International Journal of Integrated Care最新文献

{"title":"Transition to 'Close Care' with a Joint Roadmap for Person-Centered and Integrated Care.","authors":"Karin Strömqvist Bååthe, Ulrica von Thiele Schwarz, Osman Aytar, Malin Sjöqvist, Marina Arkkukangas","doi":"10.5334/ijic.10226","DOIUrl":"https://doi.org/10.5334/ijic.10226","url":null,"abstract":"<p><strong>Introduction: </strong>Health and social services face increasing fragmentation and costs, underscoring the need to transition toward more person-centered and integrated care. The Swedish government's 'Close Care' [Nära vård] initiative promotes this transition by encouraging shared regional visions and roadmaps. However, translating a vision into practice remains challenging. This study aimed to explore the experiences of healthcare and social services stakeholders regarding the transition to Close Care, focusing on using a joint roadmap.</p><p><strong>Methods: </strong>This qualitative study included three focus groups with 19 regional healthcare and municipal social service representatives, analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Four main themes summarize the findings: 1) A rocky road toward Close Care; 2) A patchwork of Roadmap practices; 3) Navigating ambiguity: defining and positioning the roadmap; 4) Mobilizing shared meaning for Close Care and the roadmap.</p><p><strong>Discussion: </strong>A growing understanding, awareness, and engagement with Close Care is demonstrated, although challenges, including limited cross-organizational leadership and dialogue, remain. Participants reported varied familiarity and strategic document use with the roadmap, which was often considered vague or irrelevant for actionable guidance.</p><p><strong>Conclusion: </strong>Roadmap clarity, linked to measurable indicators, and strategic leadership and dialogue are required to strengthen relational coordination and transition toward more person-centered and integrated care.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 4","pages":"2"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Implementation of Collaborative Care in France: Facilitators and Barriers from the First Year of the SESAME Program.","authors":"Irène Bogicevic, Milena Kostova, Pascal Clerc, Christine Passerieux, Coralie Gandre, Nadia Younes","doi":"10.5334/ijic.9845","DOIUrl":"https://doi.org/10.5334/ijic.9845","url":null,"abstract":"<p><strong>Background: </strong>The Collaborative Care Model (CoCM), which integrates mental health services into primary care through a team-based approach involving GPs, care managers (CM), and mental health consultants, is a proven way to meet these challenges. A first CoCM adaptation in French primary care settings called SESAME has been implemented since 2021.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with all the healthcare professionals involved in SESAME to examine the facilitators and barriers experienced during the first year. Data were analyzed using a qualitative approach combining manual thematic analysis and lexicometric analysis with ALCESTE software.</p><p><strong>Results: </strong>Four discourse classes emerged from the analysis. Key facilitators included prior collaborative experience, effective digital communication tools, and clear role understanding. Barriers such as technological challenges, role ambiguity, and referral framework misunderstandings were also identified. The structured inclusion process and rapid access to care were appreciated, but challenges persisted in referral processes and role boundary definitions. Financial coverage and a less stigmatizing approach were seen as benefits.</p><p><strong>Conclusion: </strong>This study provides insights into the early implementation dynamics of CoCM in a novel context, underscoring the need for clear protocols, ongoing communication, and tailored support to ensure successful integration of mental health services into primary care.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 4","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Community-Based Integrated Care on the Physical and Mental Health of Older Adults: Evidence from China.","authors":"Qinglin Xu, Cangcang Jia","doi":"10.5334/ijic.9099","DOIUrl":"https://doi.org/10.5334/ijic.9099","url":null,"abstract":"<p><p>This study examined the association between community-based integrated care and older individuals' self-rated health, physical health, and mental health. The core components of community-based integrated care services include four major components: daily care, medical services, health services and psychological support. The study used data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The study employed a rigorous methodological framework to mitigate potential endogeneity biases, integrating ordinary least squares (OLS) regression with propensity score matching (PSM) and an instrumental variables (IV) approach. This multi-method design aimed to address both observed confounders and unobserved heterogeneity or reverse causality, thereby enhancing the robustness of causal inferences. The results of the study suggest that older persons who received community-based integrated care were associated with better self-rated health, physical health, and mental health than those who did not receive it. Overall, community-based integrated care was associated with greater health benefits among older persons aged 80 and above, women, older people living alone, and older people who reside in rural regions. Community-based integrated care is positively associated with the health status of older people, and a higher degree of community-based integrated care is associated with better physical and mental health among older people.