Chronic Care Initiatives for the Elderly: Can They Bridge the Gerontology-Medicine Gap?

Lynch, Marty; Estes, Carroll L.; Hernandez, Mauro

doi:10.1177/0733464804271455

Cited by 13 publications

(9 citation statements)

References 42 publications

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“…2003, van Raak et al . 2003, Leichsenring & Alaszewski 2004, Lynch et al . 2005), and some key issues emerge.…”

Section: Methodsmentioning

confidence: 99%

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Managing effective partnerships in older people's services

Nies¹

2006

Health Soc Care Community

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The integration of older people's services is a challenge to all countries with an ageing population. Although it is widely acknowledged that acute care, long-term care, social care, housing, leisure, education and other services should all operate in a more 'joined-up manner', achieving this in practice remains extremely difficult. Against this background, the European Union (EU) Care and Management of Services for Older People in Europe Network (CARMEN) project set out to explore the management of integrated care in 11 EU countries. Summarising key themes from the project, this paper explores the management of integrated care, the skills required, the mechanisms which aid successful integrated approaches, and future research priorities. Although very challenging, the concept of integrated care is still a promising way forward when seeking to meet the challenges of an ageing society.

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“…2003, van Raak et al . 2003, Leichsenring & Alaszewski 2004, Lynch et al . 2005), and some key issues emerge.…”

Section: Methodsmentioning

confidence: 99%

“…2004, Leichsenring 2004a, Nies 2005). Thus, traditional disease‐specific approaches may not be appropriate for older people with multiple symptoms (Lynch et al . 2005).…”

Section: Introductionmentioning

confidence: 99%

Managing effective partnerships in older people's services

Nies¹

2006

Health Soc Care Community

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“… 2 However, an increasing proportion of the population has complex needs. This includes the older population with chronic diseases and multiple morbidities, 3 , 4 children born with complex conditions who are now living to adulthood, and people with learning disabilities who may need continuous care. 5 For these people, care delivery systems that are predominantly designed for acute illness may be both inappropriate and inadequate.…”

Section: Introductionmentioning

confidence: 99%

Integrating funds for health and social care: an evidence review

Mason

Goddard

Weatherly

et al. 2015

J Health Serv Res Policy

150

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ObjectivesIntegrated funds for health and social care are one possible way of improving care for people with complex care requirements. If integrated funds facilitate coordinated care, this could support improvements in patient experience, and health and social care outcomes, reduce avoidable hospital admissions and delayed discharges, and so reduce costs. In this article, we examine whether this potential has been realized in practice.MethodsWe propose a framework based on agency theory for understanding the role that integrated funding can play in promoting coordinated care, and review the evidence to see whether the expected effects are realized in practice. We searched eight electronic databases and relevant websites, and checked reference lists of reviews and empirical studies. We extracted data on the types of funding integration used by schemes, their benefits and costs (including unintended effects), and the barriers to implementation. We interpreted our findings with reference to our framework.ResultsThe review included 38 schemes from eight countries. Most of the randomized evidence came from Australia, with nonrandomized comparative evidence available from Australia, Canada, England, Sweden and the US. None of the comparative evidence isolated the effect of integrated funding; instead, studies assessed the effects of ‘integrated financing plus integrated care’ (i.e. ‘integration’) relative to usual care. Most schemes (24/38) assessed health outcomes, of which over half found no significant impact on health. The impact of integration on secondary care costs or use was assessed in 34 schemes. In 11 schemes, integration had no significant effect on secondary care costs or utilisation. Only three schemes reported significantly lower secondary care use compared with usual care. In the remaining 19 schemes, the evidence was mixed or unclear. Some schemes achieved short-term reductions in delayed discharges, but there was anecdotal evidence of unintended consequences such as premature hospital discharge and heightened risk of readmission. No scheme achieved a sustained reduction in hospital use. The primary barrier was the difficulty of implementing financial integration, despite the existence of statutory and regulatory support. Even where funds were successfully pooled, budget holders’ control over access to services remained limited. Barriers in the form of differences in performance frameworks, priorities and governance were prominent amongst the UK schemes, whereas difficulties in linking different information systems were more widespread. Despite these barriers, many schemes – including those that failed to improve health or reduce costs – reported that access to care had improved. Some of these schemes revealed substantial levels of unmet need and so total costs increased.ConclusionsIt is often assumed in policy that integrating funding will promote integrated care, and lead to better health outcomes and lower costs. Both our agency theory-based framework and the evidence indicate that the link is like...

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“…For example, in Canada, Beland et al's (2006a, 2006b RCT found that clients receiving an integrated, multidisciplinary service were less likely to be admitted to acute hospitals and once there, less likely to become 'bed blockers', that is, to be trapped in acute hospitals waiting for places in nursing home care. In the USA, Lynch et al (2005) discuss case studies of several innovations in addressing chronic health conditions that have the apparent potential to reduce costs, as well as providing better care for older people. They identify a tension between medical approaches, which they characterise as 'disease management', and services provided at home which tend to focus on function, or on supporting ability, and suggest that incentives are needed to promote service integration for such innovations to be successful.…”

Section: Models Of Carementioning

confidence: 99%

Research on the Costs of Long-Term Care for Older People – Current and Emerging Issues

Bowes¹

2007

Social Policy & Society

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This review explores debates concerning the costs of long-term care for older people, and aims to give an overview of the recent and current research agenda in this area, referring primarily to work published [2000][2001][2002][2003][2004][2005][2006]. The focus of much work is on the identification of costs, their distribution and the contexts of policy and delivery of services in which these operate. Live debates concern future costs, their control and related issues of social justice and equity.A particular focus of recent work has been potential international lessons. For example, Harrington et al. (2002) and Schunk and Estes (2001) consider the transferability of the German long-term care financing model to the USA and a number of cross national surveys have been published (e.g. OECD, 2005). There are of course significant issues attached to comparability of research findings and the potential transferability of policies between different welfare and fiscal regimes. The most fruitful comparisons to date have involved countries more similar in terms of economic development, and this review focuses on OECD countries. In low-income, less developed economies, issues are significantly different (HelpAge International, 2002). Predicting future costsUncertainties in predicting the future costs of long-term care have been a recurrent theme. OECD (2005: 31) describes prediction as an 'art', whilst indicating that recent work is increasingly identifying key drivers of changing costs. For example, Comas-Herrera et al. 's (2006) projections for Germany, Italy, Spain and the UK suggest that costs may double between 2000 and 2050, but they caution that the figures are sensitive to a number of key factors, including numbers of older people, levels of disability, the availability of informal care, the real costs of services and models of care in operation. Furthermore, they emphasise that calculating the full costs of care is a complex matter. Their study built on earlier work in England (Pickard et al., 2000;Wittenberg et al., 2001) which concluded that the sensitivity of future long-term care expenditure projections to a wide range of factors meant that policy makers needed to 'plan for uncertainty ' (Wittenberg et al. 2001: 15). In addition, it is important to note that researchers have varied in their consideration of total costs as compared with costs to the public purse. Most frequently, the concern is with the latter.

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Chronic Care Initiatives for the Elderly: Can They Bridge the Gerontology-Medicine Gap?

Cited by 13 publications

References 42 publications

Managing effective partnerships in older people's services

Managing effective partnerships in older people's services

Integrating funds for health and social care: an evidence review

Research on the Costs of Long-Term Care for Older People – Current and Emerging Issues

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