K. Chadd, S. Chalmers, Kate Harrall, Kathryn Moyse, Gemma M. Clunie
{"title":"An evaluation of speech and language therapy services for people with long COVID in the UK: a call for integrated care","authors":"K. Chadd, S. Chalmers, Kate Harrall, Kathryn Moyse, Gemma M. Clunie","doi":"10.1108/jica-07-2022-0038","DOIUrl":"https://doi.org/10.1108/jica-07-2022-0038","url":null,"abstract":"PurposeLong COVID is a complex and highly heterogeneous condition with a variable symptom profile, and calls have been made for an integrated care approach to be taken for its management. To date, no studies have explored speech and language therapy services or needs associated with long COVID. This service evaluation aimed to gauge the level of demand on speech and language therapy services for individuals with long COVID in the UK; their clinical needs, the organisational arrangements of services and the barriers and facilitators of delivering quality care.Design/methodology/approachA service evaluation was undertaken via distribution of an online survey to speech and language therapists (SLTs) receiving referrals for individuals with long COVID. Analysis was completed using descriptive statistics, with thematic analysis to evaluate qualitative data.FindingsOne hundred and eleven SLTs responded. Eighty-six percent were seeing individuals with long COVID in their “everyday” service, in uni- or multi-disciplinary teams, without any “dedicated” resource. Dysphagia and dysphonia were the most reported symptoms. Most respondents (66.7%) indicated the individuals they were seeing were of working age, and that an individuals' speech and language therapy needs were impacting their wellbeing. Perceived barriers to quality care included fragmented and non-integrated care pathways. Multi-disciplinary and integrated working was a key enabler.Originality/valueThis study provides novel insights into the current speech and language therapy needs of and care pathways for individuals with long COVID in the UK SLTs have unique expertise and are integral to supporting individuals with long COVID and should be a part of integrated care teams.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"92 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89028501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carolyn Steele Gray, I. Efimenko, J. Piera-Jiménez, N. Guldemond
{"title":"Guest editorial: Advancing integrated care with digital health innovation issue editorial","authors":"Carolyn Steele Gray, I. Efimenko, J. Piera-Jiménez, N. Guldemond","doi":"10.1108/jica-10-2022-088","DOIUrl":"https://doi.org/10.1108/jica-10-2022-088","url":null,"abstract":"The proposed framework, being applied in Finland, acts as a set of standards to format data to allow it to move from one place to another (known as the “middle layer” in interoperable systems) bringing together different data elements to support a Virtual Care Operator model – an “information-focused approach to integration, coordination and continuity of care.” Domains in this model focus on technology, team organization, program support, integration of information systems, performance and quality, with maturity assessed on how well the model is enabling integration of service delivery around coordination of activities and other key issues like equity. Aird and colleagues present an implementation focused evaluation, using a multi-method approach to explore the roles and use of a new system of information exchange between one hospital and one long-term care home in Canada. Stamenova et al. evaluate a virtual visit program put in place to provide access to care during the COVID-19 pandemic using a convergent mixed-methods design which draws on usage data, surveys and interviews with patients and provider users of virtual care systems across different units within a hospital.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"116 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77003725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The ‘Service Transformation Outline’ toolkit to assist in the design, comparison and replication of integrated care programmes","authors":"A. Rossi Mori","doi":"10.1108/jica-01-2022-0009","DOIUrl":"https://doi.org/10.1108/jica-01-2022-0009","url":null,"abstract":"PurposeThe author is introducing a toolkit that can assist stakeholders to design, compare and replicate integrated care programmes, by making explicit their view on the transformations of care and cure services, according to a structured template. The purpose of this paper is to address this issue.Design/methodology/approachThe toolkit is made of two elements: a classification and a template. The author adopted a step-wise approach of semantic modelling to work out three layers of a classification in the domain of integration needs related to care and cure services. The third layer consists of 23 non-overlapping classes that fully cover that semantic domain. The classes are used to build a template to elicit the stakeholder's standpoint about the transformations involved in the deployment of a programme. The result is the «Outline» of the programme.FindingsSo far, in eight years the author applied the toolkit to 100+ programmes either to design, simulate or evaluate them, either to compare them to similar ones in the same or in different jurisdictions, and we refined the description of the classes according to that experience.Research limitations/implicationsThe objective of the toolkit is not to provide solutions, but to stimulate reflections on the transformations involved in a programme and their practical consequences in a precise context. In fact, the Outlines cannot be generalized: they are conceived to reflect the perspective of the stakeholders and thus are intrinsically subjective; in addition, they must be contingent, as they must depend on the local context in the particular timeframe. In