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 3","pages":"21"},"PeriodicalIF":2.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"Iron Triangle\" of Healthcare Services: Evaluating an Integrated Healthcare Alliance's Impact on Primary Care in Shenzhen, China.","authors":"Shilan Tang, Miao Yu, Xizi Wan","doi":"10.5334/ijic.10192","DOIUrl":"https://doi.org/10.5334/ijic.10192","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;In response to the challenges of inequitable healthcare access and underdeveloped primary care systems, integrated care reforms have emerged as a promising solution. This study examines the effectiveness of one such reform, i.e. the establishment of a cross-regional, tightly integrated healthcare alliance (specifically an urban healthcare group) in the resource-constrained Dapeng District of Shenzhen, China. We assess its impact on service delivery performance through the lens of three core health system objectives: accessibility, quality, and affordability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We utilised longitudinal data from 2012 to 2023 and defined seven indicators aligned with the three core health system goals: accessibility, quality, and affordability. Both annual and quarterly data were used, with quarterly data applied to the interrupted time-series analysis. We employed an interrupted time-series analysis (ITSA) to estimate both immediate level changes and subsequent slope changes in the trends. Serial autocorrelation was assessed using the Durbin-Watson (DW) test. Where autocorrelation existed, we used Prais-Winsten generalised least squares (GLS) to ensure robust estimation. Furthermore, we analysed bidirectional referral data to corroborate the effectiveness of the hierarchical diagnosis and treatment system. We also incorporated per-capita medical expenditure, drawn from district administrative records, to track affordability trends over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The reform was associated with significant improvements across quality, accessibility, and affordability. The capacity of local healthcare institutions to manage severe and complex conditions was substantially enhanced, reflected in significant post-reform trend increases in both Level III/IV surgeries (&lt;i&gt;β&lt;sub&gt;3&lt;/sub&gt;&lt;/i&gt; = 14.498, p &lt; 0.001) and Type C/D cases (&lt;i&gt;β&lt;sub&gt;3&lt;/sub&gt;&lt;/i&gt; = 51.743, p &lt; 0.001). Accessibility improved notably through expanded bed capacity, with a significant increase in beds per 1,000 population (&lt;i&gt;β&lt;sub&gt;3&lt;/sub&gt;&lt;/i&gt; = 0.031, p &lt; 0.01). Physician and nurse densities showed significant immediate-level increases at the reform point, but their post-reform trend changes were not statistically significant. Affordability also improved, including immediate increases in the proportion of medical insurance patients (&lt;i&gt;β&lt;sub&gt;2&lt;/sub&gt;&lt;/i&gt; = 0.085, p &lt; 0.05) and the proportion of medical income from medical insurance (&lt;i&gt;β&lt;sub&gt;2&lt;/sub&gt;&lt;/i&gt; = 0.113, p &lt; 0.01). Furthermore, both outpatient and inpatient unit costs in Dapeng remained consistently below the Shenzhen citywide average and exhibited slower growth rates. Finally, the hierarchical care system showed strengthened performance, exemplified by a marked increase in the share of consultations delivered by community health centres (CHCs) from 28.13% in 2019 to 55.43% in 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The integrated urban healthcare group model effectively s","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 3","pages":"22"},"PeriodicalIF":2.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Impact of Integrated Care.","authors":"Nicholas Goodwin","doi":"10.5334/ijic.11901","DOIUrl":"10.5334/ijic.11901","url":null,"abstract":"","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 3","pages":"20"},"PeriodicalIF":2.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Complex Implementation to Shape, Spread, Scale, and Sustain a New Dementia Care Resource for Better, More Integrated Care.","authors":"Celina Carter, Clementine Rotsaert, Paige Fernandes, Paul Holyoke","doi":"10.5334/ijic.9872","DOIUrl":"10.5334/ijic.9872","url":null,"abstract":"<p><strong>Introduction: </strong>Researchers collaborated with experts-by-experience to create 'Our Dementia Journey Journal' (ODJJ), an interactive resource designed to enhance integrated care through communication and relationship building between caregivers and care providers. This study investigated how best to scale and spread the resource.