Journal of Integrated Care最新文献

{"title":"Challenges and chances for local health and social care integration – Lessons from Greater Manchester, England","authors":"Ming Chang","doi":"10.1108/jica-07-2021-0040","DOIUrl":"https://doi.org/10.1108/jica-07-2021-0040","url":null,"abstract":"PurposeSustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances.Design/methodology/approachDocumentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically.FindingsThe study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress.Research limitations/implicationsThe findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs.Originality/valueThis study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89779100","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":"Patient experience and satisfaction with admission to an acute geriatric community hospital in the Netherlands: a mixed method study","authors":"M. Ribbink, Catharina C. Roozendaal, J. MacNeil-Vroomen, R. Franssen, B. Buurman","doi":"10.1108/jica-04-2021-0018","DOIUrl":"https://doi.org/10.1108/jica-04-2021-0018","url":null,"abstract":"PurposeThe acute geriatric community hospital (AGCH) in an intermediate care facility is an alternative to conventional hospitalization. A comprehensive geriatric assessment and rehabilitation are integrated into acute medical care for older patients. This study aims to evaluate patient experience and satisfaction with the AGCH.Design/methodology/approachThis is a mixed method observational study including a satisfaction questionnaire and qualitative interviews with AGCH patients or informal caregivers.FindingsA total of 152 participants filled in the questionnaire, and thirteen semi-structured interviews were conducted. Twelve categories and four overarching themes emerged in the analysis. In general, study participants experience the admission to the AGCH as positive and are satisfied with the care they received; there were also suggestions for improvement.Research limitations/implicationsLimitations of this study include possible participation bias. The results show that patients value this type of care indicating that it should be implemented elsewhere. Further research will focus on health outcomes, readmission rates and cost effectiveness of the AGCH.Originality/valueThis is the first study to evaluate care satisfaction with the AGCH. It shows that hospitalized older adults positively value the AGCH as an alternative to hospitalization.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"7 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89866736","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":"Importance of telephone follow-up and combined home visit and telephone follow-up interventions in reducing acute healthcare utilization","authors":"Yuan Ying Lee, L. H. Tiew, Yee Kian Tay, J. Wong","doi":"10.1108/jica-04-2021-0019","DOIUrl":"https://doi.org/10.1108/jica-04-2021-0019","url":null,"abstract":"PurposeTransitional care is increasingly important in reducing readmission rates and length of stay (LOS). Singapore is focusing on transitional care to address the evolving care needs of a multi-morbid ageing population. This study aims to investigate the impact of transitional care programs (TCPs) on acute healthcare utilization.Design/methodology/approachA retrospective, longitudinal, interventional study was conducted. High-risk patients were enrolled into a transitional care program of local tertiary hospital. Patients received either telephone follow-up (TFU) or home-based intervention (HBI) with TFU. Readmission rates and LOS were assessed for both groups.FindingsThere was no statistically significant difference in readmissions or LOS between TFU and HBI. After excluding demised patients, TFU had statistically significant lower LOS than HBI. Both interventions demonstrated statistically significant reductions in readmissions and LOS in pre–post analyses.Research limitations/implicationsTFU may be more effective than HBI in patients with lower clinical severity, despite both interventions showing statistically significant reductions in acute healthcare utilization. Study findings may be used to inform transitional care practices. Future studies should continue to examine the comparative effectiveness of transitional care interventions and the patient populations most likely to benefit.Originality/valuePrevious studies demonstrated promising outcomes for TFU and HBIs, but few have evaluated their comparative effectiveness on acute healthcare utilization and specific patient populations most likely to benefit. This study evaluated interventional effectiveness of both, which might be useful for informing allocation of resources based on clinical complexity and care needs.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"44 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83715744","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":"Teaming up for more comprehensive care: case study of the Geriatric flying squad and emergency responders (Ambulance, Police, Fire and Rescue)","authors":"Lynda Elias, Genevieve Maiden, Julie Manger, Patricia Reyes","doi":"10.1108/jica-05-2021-0025","DOIUrl":"https://doi.org/10.1108/jica-05-2021-0025","url":null,"abstract":"PurposeThe purpose of this paper is to describe the development, implementation and initial evaluation of the Geriatric Flying Squad's reciprocal referral pathways with emergency responders including New South Wales Ambulance, Police and Fire and Rescue. These innovative pathways and model of care were developed to improve access to multidisciplinary services for vulnerable community dwelling frail older people with the intent of improving health and quality of life outcomes by providing an alternative to hospital admission.Design/methodology/approachThis is a case study describing the review of the Geriatric Flying Squad's referral database and quality improvement initiative to streamline referrals amongst the various emergency responders in the local health district. The implementation and initial evaluation of the project through online survey are further described.FindingsSustainable cross-sector collaboration can be achieved through building reciprocal pathways between an existing rapid response geriatric outreach service and emergency responders including Ambulance, Police, Fire and Rescue. Historically, emergency services would have transferred this group to the emergency department. These pathways exemplify person-centred care, underpinned by a multidisciplinary, rapid response team, providing an alternative referral pathway for first responders, with the aim of improving whole of health outcomes for frail older people.Practical implicationsEnablers of these pathways include a single point of contact for agencies, extended hours to support referral pathways, education to increase capacity and awareness, comprehensive and timely comprehensive assessment and ongoing case management where required and contemporaneous cross-sector collaboration to meet the medical and psychosocial needs of the client.Originality/valueThe Geriatric Flying Squad reciprocal pathways are a unique model of care with a multi-agency approach to addressing frail older people's whole of health needs.