scholarly journals OPEN ARCH: integrated care at the primary–secondary interface for the community-dwelling older person with complex needs

2020 ◽  
Vol 26 (2) ◽  
pp. 104
Author(s):  
Jennifer Mann ◽  
Rachel Quigley ◽  
Desley Harvey ◽  
Megan Tait ◽  
Gillian Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Older Persons ◽  
Healthcare Delivery ◽  
Community Dwelling ◽  
Ageing Population ◽  
Preventative Care ◽  
Older Person ◽  
Complex Needs ◽  
Open Arch

Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary–secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population.

scholarly journals Impact of an Integrated Community-based Model of Care for Older People with Complex Conditions on Hospital Emergency Presentations and Separations: A Step-wedged Randomized Trial

2021 ◽  
Author(s):  
Mann Jennifer ◽  
Fintan Thompson ◽  
Robyn McDermott ◽  
Adrian Esterman ◽  
Edward Strivens
Keyword(s):  
Older People ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Ageing Population ◽  
Significant Finding ◽  
Older Person ◽  
Complex Needs ◽  
Significant Difference ◽  
The Impact ◽  
Open Arch

Abstract BackgroundAn ageing population and rise in multi-morbidity increase hospital utilisation and acuity of presentation, particularly amongst the older person with complex needs. Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible client outcomes. Integrated care models can improve outcomes for the older person by aligning primary practice with the specialist health care and social services required to manage complex needs. This paper describes the impact of a community facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital separations amongst older people with complex needs.MethodsThe OPEN ARCH study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n=14) are considered ‘clusters’ each comprising a mixed number of participants. 80 community dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included in the study. Clusters were randomly assigned to the time at which they would commence the OPEN ARCH intervention, with intervention periods of 3, 6 and 9 months duration. Each participant was its own control. ED presentations and hospital separations were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to determine the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels.ResultsThe OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or hospitalisations. However, a stabilising of ED presentations and trend toward lower hospitalisation rates over time was observed. ConclusionsWhile this study detected no statistically significant different change in ED presentations or hospital separations, a plateauing of ED presentation and hospitalisation ratesis a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registrationThe OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethic Committee, HREC/17/QCH/104 – 1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

scholarly journals Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Mann ◽  
Fintan Thompson ◽  
Robyn McDermott ◽  
A. Esterman ◽  
Edward Strivens
Keyword(s):  
Older People ◽  
Older Persons ◽  
Hospital Admissions ◽  
Community Dwelling ◽  
Trial Registration ◽  
Significant Finding ◽  
Complex Needs ◽  
Primary Practice ◽  
The Impact ◽  
Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

Integrated care for community dwelling older Australians

2019 ◽  
Vol 27 (2) ◽  
pp. 173-187 ◽  
Author(s):  
Jennifer Mann ◽  
Sue Devine ◽  
Robyn McDermott
Keyword(s):  
Public Policy ◽  
Health System ◽  
Integrated Care ◽  
Scoping Review ◽  
Older Persons ◽  
Community Dwelling ◽  
Older Person ◽  
Content Type

PurposeIntegrated care is gaining popularity in Australian public policy as an acceptable means to address the needs of the unwell aged. The purpose of this paper is to investigate contemporary models of integrated care for community dwelling older persons in Australia and discuss how public policy has been interpreted at the service delivery level to improve the quality of care for the older person.Design/methodology/approachA scoping review was conducted for peer-reviewed and grey literature on integrated care for the older person in Australia. Publications from 2007 to present that described community-based enablement models were included.FindingsCare co-ordination is popular in assisting the older person to bridge the gap between existing, disparate health and social care services. The role of primary care is respected but communication with the general practitioner and introduction of new roles into an existing system is challenging. Older persons value the role of the care co-ordinator and while robust model evaluation is rare, there is evidence of integrated care reducing emergency department presentations and stabilising quality of life of participants. Technology is an underutilised facilitator of integration in Australia. Innovative funding solutions and a long-term commitment to health system redesign is required for integrated care to extend beyond care co-ordination.Originality/valueThis scoping review summarises the contemporary evidence base for integrated care for the community dwelling older person in Australia and proposes the barriers and enablers for consideration of implementation of any such model within this health system.

scholarly journals Integrated care in mental health: next steps after the NHS Long Term Plan

