Mixed-method evaluation of CARITAS: a hospital-to-community model of integrated care for dementia

Abstract

ObjectivesThe capability and capacity of the primary and community care (PCC) sector for dementia in Singapore may be enhanced through better integration. Through a partnership involving a tertiary hospital and PCC providers, an integrated dementia care network (CARITAS: comprehensive, accessible, responsive, individualised, transdisciplinary, accountable and seamless) was implemented. The study evaluated the process and extent of integration within CARITAS.DesignTriangulation mixed-methods design and analyses were employed to understand factors underpinning network mechanisms.SettingThe study was conducted at a tertiary hospital in the northern region of Singapore.ParticipantsWe recruited participants who were involved in the conceptualisation, design, development and implementation of the CARITAS Programme from a tertiary hospital and PCC providers.InterventionWe used the Rainbow Model of Integrated Care-Measurement Tool (RMIC-MT) to assess integration from managerial perspectives. RMIC-MT comprises eight dimensions that play interconnected roles on a macro-level, meso-level and micro-level. We administered RMIC-MT to healthcare providers and conducted in-depth interviews with key CARITAS stakeholders.Primary and secondary outcome measuresWe assessed integration scores across eight dimensions of the RMIC-MT and factors underpinning network mechanisms.ResultsCompared with other dimensions, functional integration (mechanisms by which information and management modalities are linked) achieved the lowest mean score of 55. Other dimensions (eg, clinical, professional and organisational integration) scored about 70. Presence of inspiring clinical leaders and tacit interdependencies among partners strengthened the network. However, the lack of structured documentation and a shared information-technology platform hindered functional integration.ConclusionCARITAS has reached maturity in micro-levels and meso-levels of integration, while macro-integration needs further development. Integration can be enhanced by assessing service gaps, increasing engagement with stakeholders and providing a shared communication system.

Evaluating the safety and patient impacts of an artificial intelligence command centre in acute hospital care: a mixed-methods protocol

“…A mixed-method approach is well suited to study complexity interventions 28 and the complex adaptive systems to which they are applied. Mixed-method approaches have been used to study information flow and organisational networks, 29 integration of organisational interventions, 30 31 effectiveness of service models, 32 and how health information technology affects communication, 33 patient monitoring, 34–36 care provision 37 and clinical decision making. 38 …”

Implementation of Integrated Care for the Aged Population in Anhui and Fujian Province of China: A Qualitative Study

“…The six key domains provide a framework to characterize the degree of integration from a multifocal perspective. The literature suggests that the RMIC has been well applied to explore and analyse the integration perspectives of different stakeholders’ at different levels in various study settings including Australia [ 19 ], Norway [ 20 ], Singapore [ 21 ], China [ 22 23 24 25 ], etc. Furthermore, Chen Z 2019 have already explored and validated the RMIC in China’s context, which confirmed its adaptation and applicability in China particularly regarding the key domains covered in this model [ 25 ].…”

Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review

“…A handful of programmes described a focus on lowering hospital resource utilisation by supporting patients during care transitions (36%) [28,31,39,42,43,45,46,50,55,56], and facilitating referrals from the specialist outpatient clinics (SOCs) to primary care providers (PCPs) (18%) [28,39,40,51,54]. The remaining 13 articles (46%) aimed to optimise the management of specific chronic diseases [29,[31][32][33][34][35]37,45,46,49,50,52,53]. Importantly, heightened emphasis on reducing hospital resource utilisation and facilitating care transitions to lower levels of care aligns with the local vision of shifting care Beyond Hospital to Community.…”

“…Half of the articles reviewed depicted off-site care delivery [30,32,36,38,[41][42][43][44]47,48,[51][52][53]55], nine in the hospital setting [29,31,39,40,45,46,49,50,54] and three in primary care settings [34,35,37]. Only Ang et al and Ha et al, reported care delivery occurring in both hospital and primary care settings under the same respective programme [28,33].…”

“…Therefore, the strength of partnership and trust between providers in the community and hospital specialists impact the uptake of care coordination initiatives and alignment of outcomes for both providers and patients [41,47]. Moreover, leveraging partnerships between private and community stakeholders, streamlining referral processes and adopting collaborative care models encompassing mutually agreed upon right-siting workstreams empowers the shift of care Beyond Hospital to Community [32,33,37,39,44,46,51,54,55].…”