The business of integrated care: implementing new models of care in a fee-for-service setting

2018 ◽  
Vol 26 (1) ◽  
pp. 16-28 ◽  
Author(s):  
Serena Yu ◽  
Kees van Gool ◽  
Karen Edwards ◽  
Sue Kirby ◽  
Karen Gardner ◽  
...  
Keyword(s):  
Data Collection ◽  
Integrated Care ◽  
Models Of Care ◽  
Rural Setting ◽  
Fee For Service ◽  
Content Type ◽  
Practice Level ◽  
South Wales ◽  
Administration Time ◽  
Rural Sites

Purpose The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model. Design/methodology/approach Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers. Findings There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities. Research limitations/implications The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites. Practical implications At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability. Originality/value This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints.

Person-centred integrated care with a health promotion/public health approach: a rapid review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Teresa Burdett ◽  
Joanne Inman
Keyword(s):  
Public Health ◽  
Health Promotion ◽  
Integrated Care ◽  
Population Health ◽  
Active Agent ◽  
Well Being ◽  
Models Of Care ◽  
Rapid Review ◽  
Public Health Approach ◽  
Content Type

PurposeDue to the need for the development of person-centred integrated models of care with a population health approach, this paper explored contemporary literature in this arena.Design/methodology/approachA systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Papers included in this review focused upon person-centred integrated care and a health promotion/public health approach (January 2018–October 2020). Papers were excluded due to not being written in English, not fitting the age criteria and not being peer reviewed.FindingsEight studies met the inclusion criteria and three overarching themes were identified with regards to person-centred integrated care as a health promotion/public health approach: Core components; Development, implementation, and evaluation of models of care and relationship to population health and wellbeing outcomes.Research limitations/implicationsThe need for person-centred integrated care as a health promotion/public health approach, to enhance population health and well-being outcomes requires further research to continue to develop, implement and evaluate models of care.Originality/valueThe international scope of this contemporary review brought together the three concepts of person-centred integrated care and public health, exploring the translation of policy into practice (WHO, 2016). The juxtaposition of public health approaches in the background/consequential or foreground/active agent demonstrates how promotion, prevention and population health can be re-valued in integrated people-centred health services (WHO, 2016).

scholarly journals Making it personal – population health management and the NHS

2020 ◽  
Vol 28 (3) ◽  
pp. 243-252
Author(s):  
Martin McShane ◽  
Karen Kirkham
Keyword(s):  
Integrated Care ◽  
Population Health ◽  
Health Management ◽  
Major Change ◽  
Models Of Care ◽  
Population Health Management ◽  
Content Type ◽  
Disease Patterns ◽  
Learning Health System ◽  
Care Systems

PurposeChanges in demographics and disease patterns are challenging health and care systems across the world. In England, national policies have reset the direction of travel for the NHS. Collaboration, integration and personalisation are intended to become prime principles and drivers for new models of care. Central to this is the concept of population health management. This has emerged, internationally, as a method to improve population health. Fundamental for population health management to succeed is the use of integrated data, analytics combined with professional insight and the adoption of a learning health system culture. This agenda reaches beyond the NHS in England and the public health profession to embrace a broad range of stakeholders. By drawing on international experience and early experience of implementation in the United Kingdom, the potential for health and care systems in England to become world leading in population health management is explored.Design/methodology/approachA viewpoint paper.FindingsPopulation health management is a major change in the way health and care systems look at the challenges they are facing. It makes what is happening to individuals, across the continuum of care, the essence for insight and action. The NHS has the components for success and the potential to become world leading in delivery of population health management as part of its integrated care agenda.Originality/valueThis is the first viewpoint paper to set out how population health management contributes to the integrated care agenda in the NHS.