2019 ◽  
Vol 214 (06) ◽  
pp. 315-317 ◽  
Author(s):  
Derek K. Tracy ◽  
Kara Hanson ◽  
Tom Brown ◽  
Adrian J. B. James ◽  
Holly Paulsen ◽  
...  
Keyword(s):  
Integrated Care ◽  
Royal College ◽  
Ageing Population ◽  
Select Committee ◽  
Complex Needs ◽  
Health And Social Care ◽  
Care Systems ◽  
The Uk

SummaryHealth and social care face growing and conflicting pressures: mounting complex needs of an ageing population, restricted funding and a workforce recruitment and retention crisis. In response, in the UK the NHS Long Term Plan promises increased investment and an emphasis on better ‘integrated’ care. We describe key aspects of integration that need addressing.Declaration of interestD.K.T. and S.S.S. are on the editorial board of the British Journal of Psychiatry and executives of the Academic Faculty at the Royal College of Psychiatrists. A.J.B.J., H.P. and Z.M. have roles at the Royal College of Psychiatrists that include evaluation of integrated care systems. A.J.B.J. is married to Dr Sarah Wollaston, Member of Parliament for Totnes and Chair of the Health Select Committee.

Why care about integrated care? Part 2. Integrated care systems: an irresistible force changing mental health services

2020 ◽  
pp. 1-12 ◽  
Author(s):  
Derek K. Tracy ◽  
Frank Holloway ◽  
Kara Hanson ◽  
Nikita Kanani ◽  
Matthew Trainer ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Integrated Care ◽  
Healthcare Delivery ◽  
Local Implementation ◽  
The Past ◽  
Care Systems

SUMMARY Part 1 of this three-part series on integrated care discussed the drivers for change in healthcare delivery in England set out in the NHS Long Term Plan. This second part explores the evolution of mental health services within the wider National Health Service (NHS), and describes important relevant legislation and policy over the past decade, leading up to the 2019 Long Term Plan. We explain the implications of this, including the detail of emerging structures such as integrated care systems (ICSs) and primary care networks (PCNs), and conclude with challenges facing these novel systems. Part 3 will address the practical local implementation of integrated care.

scholarly journals 211 A Novel Integrated Care Approach: Supporting Older Persons to Remain at Home

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Sarah Tormey ◽  
Laura Binions ◽  
Aoife Dunne ◽  
Josephine Soh ◽  
Marie O'Connor ◽  
...  
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Older Persons ◽  
Care Team ◽  
Resource Utilisation ◽  
Day Hospital ◽  
Clinical Frailty Scale ◽  
Integrated Network ◽  
Rapid Access ◽  
Co Morbidity

Abstract Background An Integrated Care Team (ICT) was established within our Day Hospital in September 2018 serving a catchment of older persons encompassing 3 Community Healthcare Organisations. The geographical spread of our patients poses challenges to the ICT in establishing an integrated network of services for patients. Provided here is a descriptive analysis of our patient cohort including basic demographics, co-morbidities, interventions and outcomes. Methods The team comprises of a Senior Physiotherapist, Occupational Therapist and Medical Social Worker supported by two Geriatricians. Referrals to the ICT are via the Day Hospital with a weekly multi-disciplinary team (MDT) meeting where they are discussed and prioritised. Interventions offered include domiciliary and day hospital based assessments. Following assessment appropriate targeted therapeutic intervention is provided which includes rapid access to enabling equipment, access to community supports and rapid access Geriatrician review. Additionally the ICT communicate with the acute and primary care services to identify existing or previous resource utilisation. Results In the inaugural 15 weeks of the service,132 referrals were received. This cohort had a mean age of 81,range (60-102) years; 58% female, 42%male. The Charlson Co-morbidity Index (CCI) score ranged from 2-9 with a mean score of 5. Of these, 50% had a Dementia diagnosis, 33% had a Falls history and 17% had a Stroke diagnosis. The mean Rockwood Clinical Frailty Scale score was 5; range ( 2-7). 62% of referrals were reviewed by both Physiotherapy and Occupational therapy, 58% by Medical Social Work. 34/132 required input from all 3 disciplines. Conclusion The ICT service has augmented the existing Day Hospital with timely multi-disciplinary assessment and treatment enabling older persons’ independence within their home in addition to forward planning if dependency levels increase. Additional benefits include reduction of primary care team waiting lists and forging links with our community and local rehab services. Future ambitions include recruitment of specialist nursing and direct referral pathways from our community colleagues.

