Integrated care: learning from East London

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697265
Author(s):  
Sonia Bussu
Keyword(s):  
Integrated Care ◽  
Evidence Base ◽  
Community Health Services ◽  
Health Economy ◽  
Local Health ◽  
Frontline Staff ◽  
Care Community ◽  
Organisation Development ◽  
Integrated Care Pathways ◽  
Local Health System

BackgroundDespite a growing body of literature on integrated, there remains a relatively small evidence base to suggest which elements of integrated care are most effective and how to implement them successfully. This might also be due to the fact that policy thinking around integrated care is struggling to translate into organisation change at the point of delivery. Better understanding of patterns of collaborations and integrated pathways is crucial to understand frontline staff’s OD needs and provide adequate support.AimThis paper focuses on the frontline level to assess progress towards integrated care in East London.MethodWe use admission avoidance (Rapid Response service) and discharge services (Discharge to Assess) as a lens to examine how frontline staff from secondary care, community health services and social service work together to deliver more integrated care. The study uses the Researcher in Residence (RiR), where the researcher is embedded in the in the organisations she is evaluating, as a key member of the delivery team.ResultsInitial findings suggest that while work on integrated care has enabled some level of collaborative working at strategic levels in partner organisations, on the frontline professionals are grappling with issues such as professional identity, professional boundaries, mutual trust and accountability, as new services and roles struggle to be fully embedded within the local health system.ConclusionThe paper sheds light on to the complexity on integrated care at the point of delivery. Better understanding of integrated care pathways is crucial to evidence patterns of collaboration across organisations; assess how these new roles and teams are embedding themselves within the local health economy; identify organisation development needs; and provide adequate support to frontline staff.

scholarly journals Integrated care pathways on dementia in Italy: a survey testing the compliance with a national guidance

2019 ◽  
Vol 41 (4) ◽  
pp. 917-924
Author(s):  
Giuseppe Gervasi ◽  
Guido Bellomo ◽  
Flavia Mayer ◽  
Valerio Zaccaria ◽  
Ilaria Bacigalupo ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Pathway ◽  
Care Pathways ◽  
Local Health ◽  
Health Authorities ◽  
People With Dementia ◽  
Specific Objective ◽  
Item Checklist ◽  
Integrated Care Pathways ◽  
Integrated Care Pathway

AbstractDementias are chronic, degenerative neurological disorders with a complex management that require the cooperation of different healthcare professionals. The Italian Ministry of Health produced the document “Guidance on Integrated Care pathway for People with Dementia” (GICPD) with the specific objective of providing a standardized framework for the definition, development, and implementation of integrated care pathways (ICP) dedicated to people with dementia. We searched all available Italian territorial ICPs. Two raters assessed the retrieved ICPs with a 2-point scale on a 43-item checklist based on the GICPD. Only 5 out of 21 regions and 5 out of 101 local health authorities had an ICP, with most ICPs having a moderate compliance to the GICPD, in particular for the items referring to the development and implementation of the care pathways. A low to moderate inter-rater agreement was observed, mainly due to a lack of standardized models to describe ICPs for dementias. Results suggest that policy- and decision-makers should pay more attention to the GICPD when producing ICPs. The direct communication with clinicians, and the implementation of more precise and appropriate clinical outcomes, could increase the involvement of clinicians, whose participation is crucial to guarantee that ICPs meet needs of patients and their carers.

scholarly journals Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

2021 ◽  
Author(s):  
Aoife Watson ◽  
Donna McConnell ◽  
Vivien Coates
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Integrated Care ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Community Based Interventions ◽  
Community Based ◽  
Integrated Care Pathways ◽  
Effective Community ◽  
Balance Of Care

Abstract Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

Integrated Care Pathways: An Orthopaedic Experience

Physiotherapy ◽  
1996 ◽  
Vol 82 (1) ◽  
pp. 28-30 ◽  
Author(s):  
P POOLE ◽  
S JOHNSON
Keyword(s):  
Integrated Care ◽  
Care Pathways ◽  
Integrated Care Pathways

scholarly journals The Electronic Health Insurance Card for Asylum-Seekers in Berlin: Effects on the Local Health System