Integrated ambulatory care in the New Zealand health system: a scoping review

2020 ◽  
Vol 28 (3) ◽  
pp. 253-280
Author(s):  
Gagan Gurung ◽  
Carol Atmore ◽  
Robin Gauld ◽  
Tim Stokes
Keyword(s):  
New Zealand ◽  
Leadership Development ◽  
Ambulatory Care ◽  
Integrated Care ◽  
Scoping Review ◽  
Grey Literature ◽  
Models Of Care ◽  
Content Type ◽  
Workforce Skills ◽  
Care Models

PurposeThe purpose of this paper is to identify and describe the international and New Zealand (NZ) evidence for models of integrated ambulatory care and describe key implementation issues and lessons learnt.Design/methodology/approachA scoping review was conducted for published and grey literature on integrated care. Publications from 2000 to February 2019 that described integrated ambulatory care were included.FindingsA total of 34 articles were included. Internationally and in NZ, the most common models of integrated care found were: transfer, relocation and joint working. The international literature showed that transferring care from hospitals to community and other integrated models of care between the primary–specialist interface increased access and convenience for patients. However, there was insufficient evidence of clinical and economic outcomes. Very few NZ-based studies reported on effectiveness of models of care. Key implementation issues were: no viable and sustainable funding, lack of infrastructure, lack of confidence, trust and communication between providers, increased workload and time and knowledge and skills gap to perform new roles. The NZ literature highlighted the need for an appropriate location for services, committed leadership, development of a governance group representing different provider groups, strong communication mechanisms, new workforce skills and overall change management.Originality/valueThe review provides an overview of key components of integrated care models in ambulatory settings and identifies some common elements across the models of care. The findings can inform the design and implementation of integrated ambulatory care in health systems.

Risk perception and awareness of earthquake: the case of Dhaka

2019 ◽  
Vol 10 (1) ◽  
pp. 65-82 ◽  
Author(s):  
Mohammad Lutfur Rahman
Keyword(s):  
Risk Perception ◽  
Data Collection ◽  
Seismic Risk ◽  
Public Awareness ◽  
Content Type ◽  
Earthquake Preparedness ◽  
Level Of Knowledge ◽  
Seismic Risk Perception ◽  
The Many ◽  
And Behavior

Purpose Among the many studies about risk perception, only a few deal with Bangladesh. Paul and Bhuiyan’s (2010) study has shown the earthquake-preparedness level of residents of Dhaka, but there are some biases in the data collection. This paper aims to examine the seismic-risk perception and the level of knowledge on earthquake and preparedness among the residents of Dhaka. Design/methodology/approach A questionnaire was developed, and data collection was undertaken through home and sidewalk surveys. This paper investigates how attitude, perception and behavior differ depending on gender, age, education and casualty awareness. This research tries to examine and make a comparison of the risk perception and preparedness level between different groups of gender, age and level of education. Findings This research shows that female respondents have a much better risk perception of and are better prepared for earthquakes than male respondents; younger people have a higher knowledge about earthquake preparedness than older people and less-educated people are at a higher risk of unpreparedness than more-educated people. Research limitations/implications This research is only limited to the Dhaka Division. Originality/value This paper concludes by noting that public awareness on seismic-risk perception and mitigation is poor, and their knowledge on basic theory and emergency response must be improved.

scholarly journals Characterization and Molecular Epidemiology of a Fungal Infection of Edible Crabs (Cancer pagurus) and Interaction of the Fungus with the Dinoflagellate Parasite Hematodinium

2012 ◽  
Vol 79 (3) ◽  
pp. 783-793 ◽  
Author(s):  
Amanda L. Smith ◽  
Kristina M. Hamilton ◽  
Lucy Hirschle ◽  
Emma C. Wootton ◽  
Claire L. Vogan ◽  
...  
Keyword(s):  
Ribosomal Dna ◽  
Host Response ◽  
Small Subunit ◽  
Fungal Isolate ◽  
Content Type ◽  
Cancer Pagurus ◽  
South Wales ◽  
Disease Condition ◽  
Fungal Sepsis ◽  
Host Tissues

ABSTRACTThis study reports on an emerging fungal disease of the edible crab,Cancer pagurus. Juvenile (prerecruit) crabs were found to be subject to this disease condition during the months of May to September at two intertidal sites in South Wales, United Kingdom. Histopathology revealed that the fungi overwhelm the host response in the tissues, leading to progressive septicemia. The causative agent of this infection was isolated and grown in pure culture and was identified as a member of theOphiocordycepsclade by sequencing of the small subunit of the fungal ribosomal DNA (rDNA). Of the crabs naturally infected with the fungus, 94% had a coinfection with the parasitic dinoflagellateHematodiniumspecies. To determine if there was any interaction between the two disease-causing agents, apparently fungus-free crabs, both with and without naturalHematodiniuminfections, were challenged with the fungal isolate. The presence ofHematodiniumcaused a significant reduction in fungal multiplication in the hemocoel of the crabs in comparison to that inHematodinium-free individuals. Histopathology of coinfected crabs showed a systemic multiplication ofHematodiniumwithin host tissues, leading to a rapid death, whileHematodinium-free crabs experimentally infected with the fungal isolate died due to fungal sepsis (septicemia) with the same characteristic pathology as seen in natural infections.

