Evidence Supporting Integrated Care

Nolte, Ellen

doi:10.1007/978-3-030-69262-9_3

Cited by 12 publications

(18 citation statements)

References 39 publications

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“…Robust evaluations, particularly of integrated care programmes, have proved to be not only beneficial but also highly valued by commissioners and providers [ 71 79 ]. Even though current evidence indicates that integrated care is likely to reduce cost and improve outcomes [including health and patient experience] [ 80 81 82 ], more rigorous economic evaluations are needed as the evidence is of poor methodological quality [ 82 83 ]. In evaluating integrated care programmes, it is essential to acknowledge the complex nature of these interventions and the consequent limitation of traditional analytical methods [ 56 57 84 85 86 ].…”

Section: Discussionmentioning

confidence: 99%

Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context

Gongora-Salazar¹,

Glogowska²,

Fitzpatrick³

et al. 2022

Int J Integr Care

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Background:The emergence of Integrated Care Systems (ICSs) across England poses an additional challenge and responsibility for local commissioners to accelerate the implementation of integrated care programmes and improve the overall efficiency across the system. To do this, ICS healthcare commissioners could learn from the experience of the former local commissioning structures and identify areas of improvement in the commissioning process. This study describes the investment decision process in integrated care amid the transition toward ICSs, highlights challenges, and provides recommendations to inform ICSs in their healthcare commissioning role.Methods: Twenty-six semi-structured interviews were conducted with local commissioners and other relevant stakeholders in South East England in 2021. Interviews were supplemented with literature.Results: England's local healthcare commissioning has made the transition towards a new organisational architecture, with some integrated care programmes running, and a dual top-down and bottom-up prioritisation process in place. The commissioning and consequent development of integrated care programmes have been hindered by various barriers, including difficulties in accessing and using information, operational challenges, and resource constraints. Investment decisions have mainly been driven by national directives and budget considerations, with a mixture of subjective and objective approaches. A systematic and data-driven framework could replace this adhoc prioritisation of integrated care and contribute to a more rational and transparent commissioning process. Conclusion:The emerging ICSs seem to open an opportunity for local commissioners to strengthen the commissioning process of integrated care with evidence-based priority-setting approaches similar to the well-established health technology assessment framework at the national level.

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Section: Discussionmentioning

confidence: 99%

Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context

Gongora-Salazar¹,

Glogowska²,

Fitzpatrick³

et al. 2022

Int J Integr Care

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“…13 However, the need for more evidence on the effectiveness and economic impacts of these models has been widely acknowledged. [16][17][18][19] While there are costs associated with the introduction and delivery of integrated care approaches, there is potential for these costs to be offset by savings in other parts of the health system. 19 20 The MeCare programme is a patient-centred model of care that uses remote monitoring and telehealth to support patients with chronic disease who are frequent users of health services.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…While there are costs associated with the introduction and delivery of integrated care approaches, there is potential for these costs to be offset by savings in other parts of the health system. 19 20 The MeCare programme is a patient-centred model of care that uses remote monitoring and telehealth to support patients with chronic disease who are frequent users of health services. The programme aims to reduce unnecessary hospital admissions by improving participants’ self-management, health literacy and activation.…”

Section: Introductionmentioning

confidence: 99%

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Economic evaluation of an integrated virtual care programme for people with chronic illness who are frequent users of health services in Australia

Carter

Wallis²,

McGowan³

et al. 2023

BMJ Open

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ObjectiveThe MeCare programme is a tailored virtual care initiative targeted at frequent users of health services who have at least one chronic condition including cardiovascular disease, chronic respiratory disease, diabetes or chronic kidney disease. The programme aims to prevent unnecessary hospitalisations by helping patients to self-manage, improve their health literacy and engage in positive health behaviours. This study investigates the impact of the MeCare programme on healthcare resource use, costs and patient-reported outcomes.Methods and analysisA retrospective pre–post study design was adopted. Data on emergency department presentations, hospital admissions, outpatient appointments and their associated costs were obtained from administrative databases. Probabilistic sensitivity analysis using Monte Carlo simulation was used to model changes in resource use and costs prior to, and following, participant enrolment on the MeCare programme. Generalised linear models were used to investigate the observed changes in patient-reported outcomes.ResultsThe MeCare programme cost $A624 per participant month to deliver. Median monthly rates of ED presentations, hospital admissions and average length of stay post-MeCare reduced by 76%, 50% and 12%, respectively. This translated to a median net cost saving of $A982 per participant month (IQR: −1936; −152). A significant, positive trend in patient experience based on responses to the Patient Assessment of Care for Chronic Conditions Questionnaire was observed over the duration of programme enrolment.DiscussionThe MeCare programme is likely to result in substantial cost savings to the health system, while maintaining or improving patient-reported outcomes. Further research in multisite randomised studies is needed to confirm the generalisability of these results.

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“…Integrated health and social care (IHSC) can be defined as when "healthcare organizations from across the care continuum are working with social services organizations to provide care that is complementary and coordinated and seamless so that positive health outcomes from a holistic perspective" (Cheng and Catallo, 2020). There is evidence that shows IHSC can help to improve health and social care outcomes for older adults and other vulnerable population groups (Suter et al, 2007;B€ ack and Calltorp, 2015;B eland et al, 2006;Carswell, 2015;Gray et al, 2016;H ebert, 2017;MacAdam, 2015;Nolte and Pitchforth, 2014). It has contributed toward minimizing inappropriate acute care utilization and improved client satisfaction, feelings of empowerment (B€ ack and Calltorp, 2015;Gray et al, 2016;H ebert, 2017;MacAdam, 2015).…”

Section: Introductionmentioning

confidence: 99%

Case study of an integrated health and social care initiative for geriatric patients in rural Alberta

Cheng

Catallo

2023

JICA

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PurposeRural regions in Canada are aging faster than urban centers, but access to health and social care is limited. Integrated health and social care (IHSC) through collaboration across different health and social care organizations can support enhanced care for older adults living in rural regions. However, IHSC is not well understood within a rural Canadian context.Design/methodology/approachA case study of a Canadian IHSC initiative, Geriatric Assessment Program Collaboratory (GAPC), in northern Alberta was undertaken to understand how successful IHSC can occur in an urban/rural region. The study used key informant interviews and a focus group of representatives from the GAPC organizations.FindingsNine factors were identified that support GAPC: communications, information sharing, shared vision and goals, inter-organizational culture, diffused leadership, team-based approaches, dedicated resources, role clarity, champions and pre-existing relationships. Eight external influence factors were identified as influencing partnership including geography, strong sense of community, inter-sectoral work, public policy, governance authorities and structures, funding models, aging communities and operating within a not-for-profit (NFP) setting.Originality/valueThe study reveals insights into how IHSC can occur within a rural Canadian context. This study demonstrates that IHSC occurs at the local level and that primary care providers can drive IHSC successfully.

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Evidence Supporting Integrated Care

Cited by 12 publications

References 39 publications

Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context

Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context

Economic evaluation of an integrated virtual care programme for people with chronic illness who are frequent users of health services in Australia

Case study of an integrated health and social care initiative for geriatric patients in rural Alberta

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