In this focus piece, trends and conditions for task shifting and its (un)anticipated effects are discussed. We argue that, only when designed to face specific complexities at the workplace and taking into account the balance between specialists and generalists, task shifting may substantially contribute to enhanced quality of care that meets the changing needs of society.

Geospatial-qualitative methods, which combine both observation and interpretative accounts during data collection through extended exposure and movement in place, have been increasingly used to explore “person–place” interactions and assess communities of place. Despite their increased use, there is a lack of reflexive discussion on how they differ in capturing person–place interactions and ways to combine them. Drawing on our experiences using three related methods—Photovoice, Walking through Spaces, and interactive Participatory Learning and Action exercise-led community focus groups—we compared the methodological advantages that each method brings to the construction of “place” and in exploring person–place interactions among the community of older adults living in a neighborhood of Singapore for a neighborhood assessment. We then illustrated how using a Focus–Expand–Compare approach for methodological triangulation can add value in generating greater depth and breadth of perspectives on a topic of interest explored for intervention development.