What would I change the next time? A confessional tale of in‐depth qualitative data collection

2012 ◽  
Vol 12 (1) ◽  
pp. 98-110 ◽  
Author(s):  
Claire Smith
Keyword(s):  
Data Collection ◽  
Design Methodology ◽  
Qualitative Data ◽  
Content Type ◽  
Qualitative Data Collection

PurposeThe purpose of this paper is to discuss how fieldwork impacted the author's own and one participant's positioning; the author's reflexivity, experiences and feelings of alterity; the participant's performances and conversations between the author and participant.Design/methodology/approachThe author uses a confessional tale to describe the time spent with the participant and confesses how it impacted on the author as the researcher. The author examines her biases, feelings, and vulnerabilities, and explores some of the methodological and positioning issues with which she struggled.FindingsThe author ponders on what she learned while being in such close quarters with a participant and discusses what she should keep in mind about herself as the researcher during subsequent data collection forays. Researchers should know themselves well before attempting such closeness because when we are researchers, we can’t change who we are as people.Originality/valueIt is believed that the extreme researcher/participant closeness was unique but was, at the same time, an extremely useful form of data collection.

The storm after the storm: the long-term lingering impacts of hurricanes on schools

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Cassandra R. Davis ◽  
Sarah R. Cannon ◽  
Sarah C. Fuller
Keyword(s):  
North Carolina ◽  
Data Collection ◽  
Instructional Time ◽  
Emotional Needs ◽  
Social Emotional ◽  
Content Type ◽  
The North ◽  
State Education ◽  
The Impact

PurposeThe purpose of this paper is to identify and describe the long-term impacts of hurricanes on schools and discuss approaches to improving recovery efforts.Design/methodology/approachInterviews with 20 school districts in Texas and North Carolina after Hurricanes Harvey (2017) and Matthew (2016). In total, 115 interviews were conducted with teachers, principals, district superintendents and representatives from state education agencies. Interview questions focused on the impact of storms and strategies for recovery.FindingsThe authors uncovered three long-term impacts of hurricanes on schools: (1) constrained instructional time, (2) increased social-emotional needs and (3) the need to support educators.Research limitations/implicationsThis paper focuses on two storms, in two states, in two successive years. Data collection occurred in Texas, one academic year after the storm. As compared to the North Carolina, data collection occurred almost two academic years after the storm.Practical implicationsThis paper illuminates strategies for stakeholders to implement and expedite hurricane recovery through; (1) updating curricula plans, (2) providing long-term counselors and (3) supporting educators in and out of school.Originality/valueTo date, very few studies have explored the ways in which schools face long-term impacts following a disaster. This paper provides insight to the challenges that prolong the impacts of disasters and impede recovery in schools. With hurricanes and related disasters continuing to affect schooling communities, more research is needed to identify the best ways to support schools, months to years after an event.

Achieving person-centredness through technologies supporting integrated care for older people living at home: an integrative review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Julie MacInnes ◽  
Jenny Billings ◽  
Alexandra Lelia Dima ◽  
Chris Farmer ◽  
Giel Nijpels
Keyword(s):  
Older People ◽  
Integrated Care ◽  
Digital Technologies ◽  
Healthcare Management ◽  
Integrative Review ◽  
Scientific Publications ◽  
Content Type ◽  
Range Type ◽  
Care For Older People ◽  
At Home

PurposeThe purpose of this paper is to identify the range, type and outcomes of technological innovations aimed at supporting older people to maintain their independence within the context of integrated care at home. We also discuss key emergent themes relevant to the use of person-centred technology for older people in integrated care and propose recommendations for policy and practice.Design/methodology/approachAn integrative review methodology was used to identify and describe recent scientific publications in four stages: problem identification, literature search, data evaluation and data analysis.FindingsTwelve studies were included in the review. Three studies described remote consultations, particularly telemedicine; five studies described tools to support self-management; three studies described the use of healthcare management tools, and one study described both remote consultation and self-care management. Emergent themes were: acceptability, accessibility and use of digital technologies; co-ordination and integration of services; the implementation of digital technologies; and safety and governance. Several recommendations are proposed relevant to integrated care teams, technology developers and researchers.Originality/valueThis review uniquely considers the extent to which novel digital technologies used in integrated care for older people are person-centred.