</p><p><strong>Methods: </strong>ODJJ was implemented as a pilot in three communities with seven sites. A mixed-methods multi-phase sequential design with embedded formative and outcome evaluations was used, with experts-by-experience integrated throughout.</p><p><strong>Results: </strong>ODJJ was implemented serially in long-term care homes, First Nation communities, and South Asian communities. Implementation approaches and tools evolved through sharing experiences and tactics, with greatest uptake and use in the later sites.</p><p><strong>Discussion: </strong>The study confirmed that ODJJ can strengthen communication and relationship building, but how it was perceived, accepted and used for integrated care differed. The cumulative results generated a spread and scale (marketing) strategy, with messaging, materials and supports to facilitate uptake and use across Canada.</p><p><strong>Conclusion: </strong>Pilot implementation for integrated care resources with a strong, complex evaluation can lead to a detailed plan for spread and scale.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 3","pages":"19"},"PeriodicalIF":2.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time Well Spent? Time Use for Health Information Management Across Home Care Roles: A Cross-Sectional Survey Study in Finland.","authors":"Inka Sylgren, Esa Jämsen, Paulus Torkki","doi":"10.5334/ijic.9881","DOIUrl":"10.5334/ijic.9881","url":null,"abstract":"<p><strong>Introduction: </strong>The growing number of older adults with multiple long-term conditions increases the need for better vertical integration of providers, especially in home care. Ensuring information continuity and care coordination is essential but remains time-consuming for home care professionals (HCPs).</p><p><strong>Methodology: </strong>This study aimed to quantify HCPs' time on health information management (HIM) and examine factors associated with this time use. We conducted an exploratory cross-sectional survey in four Finnish home care organizations. Respondents estimated weekly time use for five predefined tasks related to information retrieval, care coordination, and communication. Descriptive statistics, ANOVA, and multiple linear regression examined total HIM time variation.</p><p><strong>Results: </strong>Based on 625 responses, HCPs averaged 258 minutes weekly on HIM tasks. On average, highest time use was reported by registered nurses (518 minutes) and physicians (336 minutes). Across measured tasks, the largest share of the total time was spent on information retrieval (32.0-46.5%). Profession and direct patient care were the only factors associated with time use, regardless of the region's integration maturity.</p><p><strong>Conclusion: </strong>HCPs spend substantial time managing care information. Our findings highlight the critical need for better-integrated systems to enhance care coordination, reduce administrative burden, and enable professionals to devote more time to direct care.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 3","pages":"17"},"PeriodicalIF":2.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Integration of Flexible Assertive Community Treatment with District Social Support Service Teams for Patients with Severe Mental Illness in the Netherlands: A Qualitative Analysis of Team Members' Experiences.","authors":"Anne Kleijburg, Christien Muusse, Ben Wijnen, Joran Lokkerbol, Pim Candel, S Kor Spoelstra, E C Marjolijne de Jong, Silvia Evers, Hans Kroon","doi":"10.5334/ijic.9794","DOIUrl":"10.5334/ijic.9794","url":null,"abstract":"<p><strong>Introduction: </strong>To promote recovery of individuals with severe mental illness and reduce fragmentation of care, network partners collaborated to develop a cross-domain, multi-agency approach by integrating Flexible Assertive Community Treatment (FACT) teams with municipal District Social Services (DSS), referred to as FACT+DSS teams.</p><p><strong>Aim: </strong>To describe how team members experienced the implementation of the FACT+DSS teams by team members, including perceived effects on various themes such as service delivery, network collaboration, the target population, and facilitators and barriers to implementation.</p><p><strong>Methods: </strong>A qualitative study using semi-structured interviews (N = 15) was conducted to explore the experiences of team members in two new FACT+DSS teams in the Netherlands using thematic analysis.</p><p><strong>Results: </strong>The FACT+DSS approach was experienced to improve service access, continuity of care, case-finding and client enrolment (care-avoiders), time efficiency for team members, and strengthen network collaboration. Identified barriers and facilitators underlined the importance of strong leadership, ownership, equality, direct relationships, and professional expertise.