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"3 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75955814","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":"Impact of occupational therapy in an integrated adult social care service: Audit of Therapy Outcome Measure Findings","authors":"Sharon J. Davenport","doi":"10.1108/jica-04-2021-0020","DOIUrl":"https://doi.org/10.1108/jica-04-2021-0020","url":null,"abstract":"PurposeHealth and social care services should demonstrate the quality of their interventions for commissioners, patients and carers, plus it is a requirement for occupational therapists to measure and record outcomes. Use of the “Therapy Outcome Measure” (TOMs) standardised tool was implemented by an occupational therapy adult social care service to demonstrate outcomes from April 2020, following integration to a community NHS Trust.Design/methodology/approachThe aim was to demonstrate occupational therapy outcomes in adult social care through a local audit of the TOMs. The objective was to determine if clients improved following occupational therapy intervention in the four domains of impairment, activity, participation and wellbeing/carer wellbeing. 70 cases were purposively sampled over a 2-month timeframe, extracting data from the local electronic recording system.FindingsOccupational therapy in adult social care clearly makes an impact with their client group and carers. Evidence from the dataset demonstrates clinically significant change, as 93% of clients seen by adult social care occupational therapy staff showed an improvement in at least one TOMs domain during their whole episode of care. 79% of activity scores, 20% of participation scores and 50% of wellbeing scores improved following intervention. 79% of carer wellbeing scores improved following occupational therapy.Research limitations/implicationsThe audit did not collect data on uptake from the separate teams (equipment, housing, STAR and adult social care work) in occupational therapy adult social care. Potential sampling bias occurred as cases with completed scores only were purposively sampled. Sampling was not random which prevented data gathering on uptake of TOMs across the separate teams. Additionally, the audit results can only be applied to the setting from which the data was collected, so has limited external validity.Originality/valueThese novel findings illustrate the valuable and unique impact of occupational therapy in this adult social care setting. The integration of adult social care into an NHS Community Trust has supported the service to measure outcomes, by utilising the same standardised tool in use by allied health professions across the Trust.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"82 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88304022","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":"Negotiating the transition from acute hospital care to home: perspectives of patients with traumatic brain injury, caregivers and healthcare providers","authors":"T. Oyesanya, Gabrielle M. Harris, Callan D Loflin, Prvu Bettger","doi":"10.1108/jica-04-2021-0023","DOIUrl":"https://doi.org/10.1108/jica-04-2021-0023","url":null,"abstract":"PurposeThe purpose is to explore experiences transitioning home from acute hospital care from perspectives of younger traumatic brain injury (TBI) patients, family caregivers and healthcare providers (HCPs).Design/methodology/approachThe authors conducted 54 qualitative interviews (N = 36: 12 patients, 8 caregivers, 16 HCPs) and analyzed data using conventional content analysis.FindingsThe transition from hospital to home was described as a negotiation, finding a way through these obstacles: (1) preparing for discharge home during acute hospital care; (2) navigating transitions in healthcare and health; (3) addressing recovery concerns, and (4) setting goals to return to normal. Factors influencing the negotiation process included social support, health-related knowledge or training, coping mechanisms, financial stability, and home environment stability.Originality/valueYounger TBI patients and caregivers have unique needs during the transition home from the hospital. Needed support from HCPs was inconsistently provided. Findings are foundational for integrated care research and practice with TBI.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"35 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90777285","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 the indicator of relative need (IoRN2) tool improve inter-professional conversations?","authors":"W. Barron, Elaine Gifford, P. Knight, Helen Rainey","doi":"10.1108/jica-08-2021-0044","DOIUrl":"https://doi.org/10.1108/jica-08-2021-0044","url":null,"abstract":"PurposeThis paper provides an overview of an improvement project that explored whether the implementation of IoRN2, a validated freely available tool designed for any health or social care professional to use, resulted in improved conversations across professions within an integrated rehabilitative reablement service.Design/methodology/approachA qualitative descriptive evaluative approach was applied underpinned by quality improvement Lean and Total Quality Management (TQM) to capture perceptions, variables and IoRN2 value-add. Professionals' (N = 8) across Nursing, Allied Health Professions, Social Work, Quality Improvement and Support Workers participated in one-to-one semi-structured <1 h interviews. Recurring themes and experiences were identified.FindingsIoRN2 improved collaborative conversations. The evaluation of the tool demonstrated greatest impact when all professionals were IoRN2 trained. Participants, regardless of profession, believed that their conversations, professional relationships and outcomes improved when using IoRN2. When differing judgments arose with colleagues who were not IoRN2 trained, fear and tension emerged around trust, cultural manners and power play causing disconnects. Incorporating IoRN2 led to psychologically safe environments where trust, confidence and motivation to explore new creative conversations enhanced strength-based outcomes and helped to generate transformational change.Research limitations/implicationsThe small sample size offered transferable learning worthy of larger future study. The project lead was also the reablement service manager, which may have generated unintended influence.Originality/valueIoRN2 has the potential to improve how HSC professionals converse, acting as a catalytic tool for system-level integration, transformation and sustainable improvement.