Commentary on the harm reduction reference group of justice health and forensic mental health network and corrective services NSW, Australia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Julia Anne Silano ◽  
Carla Treloar ◽  
Thomas Wright ◽  
Tracey Brown ◽  
Colette McGrath ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Care ◽  
Harm Reduction ◽  
Reference Group ◽  
New South ◽  
Forensic Mental Health ◽  
Content Type ◽  
Health Network ◽  
South Wales

Purpose This commentary aims to reveal how a steering committee has effectively responded to advancing accessibility to harm reduction resources, hepatitis C virus (HCV) policy and health strategies within adult prison settings in New South Wales (NSW). Design/methodology/approach By reviewing the audit approach taken by the of the Justice Health and Forensic Mental Health Network and Corrective Services New South Wales Harm Reduction Reference Group (JHFMHN/CSNSW HRRG), this commentary emphasizes the committee’s success in identifying contemporary harm reduction issues that affect people in custodial settings. This commentary is a compilation of data gathered through the 2018 JHFMHN/CSNSW HRRG audit and corresponding program materials. Conclusions regarding the effectiveness of the working group’s audit were drawn by critically appraising the JHFMHN/CSNSW HRRG’s Final Audit Report (JHFMHN and CSNSW, 2018) with reference to current harm reduction literature. Findings The HRRG has provided leadership, professional representation and strategic advice on the development, implementation, monitoring and evaluation of best practice harm reduction strategies in prison settings. The HRRG developed and maintained networks and information exchange between the state-wide HCV health network, corrections services and the NSW harm reduction sector at large. Public health partnerships and advocacy that involve all key players, such as the HRRG, will continue to be crucial to remove barriers to enhancing HCV harm reduction measures especially in NSW prison settings. Social implications Strategies such as primary prevention and treatment can mitigate the spread of HCV in the custodial system. This audit of access to harm reduction resources was conducted on behalf of the diverse group of professionals, scholars and stakeholders comprising the HRRG. This audit and other advocacy efforts of this committee can facilitate future access to quality healthcare and the necessary policies required to support a healthier prison population at large. Originality/value Collaborating with health authorities, researchers and social service workers can enable prison health-care systems to be guided by wider health workforce programs and public health standards. This collaboration can reduce the professional isolation of custodial health-care staff and promote a balanced approach to harm reduction policies by ensuring an equitable focus on both health and security imperatives.

Mapping the urban environment using real-time physiological monitoring

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Dimitra Dritsa ◽  
Nimish Biloria
Keyword(s):  
Data Collection ◽  
Conceptual Model ◽  
Urban Environment ◽  
Physiological Responses ◽  
Physiological Data ◽  
Contextual Data ◽  
Content Type ◽  
The Relationship ◽  
The City ◽  
Urban Stress

PurposeThis paper presents a critical review of studies which map the urban environment using continuous physiological data collection. A conceptual model is consequently presented for mitigating urban stress at the city and the user level.Design/methodology/approachThe study reviews relevant publications, examining the tools used for data collection and the methods used for data analysis and data fusion. The relationship between urban features and physiological responses is also examined.FindingsThe review showed that the continuous monitoring of physiological data in the urban environment can be used for location-aware stress detection and urban emotion mapping. The combination of physiological and contextual data helps researchers understand how the urban environment affects the human body. The review indicated a relationship between some urban features (green, land use, traffic, isovist parameters) and physiological responses, though more research is needed to solidify the existence of the identified links. The review also identified many theoretical, methodological and practical issues which hinder further research in this area.Originality/valueWhile there is large potential in this field, there has been no review of studies which map continuously physiological data in the urban environment. This study covers this gap and introduces a novel conceptual model for mitigating urban stress.

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