Floundering or Flourishing? Early Insights from the Inception of Integrated Care Systems in England.

IF 2.6 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

International Journal of Integrated Care Pub Date : 2024-07-02 eCollection Date: 2024-07-01 DOI:10.5334/ijic.7738

Bethan Page, Thavapriya Sugavanam, Ray Fitzpatrick, Helen Hogan, Mirza Lalani

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Abstract

Background: In 2022, England embarked on an ambitious and innovative re-organisation to produce an integrated health and care system with a greater focus on improving population health. This study aimed to understand how nascent ICSs are developing and to identify the key challenges and enablers to integration.

Methods: Four ICSs participated in the study between November 2021 and May 2022. Semi-structured interviews with system leaders (n = 67) from health, social and voluntary care as well as representatives of local communities were held. A thematic framework approach supported by Leutz's five laws of integration framework was used to analyse the data.

Results: The benefits of ICSs include enhancing the delivery of good quality care, improving population health and providing more person-centred care in the community. However, differences between health and social care such as accountability, organisational/professional cultures, risks of duplicating efforts, tensions over funding allocation, issues of data integration and struggles in engaging local communities threaten to hamper integration.

Conclusions: Despite ICS's investing in the structural and relational components of integrated care, the unprecedented pressures on systems to reduce demand on primary and emergency care tackling elective backlogs may detract from a key goal of ICSs, improving population health and prevention.

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徘徊不前还是蒸蒸日上？英格兰综合护理系统初创期的早期启示。

背景：2022 年，英格兰开始了雄心勃勃的创新重组，以建立一个更加注重改善人口健康的综合医疗保健系统。这项研究旨在了解新生综合医疗服务机构的发展情况，并确定整合过程中的主要挑战和推动因素：四家综合医疗服务机构参与了 2021 年 11 月至 2022 年 5 月期间的研究。研究人员与来自医疗、社会和志愿服务领域的系统领导者（n = 67）以及当地社区代表进行了半结构化访谈。研究采用主题框架法，并辅以勒兹的整合五法则框架来分析数据：综合服务社的益处包括：加强提供优质护理、改善人口健康以及在社区提供更加以人为本的护理。然而，医疗和社会护理之间的差异，如问责制、组织/专业文化、重复工作的风险、资金分配方面的紧张关系、数据整合问题以及在吸引当地社区参与方面的困难，都有可能阻碍整合：尽管综合医疗服务系统对综合医疗服务的结构和关系部分进行了投资，但该系统在减少对初级和急诊医疗服务的需求、解决非急诊积压方面所面临的前所未有的压力，可能会偏离综合医疗服务系统的主要目标，即改善人口健康和预防。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Integrated Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

3.80

自引率

8.30%

发文量

887

审稿时长

>12 weeks

期刊介绍： Established in 2000, IJIC’s mission is to promote integrated care as a scientific discipline. IJIC’s primary purpose is to examine critically the policy and practice of integrated care and whether and how this has impacted on quality-of-care, user experiences, and cost-effectiveness. The journal regularly publishes conference supplements and special themed editions. To find out more contact Managing Editor, Susan Royer. The Journal is supported by the International Foundation for Integrated Care (IFIC).