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"9 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82655323","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":"Community frailty team workforce development – a personal reflection","authors":"Eleanor Corbett, L. Lewis","doi":"10.1108/JICA-04-2021-0021","DOIUrl":"https://doi.org/10.1108/JICA-04-2021-0021","url":null,"abstract":"PurposeThis paper represents a personal view of a newly appointed consultant practitioner trainee in frailty. This role was created as a result of a rapid workforce review of a Frailty Support Team (FST) in response to the COVID-19 pandemic.Design/methodology/approachThe FST traditionally worked alongside other community services. A “One Team” approach was developed whereby prior silos of community nursing, therapy and frailty teams became a single, locality based and mutually supportive integrated community service. This significantly increased capacity for an urgent community response for older people with complex needs and improved clinical management and coordination of care. As a workforce review identified the need for skills development, new roles for trainee advanced frailty practitioners (AFPs) and a consultant practitioner trainee in frailty were established.FindingsStaff experience of the “One Team” model was positive. The changes were thought to encourage closer and more efficient working between primary care and a range of community health services. The improved communication between professionals enabled more personalised care at home, reducing pressure on emergency hospital services. A rapid review of the workforce model has enabled the enhanced team capacity to cover a wider geographical area and improved recruitment and retention of staff by introducing a new pathway for career progression within the expanding specialism of frailty.Originality/valueThe challenge of COVID-19 has prompted rapid service redesign to create an enhanced “One Team in the community.” The innovative workforce model looks beyond traditional roles, values the experience and capabilities of staff and develops the skills and confidence required to provide a more integrated and person-centred specialist community pathway for people living with frailty.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"82 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83751930","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":"Care transition for complex patients: a framework to analyse and develop the Operating Centres for Transition","authors":"A. Zazzera, L. Ferrara, V. Tozzi","doi":"10.1108/jica-05-2021-0026","DOIUrl":"https://doi.org/10.1108/jica-05-2021-0026","url":null,"abstract":"PurposeTransitional care (TC) models emerged to ensure healthcare coordination and continuity, as at-risk patients transfer between different settings or different levels of care within the same setting. TC models have been developed in many countries as well as within different healthcare service delivery models and organizations. This paper aims to focus on a TC model developed in Italy called Operating Centre for Transition (OCT), in order to (1) explore its distinctive features by establishing a framework of analysis, (2) apply the framework to study two OCTs and (3) provide recommendations on how to use the framework to evaluate and develop new OCTs in the future.Design/methodology/approachThe authors adopted a grounded theory method to develop and validate the framework of analysis. The authors employed several qualitative methods following four iterative and recursive steps: (1) desk analysis of relevant documents, (2) in-depth interviews to key informants, (3) three meetings of an expert working group and (4) application of the framework to two case studies.FindingsThe framework of analysis identifies three core dimensions that are always present in any OCT: the service model, the functions and the organizational features. Moreover, for every dimension several variables that capture and understand OCTs’ nature, role and development level are identified.Originality/valueThe results of the study highlight the key elements of the OCT model in Italy and show that the proposed framework can be useful both to analyse existing OCTs and to support health managers and policy makers to create new OCTs or develop those already active.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"27 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84506121","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":"Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues","authors":"M. Clark, M. Cornes, M. Whiteford, R. Aldridge, E. Biswell, R. Byng, G. Foster, J. Fuller, A. Hayward, N. Hewett, Alan Kilminster, J. Manthorpe, J. Neale, M. Tinelli","doi":"10.1108/jica-03-2021-0012","DOIUrl":"https://doi.org/10.1108/jica-03-2021-0012","url":null,"abstract":"PurposePeople experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.Design/methodology/approachThe paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.FindingsSupporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.Research limitations/implicationsThe data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.Practical implicationsIntegration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.Social implicationsAddressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.Originality/valueThis paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"82 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80727033","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}