</p><p><strong>Conclusion: </strong>Participants experienced the FACT+DSS approach as a highly positive development, improving network collaboration and recovery-oriented care for clients. Our findings may contribute to the development and implementation of FACT (and related practices) as an integrated multi-agency approach.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 3","pages":"16"},"PeriodicalIF":2.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Dutch Examples of Acute Geriatric Community Hospitals for Older Adults: A Comparative Process Evaluation.","authors":"Eline Kroeze, Laurien Kanis, Gercora Hoitinga, Susanne Smorenburg, Janet MacNeil Vroomen, Anneke van Vught, Bianca Buurman","doi":"10.5334/ijic.10214","DOIUrl":"10.5334/ijic.10214","url":null,"abstract":"<p><strong>Background: </strong>Older adults with frailty are at high risk of adverse outcomes during hospitalisation. To address this, two Acute Geriatric Community Hospitals (AGCH1 and AGCH2) were established in the Netherlands. This study examined similarities and differences in setting, staffing, care pathways, patient populations, outcomes, and improvement opportunities in the first quarter of 2024.</p><p><strong>Methods: </strong>We conducted a mixed-methods evaluation using questionnaires (n = 2), documents (n = 10), case vignettes (n = 20), case vignette surveys (n = 7), and focus groups (n = 2). Quantitative data on patients admitted between January 1 and March 31, 2024, (n = 161) were collected in aggregated form via the questionnaires and analysed descriptively; qualitative data were analysed thematically.</p><p><strong>Results: </strong>Both sites implemented the core model elements but varied in setting and staffing. Patients showed high multimorbidity with respiratory conditions and infections as common diagnoses. Across ten case vignettes per AGCH, experts reported variation in referral appropriateness. Mean length of stay was shorter at AGCH2 (9.0 vs. 12.5 days), while less patients were discharged home (51.7% vs. 70.3%). Focus groups highlighted seven improvement areas: referral, expectation management, discharge planning, IT integration, funding, and evening/night/weekend care.</p><p><strong>Conclusions: </strong>The two AGCHs appeared to have largely similar care pathways, patient populations, and improvement opportunities, but differed in context, staffing, and outcomes. Sustainable implementation requires continuous learning, clear referral pathways, and skill mix review; national scale-up demands effectiveness studies, role delineation, and defining core versus adaptable model elements.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 3","pages":"18"},"PeriodicalIF":2.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of 72-Hour Hospital Treatment Responsibility Post Discharge to Municipal Nursing Care.","authors":"Elise Harder, Ann-Sofie Kofoed Berthelsen, Julie Christina Grew, Sidsel Maria Jørgensen, Fiona Haustedt Mossman, Michaela Louise Schiøtz","doi":"10.5334/ijic.10188","DOIUrl":"10.5334/ijic.10188","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of individuals living with chronic conditions and multi-morbidity presents challenges to healthcare systems and coordination of coherent patient pathways. In Denmark, transitions between healthcare sectors are susceptible to disruption due to inadequate cross-sectoral collaboration. To improve continuity of care and cross-sectoral collaboration, an agreement of 72-hour hospital treatment responsibility post-discharge was implemented.</p><p><strong>Methods: </strong>We used data from a questionnaire survey for healthcare professionals, data from electronic patient records, and data from cross-sectoral medical record audits to evaluate outcomes of the implementation of the agreement.</p><p><strong>Results: </strong>Survey data suggested that the agreement may enhance cross-sectoral collaboration by improving communication and understanding of other sectors, with municipal healthcare professionals perceiving these benefits more strongly. Data from electronic patient records indicated increased attention to discharge documentation. Medical record audits suggest that the agreement may be supportive where medication-related uncertainties necessitated clarification.</p><p><strong>Conclusion: </strong>The evaluation shows that the agreement can facilitate cross-sectoral communication, in some cases may improve treatment quality and safety and may support safer transitions from hospital to municipal care. The agreement does not reduce readmissions among the target group in general; however, it might facilitate avoidance of unnecessary readmissions in cases where cross-sectoral dialogue is sufficient.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":"26 3","pages":"15"},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}