Beyond multimorbidity: primary care and the older person with complex needs

2021 ◽  
Author(s):  
Jennifer Mann ◽  
Fintan Thompson ◽  
Rachel Quigley ◽  
Robyn McDermott ◽  
Susan Devine ◽  
...  
Keyword(s):  
Primary Care ◽  
Older Person ◽  
Complex Needs

scholarly journals A System of Integrated Care for Older Persons With Disabilities in Canada: Results From a Randomized Controlled Trial

2006 ◽  
Vol 61 (4) ◽  
pp. 367-373 ◽  
Author(s):  
François Béland ◽  
Howard Bergman ◽  
Paule Lebel ◽  
A. Mark Clarfield ◽  
Pierre Tousignant ◽  
...  
Keyword(s):  
Nursing Home ◽  
Integrated Care ◽  
Social Services ◽  
Caregiver Burden ◽  
Older Persons ◽  
Controlled Trial ◽  
Full Range ◽  
Community Dwelling ◽  
Elderly Persons ◽  
Persons With Disabilities

Abstract Background. Care for elderly persons with disabilities is usually characterized by fragmentation, often leading to more intrusive and expensive forms of care such as hospitalization and institutionalization. There has been increasing interest in the ability of integrated models to improve health, satisfaction, and service utilization outcomes. Methods. A program of integrated care for vulnerable community-dwelling elderly persons (SIPA [French acronym for System of Integrated Care for Older Persons]) was compared to usual care with a randomized control trial. SIPA offered community-based care with local agencies responsible for the full range and coordination of community and institutional (acute and long-term) health and social services. Primary outcomes were utilization and public costs of institutional and community care. Secondary outcomes included health status, satisfaction with care, caregiver burden, and out-of-pocket expenses. Results. Accessibility was increased for health and social home care with increased intensification of home health care. There was a 50% reduction in hospital alternate level inpatient stays (“bed blockers”) but no significant differences in utilization and costs of emergency department, hospital acute inpatient, and nursing home stays. For all study participants, average community costs per person were C$3390 higher in the SIPA group but institutional costs were C$3770 lower with, as hypothesized, no difference in total overall costs per person in the two groups. Satisfaction was increased for SIPA caregivers with no increase in caregiver burden or out-of-pocket costs. As expected, there was no difference in health outcomes. Conclusions. Integrated systems appear to be feasible and have the potential to reduce hospital and nursing home utilization without increasing costs.

Implementation of an integrated care model between general practitioner and cardiologist

2019 ◽  
Vol 27 (4) ◽  
pp. 305-315 ◽  
Author(s):  
Marijke Paula Margaretha Vester ◽  
Greetje Johanna de Grooth ◽  
Tobias Nicolaas Bonten ◽  
Bas Leendert van der Hoeven ◽  
Marieke Susanne de Doelder ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Integrated Care ◽  
Healthcare Delivery ◽  
Real Life ◽  
Cost Savings ◽  
Care Model ◽  
Potential Cost ◽  
Content Type ◽  
Program Costs

Purpose Integrated care models have shown to deliver efficient healthcare, but implementation has proven to be difficult. The Support Consultation is an integrated care model, which enables full integration by bundled payment, insurer involvement, predefined care pathways and strengthening of primary care. The purpose of this paper is to provide an indication of the improvements in healthcare delivery after implementation of this proposed model and to create a base for extension to similar interfaces between primary and secondary care. Design/methodology/approach A retrospective study was used to compare the effect on the number of referred patients with non-acute cardiac complaints and the cost effectiveness before and after implementation of the Support Consultation. Patients who previously would have been referred to the cardiologist were now discussed between general practitioner and cardiologist in a primary care setting. Findings The first consecutive 100 patients (age 55±16 years, male 48 percent), discussed in the Support Consultation, were analyzed. Implementation of the Support Consultation resulted in a net costs (program costs and referral costs) reduction of 61 percent compared with usual care. All involved parties were positive about the program. Research limitations/implications The Support Consultation has the ability to provide more effective healthcare delivery and to reduce net costs. The setting of the current study can be used as example for other specialties in countries with a similar healthcare system. Originality/value This study provides the potential cost savings after implementation of an integrated care model, based on real-life data.

Sign in / Sign up

Export Citation Format

Share Document