case of similar initiatives in other localities, the Outlines must be filled in again by the local stakeholders; however, a subsequent comparison could help to explore similarities and motivated differences.Practical implicationsIdeally the stakeholders should use the Outline of the actual transformations in a programme as a reference to mediate between the principles and the methodologies provided by the «Models» and «Conceptual Frameworks» in the literature (e.g. Chronic Care Model, Rainbow Model, Development Model of Integrated Care Patient-Centered Medical Home and Maturity Models) and the deeper studies using the specific tools developed in their disciplines (e.g. on information modelling, process modelling, cost–benefit analysis and health technology assessment). The toolkit could have its role also in a multi-annual roadmap made of a sequence of programmes to cope with the urgent challenges on ageing, social changes and technological evolution, in synergy with regulations, budget, context maturity, critical success factors and local priorities.Originality/valueThe author argues that the approach of the structured Outline is unique, as the scoring mechanism to assess the relevance of the transformation within each class on the overall change brought by the whole programme into the health systems.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"47 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88375887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Integrated care with digital health innovation: pressing challenges","authors":"Kanchan Pant, Meena Bhatia, Ranjan Pant","doi":"10.1108/jica-01-2022-0008","DOIUrl":"https://doi.org/10.1108/jica-01-2022-0008","url":null,"abstract":"PurposeDigital health care has emerged as one of the most important means to deliver integrated care by care providers in recent years. As the use of digital health increases, there are some pressing issues such as interoperability of data across different healthcare information systems, regulatory environment and security and privacy of patient’s information which need to be discussed and addressed in order to reduce information silos and to ensure efficient and seamless use of digital health technologies. The purpose of this paper is to address these issues.Design/methodology/approachIn this paper the authors outline the key concepts of interoperability, key challenges pertaining in achieving interoperability and concepts of security and privacy in context of digital health models of integrated care.FindingsThe study suggests that standardization of digital health information systems and connecting existing systems to health network, addressing privacy and security related issues through a comprehensive but supportive regulatory environment and educating citizens and healthcare providers are some of the ways to achieve effective use of digital health in models of integrated care.Originality/valueAlthough the concepts of privacy and interoperability are not new, however, as per best of the authors’ knowledge, this is the first attempt to discuss the challenges and possible actions to meet the objective of achieving integrated care through digital innovation.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89324473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tyler Aird, Ceara Holditch, S. Culgin, Margareta Vanderheyden, G. Rutledge, Carlo Encinareal, D. Perri, Fraser Edward, Hugh Boyd
{"title":"An analysis of a novel Canadian pilot health information exchange to improve transitions between hospital and long-term care/skilled nursing facility","authors":"Tyler Aird, Ceara Holditch, S. Culgin, Margareta Vanderheyden, G. Rutledge, Carlo Encinareal, D. Perri, Fraser Edward, Hugh Boyd","doi":"10.1108/jica-03-2022-0022","DOIUrl":"https://doi.org/10.1108/jica-03-2022-0022","url":null,"abstract":"PurposeThe purpose of the article is to assess the effectiveness, compliance, adoption and lessons learnt from the pilot implementation of a data integration solution between an acute care hospital information system (HIS) and a long-term care (LTC) home electronic medical record through a case report.Design/methodology/approachUtilization statistics of the data integration solution were captured at one-month post implementation and again one year later for both the emergency department (ED) and LTC home. Clinician feedback from surveys and structured interviews was obtained from ED physicians and a multidisciplinary LTC group.FindingsThe authors successfully exchanged health information between a HIS and the electronic medical record (EMR) of an LTC facility in Canada. Perceived time savings were acknowledged by ED physicians, and actual time savings as high as 45 min were reported by LTC staff when completing medication reconciliation. Barriers to adoption included awareness, training efficacy and delivery models, workflow integration within existing practice and the limited number of facilities participating in the pilot. Future direction includes broader staff involvement, expanding the number of sites and re-evaluating impacts.Practical implicationsA data integration solution to exchange clinical information can make patient transfers more efficient, reduce data transcription errors, and improve the visibility of essential patient information across the continuum of care.Originality/valueAlthough there has been a large effort to integrate health data across care levels in the United States and internationally, the groundwork for such integrations between interoperable systems has only just begun in Canada. The implementation of the integration between an enterprise LTC electronic medical record system and an HIS described herein is the first of its kind in Canada. Benefits and lessons learnt from this pilot will be useful for further hospital-to-LTC home interoperability work.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"9 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85718515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debbie Vermond, E. de Groot, N. D. de Wit, D. Zwart
{"title":"A delicate balance: how physicians manage change towards collaborative care within their institutions","authors":"Debbie Vermond, E. de Groot, N. D. de Wit, D. Zwart","doi":"10.1108/jica-04-2022-0027","DOIUrl":"https://doi.org/10.1108/jica-04-2022-0027","url":null,"abstract":"PurposeIn response to the COVID-19 pandemic, in 2020–2022, the immutable and fragmented character of our healthcare system changed. Healthcare professionals and their institutional leads proved remarkably agile and managed to change toward collaborative care. The purpose of this paper is to examine experiences with collaborative practice in healthcare during the COVID-19 pandemic in two regions in the Netherlands, to explore and understand the relationship between policy and practice and the potential development of new collaborative care routines.Design/methodology/approachUsing a methodology informed by theories that have a focus on professional working practice (so called “activity theory”) or the institutional decision-makers (discursive institutionalism), respectively, the perspective of physicians on the relationship between policy and practice was explored. Transcripts of meetings with physicians from different institutions and medical specialities about their collaborative COVID-19 care were qualitatively analysed.FindingsThe findings show how change during COVID-19 was primarily initiated from the bottom-up. Cultural-cognitive and normative forces in professional, collaborative working practice triggered the creation of new relationships and sharing of resources and capacity. The importance of top-down regulatory forces from institutional leads was less evident. Yet, both (bottom-up) professional legitimacy and (top-down) institutional support are mentioned as necessary by healthcare professionals to develop and sustain new collaborative routines.Practical implicationsThe COVID-19 crisis provided opportunity to build better healthcare infrastructure by learning from the responses to this pandemic. Now is the time to find ways to integrate new ways of working initiated from the bottom-up with those longstanding ones initiated from top-down.OriginalityThis paper presents a combination of theories for understanding collaboration in healthcare, which can inform future research into collaborative care initiatives.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"8 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86585618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Turk, V. Wontor, C. Vera-Muñoz, Lucia Comnes, Natércia Rodrigues, G. Ferrari, A. Moen
{"title":"Human-centered integrated care pathways for co-creating a digital, user-centric health information solution","authors":"E. Turk, V. Wontor, C. Vera-Muñoz, Lucia Comnes, Natércia Rodrigues, G. Ferrari, A. Moen","doi":"10.1108/jica-01-2022-0007","DOIUrl":"https://doi.org/10.1108/jica-01-2022-0007","url":null,"abstract":"PurposeA broader challenge of co-creating digital solutions with patients addresses the question how to apply an open-access digital platform with trusted digital health information as a measure to transform the way patients access and understand health information. It further addresses use this for adherence to treatment, risk minimization and quality of life throughout the integrated patient journey. The aim of this paper is to demonstrate the early steps in towards progress to co-creating the digital solution.Design/methodology/approachTo coordinate the co-creation process, the authors established a multiphased plan to deep-dive into user needs and behaviors across patient journeys, to identify nuances and highlight important patterns in stakeholder and end-user segment at various stages in the patient's journey.FindingsA set of tools was designed to serve as a human-centered compass throughout the lifecycle of the project. Those tools include shared objects; personas, user journeys, a set of performance indicators with related requirements – all those tools being consistently refined in ongoing co-creation workshops with members of the cross-functional stakeholder groups.Originality/valueIn this study, a multidisciplinary, public-private partnership looked at integrated digital tool to improve access, understanding and adherence to treatment for diverse groups of patients across all stages of their health journeys in a number of countries including European Union (EU) and United States of America (USA). As a result of this work, the authors attempt to increase the possibility that the improved availability and understanding of health information from trusted sources translates to higher levels of adherence to treatment, safer use of medication (pharmacovigilance), better health outcomes and quality of life integrated in the patient's journey.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"18 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79351164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"“Unchaining the doctor from the desk”: deliberate team-based care in action","authors":"C. Robertson, Tabitha Jones, Philippa Southwell","doi":"10.1108/jica-03-2022-0020","DOIUrl":"https://doi.org/10.1108/jica-03-2022-0020","url":null,"abstract":"PurposeAs a model of integrated care (IC), deliberate team-based care (DTBC) can help address workforce shortages facing rural communities by improving the health and wellbeing of healthcare providers. This study focuses on a GP practice implementing DTBC in rural Australia. The aim of this research was to understand the perspectives of the healthcare workers involved and to ascertain factors impacting on the day to day running of the model, patient care and clinician work-life. The authors conducted a