Integrating Care in Norfolk (ICN)—A case study on a two-year programme to improve integrated working between primary care, community health services and social care in six localities

IntroductionIn most developed countries, a significant amount of mental health and addictions care occurs in community settings. Data reflecting populations served by community-based mental health and addictions providers and the types of services provided are not available, resulting in an incomplete reflection of the entire mental health and addictions system within existing administrative data. Objectives and ApproachThe Community Business Intelligence (CBI) initiative is a data collection project that captures information on adults receiving community-based mental health, addictions, and support services in Toronto Central Local Health Integration Network (LHIN), located in Ontario, Canada. Leveraging administrative health data and data linkage capacity at the Institute for Clinical Evaluative Sciences (ICES), along with engagement of external stakeholders knowledgeable of CBI and the community health sector, we linked the 2015/16 CBI dataset to administrative health data. Demographic characteristics, health-service utilization, primary care attachment, and 30-day emergency department (ED) revisits were calculated for individuals accessing community health services. ResultsThere was an 80.8% linkage rate, of which 36.9% linked deterministically via health card number, while 43.9% linked probabilistically. After study exclusions, 37,688 individuals in the CBI dataset used community health services between April 2015 and March 2016. Compared to Toronto Central LHIN, a greater proportion in the CBI dataset were female, older than 65 years of age, and living in a low income neighbourhood. Furthermore, 95.5%of individuals had at least one outpatient physician visit, 51.3%had at least one ED visit, and 21.7%had at least one hospitalization in the past year. Few individuals in the CBI dataset were without primary care attachment (4.5%); however, a larger proportion had a 30-day ED revisit, particularly those receiving community addictions services (19%). Conclusion/ImplicationsThe availability of community health services data in the CBI dataset and its successful linkage to the administrative health data held at ICES identified health service intersections and outcomes that were previously unknown. This linkage project demonstrates a successful framework for sector-wide performance measurement to address a critical infrastructure gap.

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Primary care networks: an opportunity to improve community wound care

British Journal of Community Nursing ◽

10.12968/bjcn.2020.25.sup3.s20 ◽

2020 ◽

Vol 25 (3) ◽

pp. S20-S25

Author(s):

Liam Benison

Keyword(s):

Primary Care ◽

General Practice ◽

Health Services ◽

Health System ◽

Community Health ◽

Patient Outcomes ◽

Wound Care ◽

Community Health Services ◽

Predominant Role ◽

Poor Outcomes

Primary care networks (PCNs) were introduced in England in 2019 to bring about closer collaboration between general practice and community health services. The ambition is that greater collaboration between services will achieve better patient outcomes and reduce costs through more effective sharing of staff and resources. Wound care might be considered an ideal focus for PCNs, since general practice and community health services not only have a predominant role in the management of wounds, but variable and suboptimal practice continues and poor outcomes persist. This article investigates some ways in which PCNs might enable health-system changes that could improve the provision of wound care.

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Contracts and the Quasi-market in Community Health Services

Journal of Social Policy ◽

10.1017/s0047279400025423 ◽

1995 ◽

Vol 24 (4) ◽

pp. 529-550 ◽

Cited By ~ 27

Author(s):

Rob Flynn ◽

Susan Pickard ◽

Gareth Williams

Keyword(s):

Health Care ◽

Health Services ◽

Community Health ◽

Community Health Services ◽

Acute Hospital ◽

Three Dimensions ◽

Hospital Services ◽

Care Community ◽

Qualitative Evidence ◽

Contracting Process

ABSTRACTIn the NHS quasi-market, contracts are the crucial mechanism through which purchasers influence providers of health care. Most attention has been given to the commissioning and contracting process in acute hospital services. However, there is another important but neglected sector of health care – community health services (CHS) – in which the specification and implementation of contracts is particularly difficult. In this article, three dimensions of contracting are analysed, illustrated by qualitative evidence from case studies, concerning: the measurement of activity; the estimation of costs and prices; and the monitoring of outcomes and quality. This article argues that community health services are intrinsically problematic within the quasi-market, and suggests that the nature of the services and the system of delivery militate against provider competition. It is argued that CHS have more in common with ‘clans’ and ‘networks’ rather than markets and hierarchies, and that this requires collaborative rather than adversarial relationships between purchasers and providers.

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Community health services in urban China: a geographical case study of access to care

Health Care Reform and Globalisation ◽

10.4324/9780203106785-14 ◽

2012 ◽

pp. 178-195

Keyword(s):

Health Services ◽

Access To Care ◽

Community Health ◽

Community Health Services ◽

Urban China

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Trends in Australian government health expenditure by age: a fiscal incidence analysis

Australian Health Review ◽

10.1071/ah14043 ◽

2014 ◽

Vol 38 (5) ◽

pp. 523 ◽

Cited By ~ 3

Author(s):

Alan Tapper ◽

John Phillimore

Keyword(s):

Health Services ◽

Community Health ◽

Acute Care ◽

Health Expenditure ◽

Community Health Services ◽

Australian Government ◽

Care Community ◽

Government Health ