Journal of Integrated Care最新文献

{"title":"A maturity model framework for integrated virtual care","authors":"C. Sinn, Zain Pasat, Lindsay Klea, S. Hogeveen, Ceara Holditch, C. Beltzner, A. Costa","doi":"10.1108/jica-02-2022-0015","DOIUrl":"https://doi.org/10.1108/jica-02-2022-0015","url":null,"abstract":"PurposeRemote patient monitoring (RPM) and virtual visits have the potential to transform care delivery and outcomes but require intentional planning around how these technologies contribute to integrated care. Since maturity models are useful frameworks for understanding current performance and motivating progress, the authors developed a model describing the features of RPM that can advance integrated care.Design/methodology/approachThis work was led by St. Joseph's Health System Centre for Integrated Care in collaboration with clinical and programme leads and frontline staff offering RPM services as part of Connected Health Hamilton in Ontario, Canada. Development of the maturity model was informed by a review of existing telehealth maturity models, online stakeholder meetings, and online interviews with clinical leads, programme leads, and staff.FindingsThe maturity model comprises 4 maturity levels and 17 sub-domains organised into 5 domains: Technology, Team Organisation, Programme Support, Integrated Information Systems, and Performance and Quality. An implementation pillars checklist identifies additional considerations for sustaining programmes at any maturity level. Finally, the authors apply one of Connected Health Hamilton's RPM programmes to the Team Organisation domain as an example of the maturity model in action.Originality/valueThis work extends previous telehealth maturity models by focussing on the arrangement of resources, teams, and processes needed to support the delivery of integrated care. Although the model is inspired by local programmes, the model is highly transferable to other RPM programmes.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"70 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89358944","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":"Interdependencies or integration? A qualitative evaluation of a national emergency department improvement programme","authors":"K. Jones, Jaynie Rance","doi":"10.1108/jica-04-2022-0026","DOIUrl":"https://doi.org/10.1108/jica-04-2022-0026","url":null,"abstract":"PurposeIn Wales (United Kingdom (UK)), a programme known as the emergency department quality and delivery framework (EDQDF) was launched in 2018 with the purpose of designing a framework of what good looks like for emergency care and then implementing this framework in a measurable and sustainable way.Design/methodology/approachA gatekeeper emailed attendees of the EDQDF launch event (n = 70), providing recipients with an information sheet and inviting them to contact the researcher (KJ) if they agreed to be interviewed. The authors conducted semi-structured interviews with all respondents (n = 8) after three invitation rounds sent between August and October 2021. The authors used a thematic analysis approach (Braun and Clarke, 2006).FindingsParticipants agreed with the aims and design of the framework, and the authors identified four themes relating to barriers and to facilitators of implementation. Participants perceive a softening of geographical boundaries through the project, but findings correspond with evidence generated elsewhere regarding emergency departments’ (EDs') system-wide interdependencies and a need for cross-organisational collaboration.Research limitations/implicationsA quality improvement method for health services known as CAREMORE® is found to be a useful approach for the collaborative design of service improvements. Participants perceive a softening of geographical boundaries through the project, but the interviews correspond with evidence generated elsewhere regarding EDs' system-wide interdependencies and a need for cross-organisational collaboration.Practical implicationsThis evaluation relies on a relatively small number of participants, but as a qualitative evaluation it does not aim towards broadly generalisable findings but rather contributes to broad field concerned with the production of knowledge on the implementation of health service improvements. The project under evaluation is also on-going, and the findings reflect the period from inception to December 2021, but not beyond that date.Originality/valueThis evaluation builds upon previous work in relation to the application of CAREMORE to design a quality improvement framework in a complex area (see Nelson et al., 2018), but this evaluation considers the implementation process. The findings echo research elsewhere and add to a growing body of research that underlines system interconnectivities that impact upon the emergency department.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"49 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82198284","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":"What role can education play in integrated care? Lessons from the ECHO (Extensions for Community Health Outcomes) Concussion program","authors":"Q. J. Zhao, Nathan Cupido, C. Whitehead, M. Mylopoulos","doi":"10.1108/jica-01-2022-0012","DOIUrl":"https://doi.org/10.1108/jica-01-2022-0012","url":null,"abstract":"PurposeDesign, implementation, and evaluation are all important for integrated care. However, they miss one critical factor: education. The authors define “integrated care education” as meaningful learning that purposefully supports collaboration and the development of adaptive expertise in integrated care. The ECHO (Extensions for Community Health Outcomes) model is a novel digital health solution that uses technology-enabled learning (TEL) to facilitate, support, and model integrated care education. Using ECHO Concussion as a case study, the authors describe the effects of technology-enabled integrated care education on the micro-, meso-, and macro-dimensions of integrated care.Design/methodology/approachThis case study was constructed using data extracted from ECHO Concussion from video-archived sessions, participant observation, and internal program evaluation memos. The research team met regularly to discuss the development of relevant themes to the dimensions of integrated care.FindingsOn the micro-level, clinical integration occurs through case-based learning and the development of adaptive expertise. On the meso-level, professional integration is achieved through the development of the “specialist generalist,” professional networks and empathy. Finally, on the macro-level, ECHO Concussion and the ECHO model achieve vertical and horizontal system integration in the delivery of integrated care. Vertical integration is achieved through ECHO by educating and connecting providers across sectors from primary to quaternary levels of care. Horizontal integration is achieved through the establishment of lateral peer-based networks across sectors as a result of participation in ECHO sessions with a focus on population-level health.Originality/valueThis case study examines the role of education in the delivery of integrated care through one program, ECHO Concussion. Using the three dimensions of integrated care on the micro-, meso-, and macro-levels, this case study is the first explicit operationalization of ECHO as a means of delivering integrated care education and supporting integrated care delivery.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"11 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84841561","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 development of a platform to ensure an integrated care plan for older adults with complex care needs living at home","authors":"L. Villa-García, Ariadna Puig, Pau Puigpelat, Montse Solé-Casals, Oriol Fuertes","doi":"10.1108/jica-01-2022-0010","DOIUrl":"https://doi.org/10.1108/jica-01-2022-0010","url":null,"abstract":"PurposeThe purpose of this paper is to describe the design and development of the digital platform for the development and monitoring of care plans for older adults with complex care needs who are users of a home care service.Design/methodology/approachCase study. The authors conducted an iterative process of design adapted to the environment and user-centred, agile development and research methodologies and a framework of complex interventions. They followed a four-step process: (1) conceptualization: analysis and design; (2) usability and high-fidelity prototyping; (3) software development; and (4) field testing in usual care. Older adults, informal caregivers, professional caregivers, and healthcare and social workers identified specific requirements and participated continuously through interviews, focus groups and consensus.FindingsIn the conceptualization phase, the theory, context and requirements were identified, and the content and prototypes were developed. In the usability phase, the design was validated. The approach employed resulted in a digital technology that supports a person-centred care model in a home care company. In the conceptualization phase, the theory, context and requirements were identified, and the content and prototypes were developed. In the usability phase, the design was validated. The approach employed resulted in a digital technology that supports a person-centred care model in a home care company.Originality/valueThe methodology employed has allowed the development of a platform based on theory, user needs and context. This could increase the possibilities of use and implementation of the technology and inspire other developers.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91220259","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":"Hospital-based ambulatory clinic adoption of video and telephone visits before and during the COVID-19 pandemic: a convergent mixed-methods study","authors":"V. Stamenova, Suman Budhwani, C. Soobiah, J. Fujioka, Rumaisa Khan, Rebecca Liu, Ilana Halperin, R. Bhatia, L. Desveaux","doi":"10.1108/jica-01-2022-0011","DOIUrl":"https://doi.org/10.1108/jica-01-2022-0011","url":null,"abstract":"PurposeThe purpose of this study is to understand virtual care use (e.g. telephone and video visits) during the COVID-19 pandemic across three hospital-based ambulatory clinics (i.e. mental health, renal and respiratory care) and to describe associated patient and provider experiences.Design/methodology/approachA mixed-methods convergent study was conducted including quantitative electronic medical records data on virtual care use, electronic surveys assessing domains of experience (e.g. satisfaction, acceptance and technology use) among patient and providers and semi-structured interviews exploring the associated barriers and facilitators of virtual care adoption.FindingsVirtual care adoption rates and relative modality use (telephone vs video) varied across specialty clinics. Mental health clinics) showed the greatest use of virtual care and greater use of video over telephone, as compared to renal and respiratory care, where telephone was used almost exclusively. Patients and providers reported an overall good satisfaction and acceptance of virtual care (60–72%) across clinics, but commonly observed barriers (technical problems, behavioral adaptations needed and inequity) persisted. Good value propositions, tech support and the presence of early adopters who can support others in workflow re-design and highlight value propositions of virtual care were listed as adoption facilitators.Originality/valueThe study provides a unique opportunity to compare the rate of virtual care adoption before and during the COVID-19 pandemic across distinct specialties that operate within the same organizational and political setting. This study showed that the nature of the condition (e.g. mental health conditions) and the characteristics of the users (e.g. younger patients) may drive models of care with higher rate of video use. Focusing on removing common barriers, like providing tech support and ensuring equitable access to patients, continues to be important even in the context of high virtual care adoption rates during the pandemic.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"20 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85006626","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":"Healthcare provider selection for elderly patients suffering from NCD's: an analysis with the combined approach of DEMATEL and AHP","authors":"Ankit Singh, A. Jha, Shankar Purbey, Priya Ravi","doi":"10.1108/jica-11-2021-0056","DOIUrl":"https://doi.org/10.1108/jica-11-2021-0056","url":null,"abstract":"PurposeElderly patients suffering from non-communicable disease face a dilemma in the selection of healthcare providers. This study attempts to identify the key variables playing a crucial role and identify the appropriate healthcare destination with the help of a combination of Decision-making Trial and Evaluation Laboratory (DEMATEL) and analytic hierarchy process (AHP) techniques. The primary objective is to introduce the DEMATEL and AHP as efficient decision-making methods to choose the right healthcare provider for elderly patients suffering from non-communicable diseases.Design/methodology/approachAn integrative approach utilizing DEMATEL and AHP is used to reach the ideal solution for healthcare provider selection decisions. The DEMATEL approach is used to segregate the cause and effect variables. Similarly, the AHP is used to identify the weights of the top five cause-inducing variables, and the paired comparison method is used to select the healthcare provider.FindingsThe variables such as dependency on family members, easily accessible services, and patient autonomy play a vital role in the selection decision of healthcare providers in elderly patients suffering from non-communicable diseases.Practical implicationsIn terms of priority, home healthcare should be considered the preferred provider for elderly patients suffering from non-communicable diseases followed by neighbourhood registered medical practitioners and hospitals.Originality/valueThis is the first of its kind study which has attempted to solve the healthcare provider selection decision with the combined approach of DEMATEL and AHP.