qualitative study on the experiences of the DTBC workers.Design/methodology/approachTeam members were invited to participate in semi-structured interviews (n = 9). Interviews were analysed using an iterative thematic analysis, summarised, collated and explored for emergent themes.FindingsKey themes included: creating change from old ways of doing things, development and implementation processes outlining how the model evolved and how it ran from day to day, model outcomes for patients and clinicians, as well as practical considerations like funding, technology and time.Originality/valueBuilding DTBC from the ground up has produced a high functioning team who demonstrate trust and equality, share information freely and all have a voice which is heard and respected. By acting as a champion and a leader, the GP has created a psychologically safe environment allowing the team to share knowledge, collaborate in problem solving and provide effective patient care which is holistic and community grounded. This work environment holds promise for creating improved work-life for rural clinicians and potential for workforce retention.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"29 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85751001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul Lillran, Annika Bengts, An Chen, Perttu J Kontunen, F. Khalil, Satu Kaleva, P. Torkki
{"title":"Personalized care with mass production efficiency: integrating care with a virtual care operator","authors":"Paul Lillran, Annika Bengts, An Chen, Perttu J Kontunen, F. Khalil, Satu Kaleva, P. Torkki","doi":"10.1108/jica-01-2022-0006","DOIUrl":"https://doi.org/10.1108/jica-01-2022-0006","url":null,"abstract":"PurposeThis article aims to describe the thinking behind MASSE, a project in Finland that helps address the fragmentation of care and patient journey disruptions for long-term care. It outlines the conceptualization of an information technology (IT)-assisted solution and presents preliminary findings and research problems in this ongoing project.Design/methodology/approachThe project employs a service engineering and design science approach with the objective of addressing chronic and multimorbid patients in specialized multiprovider environments. It does this by applying information and communication technologies and organizational design. The project has been a cocreative effort with ongoing interviews and workshops with various stakeholders to inform the conceptualization of a solution, an intermediary step before the implementation phase.FindingsPatient journey disruptions occur when caregivers do not know what to do in specific situations. A potential solution is a virtual care operator (VCO) with a personalized patient card that would enable service ecosystem actors to integrate and coordinate their tasks. This article presents the basic design principles of such a solution.Research limitations/implicationsConceptual ideas and preliminary results only indicative.Practical implicationsSystemic integration efforts like those ongoing in Finland can benefit from the VCO concept encouraging a more collaborative way of thinking about integrative solutions and opening up new avenues of research on business implications and ecosystem strategies.Social implicationsThe VCO concept answers to the continuity of care, the rising costs of health care and the growing numbers of patients with chronic disease and multimorbidity whose care remains fragmented and uncoordinated.Originality/valueTaking an ecosystem approach to care integration and addressing interoperability issues are on the cutting edge of healthcare system transformation.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"11 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90096394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A qualitative exploratory study of training requirements for general practitioners attending older people resident in care homes","authors":"S. Ruaux, N. Chadborn","doi":"10.1108/jica-11-2021-0060","DOIUrl":"https://doi.org/10.1108/jica-11-2021-0060","url":null,"abstract":"PurposeOlder people who reside in care homes have varying access and quality of medical care; in the UK, this is provided by general practitioners (GPs). The authors aimed to explore the experiences of trainee GPs in delivering integrated care and discuss, with senior GPs, opportunities to improve training.Design/methodology/approachTwo trainees and thirteen senior GPs were recruited through professional networks and participated in semi-structured interviews. Transcriptions were analysed using thematic analysis, and the theory of negotiated order was used to interpret findings.FindingsTrainees received no specific training on working with care homes. Exposure to the care home setting was variable, and could be negligible, depending on the GP practice placement. Senior GPs expressed concerns about patient safety, due to practical challenges of the consultation and a sense of lack of control. Considering the theory of negotiated order, where GPs had trusting relationships with care home staff, the input of the staff could mitigate the sense of risk. Care plans could communicate needs and preferences within the team and may be a way of extending the negotiated order, for example giving care homes authority to implement end-of-life care when the GP is not present.Research limitations/implicationsThe authors identified a need for trainees to engage with the organisational aspect of the care home to deliver integrated care. Trusted relationships with staff led to improved consultations, care plans, and better management of risk.Originality/valueThis is the first study of learning needs for GP trainees to provide integrated care for older care home residents.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83240030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}