2021 ◽  
Author(s):  
Nora Gottlieb ◽  
Vanessa Ohm ◽  
Miriam Knörnschild
Keyword(s):  
Health Insurance ◽  
Cost Analysis ◽  
Asylum Seekers ◽  
Inpatient Care ◽  
Local Health ◽  
Healthcare Provision ◽  
Barriers To Healthcare ◽  
Insurance Card ◽  
Local Health System ◽  
And Control

Background: In debates on asylum-seekers’ access to healthcare it is frequently claimed that restrictions are necessary to prevent unduly high health service utilization and costs. Within Germany, healthcare provision for asylum-seekers varies across the different states. Berlin’s authorities removed some barriers to healthcare for asylum-seekers by introducing an electronic health insurance card (HIC) in 2016. We used the HIC introduction in Berlin as an opportunity to investigate the effects of improved healthcare access for asylum-seekers on the local health system. Methods: The study applied a mixed-methods design. A cost analysis compared expenses for outpatient and inpatient health services for asylum-seekers before and after the HIC introduction, based on aggregate claims data and information on expenses for humanitarian healthcare provision that were retrieved from the Berlin authorities. Semi-structured interviews with 12 key informants explored organizational effects like administrative workloads and ethical dilemmas for staff. We performed a content analysis and used respondent validation to enhance the accuracy and trustworthiness of our results. Results: The HIC has reduced bureaucratic complexity and administrative workloads; it has enabled unprecedented financial transparency and control; and it has mitigated ethical tensions. All the while, average per person expenses for outpatient health services have declined since the HIC introduction. However, our cost analysis also indicates a rise in the utilization and costs of inpatient care. Conclusion: The HIC introduction in Berlin suggests that the removal of barriers to healthcare for asylum-seekers can create win-win-situations by reducing administrative workloads, advancing financial transparency, and mitigating ethical tensions, whilst cutting the costs of outpatient healthcare provision. Removing barriers to healthcare thus appears to be a more prudent policy choice than maintaining mechanisms of restriction and control. However, high inpatient care utilization and costs warrant further research.

scholarly journals Rigorous development of computer based Integrated Care Pathways for HIV patients

2014 ◽  
Author(s):  
Petros Papapanagiotou ◽  
Jacques Fleuriot ◽  
Areti Manataki ◽  
Andrew Winter ◽  
Rak Nandwani ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Pathways ◽  
Hiv Patients ◽  
Integrated Care Pathways ◽  
Computer Based

Central COVID-19 Coordination Centers in Germany: Description, economic evaluation and systematic review (Preprint)

2021 ◽  
Author(s):  
Nikolas Schopow ◽  
Georg Osterhoff ◽  
Nikolaus von Dercks ◽  
Felix Girrbach ◽  
Christoph Josten ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
University Hospital ◽  
Local Health ◽  
The Public ◽  
Important Benefit ◽  
Economic Analyses ◽  
Management Institutions ◽  
Local Health System ◽  
Regional Hospitals

BACKGROUND During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCC) have been established at several hospitals across Germany with the intention to assist local healthcare professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals, and therefore to prevent the collapse of local health system structures. In addition, they coordinate interhospital transfers of COVID-19 patients and provide or arrange specialized telemedical consultations. OBJECTIVE This study describes the establishment and management of a CCCC at a German university hospital. METHODS We perform economic analyses (cost, cost-effectiveness, use and utility) according to the CHEERS criteria. Additionally, a systematic review was conducted to identify publications on similar institutions worldwide. RESULTS The two months with the highest local incidence (12/2020 and 01/2021) of COVID-19 cases were considered. During this time, 17.3 requests per day were made to CCCC regarding admission or transfer of COVID-19 patients. The majority of requests was made by emergency medical services (56.3%), patients with an average age of 71.8 years were involved and 69.0% of cases had already positive PCR detection. In 59.8% of the concerning patients, further treatment by the general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% of patients were admitted to normal wards and 12.9% were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 per month. 90.4% of all patients presented to the hospital were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. CONCLUSIONS Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefit of the CCCC is that it prevents hospitals from being overrun by patients and that it avoids situations in which doctors have to weigh up one patient’s life against another´s.

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