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"52 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88360713","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":"Integration, population commissioning and prison health and well-being – an exploration of benefits and challenges through the study of telemedicine","authors":"Chantal Edge, N. Luffingham, G. Black, Julie George","doi":"10.1108/jica-11-2021-0055","DOIUrl":"https://doi.org/10.1108/jica-11-2021-0055","url":null,"abstract":"PurposeThis paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.Design/methodology/approachThe study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.FindingsThe research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.Originality/valueThis is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91063129","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":"Does a discharge to assess programme introduced in England meet the quadruple aim of service improvement?","authors":"Stuart Jeffery, J. MacInnes, Lavinia Bertini, Susie Walker","doi":"10.1108/jica-02-2022-0018","DOIUrl":"https://doi.org/10.1108/jica-02-2022-0018","url":null,"abstract":"PurposeThis paper intends to examine and evaluate the implementation and delivery of a discharge to assess pathway based on the UK Department of Health and Social Care Hospital Discharge Policy in relation to the quadruple aim of healthcare improvement: improving patient experience, reducing costs, benefiting the wider population and improving the work life of staff.Design/methodology/approachUsing a place based partnership in the south of England, 18 staff involved the delivery of discharge to assess and four patients who had recently been through the pathway were interviewed and the narratives analysed using a framework method.FindingsAll four dimensions of the quadruple aim were felt to be positively impacted by the discharge to assess pathway in varying degrees. Staff described improvements to working lives; patients described a positive experience. There was no evidence of reduced costs and wider benefit through reduced length of stay was suggested rather than demonstrated. The study showed a need to ensure both information flows and discharge process are smooth, that there is sufficient community capacity and capability, a need for strong relationships and shared goals, for clarity of pathway and empowered staff, and for an avoidance of the over prescription of care.Originality/valueThe revised discharge to assess pathway in England has been in place since 2020 and no other assessments of the pathway were found that related the changes to the quadruple aim framework.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"5 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90074779","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":"Data and care integration for post-acute intensive care program of stroke patients: effectiveness assessment using a disease-matched comparator cohort","authors":"E. Vela, Aina Plaza, G. Carot-Sans, J. Contel, M. Salvat-Plana, Marta Fabà, Andrea Giralt, A. Ribera, S. Santaeugènia, J. Piera-Jiménez","doi":"10.1101/2022.04.13.22273573","DOIUrl":"https://doi.org/10.1101/2022.04.13.22273573","url":null,"abstract":"Purpose: To assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration. Design: The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data. Findings: The study included 92 stroke patients attended within the RHP program and their matched-controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched-controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5% vs. 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group. Originality: Our analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals but also to monitor health and resource use outcomes of care delivery","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"28 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78747206","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":"Personal health budgets: a mechanism to encourage service integration?","authors":"Elizabeth Welch, Karen Spärck Jones, D. Fox, James Caiels","doi":"10.1108/jica-07-2021-0038","DOIUrl":"https://doi.org/10.1108/jica-07-2021-0038","url":null,"abstract":"PurposeIntegrated care continues to be a central aim within health and social care policy in England. Personal budgets and personal health budgets aim to place service users at the centre of decision-making and are part of a wider long-term initiative working towards personalised and integrated care. Personal budgets began in social care with the national pilot programme of individual budgets, which aimed to incorporate several funding streams into one budget, but in practice local authorities limited these to social care expenditure. Personal budgets then moved into the health care sector with the introduction of a three-year personal health budgets pilot programme that started in 2009. The purpose of the paper is to explore the post-pilot implementation of personal health budgets and explore their role in facilitating service integration. We examine this through the RE-AIM framework.Design/methodology/approachDuring 2015 and 2016, eight organisational representatives, 23 personal health budget holders and three service providers were interviewed, 42 personal health budget support plans were collected and 14 service providers completed an online survey.FindingsOverall, personal health budgets continued to be viewed positively but progress in implementation was slower than expected. Effective leadership, clear communication and longer-term implementation were seen as vital ingredients in ensuring personal health budgets are fully embedded and contribute to wider service integration.Originality/valueThe paper highlights the importance of policy implementation over the longer-term, while illustrating how the venture of personal health budgets in England could be a mechanism for implementing service integration. The findings can serve to guide future policy initiatives on person-centred care and service integration.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"6 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73223450","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}