Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models

Introduction The implementation of integrated care models requires significant efforts, especially due to institutional and organisational inertial forces that characterize health and social care systems of developed countries. It is therefore crucial to deploy strategies that promote continuous adjustment to these barriers so as to improve the benefits of integrating care. Measuring the implementation and effects of integrated care models are key component of these strategies. However, measuring integrated care also faces major challenges. This study aims to identify and characterise integrated care measurement challenges. Methods A review of reviews on the measurement of integrated care identified 12 papers. A thematic analysis was conducted to identify and categorize measurement challenges. Document analysis was done on the measurement of an integrated care model for older adults in Québec. Results Eight categories of measurement challenges were identified. These challenges include difficulties in measuring structures, processes, and effects of models; conceptual ambiguity and heterogeneity of organisational forms; involving multiple actors in the measurement strategy; and including multiple data sources, amongst others. These challenges revealed and explained potential gaps in the measurement of integrated care for older adults in Québec. For instance, the Québec measurement strategy did not include effects indicators. Conclusion Although the measurement of integrated care is a complex endeavour, there is a need for adequate measurement strategies that allow to appreciate important elements of integrate care. The findings of this study could be used as a reflexive tool in advancing research and practice of measuring integrated care.

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Human Flourishing and Integrated Care Models: The Development of the Flourish Index

The Gerontologist ◽

10.1093/geront/gny114 ◽

2018 ◽

Vol 59 (6) ◽

pp. e653-e663

Author(s):

Anna C Faul ◽

Joseph G D’Ambrosio ◽

Pamela A Yankeelov ◽

Samantha G Cotton ◽

Christian D Furman ◽

...

Keyword(s):

Older Adults ◽

Health Services ◽

Health Behaviors ◽

Integrated Care ◽

Care Coordination ◽

Determinants Of Health ◽

Individual Health ◽

Care Models ◽

Integrated Care Models

Abstract Background and Objectives In evaluating integrated care models, traditional quality measures do not account for functional and quality of life factors, affecting older adults with multiple chronic conditions. The objective of this study was the development and validation of the Flourish Index (FI), an instrument to evaluate integrated care, using a determinants of health model. Research Design and Methods The study took place within the evaluation study of the Flourish Model (FM). The FM provides care coordination services using an integrated primary care and community-based services model. Baseline data from 70 older adults were used in the validation study. Twenty-seven quality of care indicators within six determinants of health, namely biological, psychological, individual health behaviors, health services, environmental, and social, formed part of the FI. Results Categorical principal components analysis showed a 5-dimensional structure with psychological determinants loading on the biological determinants of health. Internal consistency (Cronbach’s alpha) for the determinants was as follows: biological/psychological = 0.73, individual = 0.58, environmental = 0.62, health services = 0.65, social = 0.67, total score = 0.97. Sensitivity to change was shown for the total FI score (F1,22 = 8.82, p = .01) and social (F1,22 = 5.82, p = .02), with a trend toward sensitivity for individual health behaviors (F1,22 = 3.95, p = .06) and health services (F1,22 = 3.26, p = .09). Discussion and Implications The preliminary analysis of the FI shows promise for the usability of the index to provide insight into the fundamental challenges of aging. It brings greater clarity in caring for older adults and supports quality evaluation of integrated care coordination models.

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Impact of Relaxation and Group Psycho-Education on Health Outcomes Using Integrated Care Models and Quality Improvement

Open Journal of Preventive Medicine ◽

10.4236/ojpm.2014.412100 ◽

2014 ◽

Vol 04 (12) ◽

pp. 887-896 ◽

Cited By ~ 1

Author(s):

Martha Okafor ◽

Victor Ede ◽

Rosemary Kinuthia ◽

Debbie Strotz ◽

Cathryn Marchman ◽

...

Keyword(s):

Quality Improvement ◽

Health Outcomes ◽

Integrated Care ◽

Care Models ◽

Integrated Care Models

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Responses From an Informal Qualitative Survey About Child and Adolescent Integrated Care Models

Journal of the Academy of Consultation-Liaison Psychiatry ◽

10.1016/j.jaclp.2021.07.014 ◽

2021 ◽

Vol 62 (6) ◽

pp. 671-672

Author(s):

Nadia Zaim ◽

Katherine Ort ◽

Melissa Hopkins

Keyword(s):

Integrated Care ◽

Child And Adolescent ◽

Qualitative Survey ◽

Care Models ◽

Integrated Care Models

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Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?

International Journal of Care Coordination ◽

10.1177/2053434518817019 ◽

2018 ◽

Vol 21 (4) ◽

pp. 120-139 ◽

Cited By ~ 4

Author(s):

Marta Marino ◽

Antonio G de Belvis ◽

Maria Tanzariello ◽

Emanuele Dotti ◽

Sabina Bucci ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Outcomes ◽

Integrated Care ◽

Service Providers ◽

Systems Of Care ◽

Social Needs ◽

Narrative Review ◽

A Value ◽

Care Models ◽

Integrated Care Models

Introduction The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.

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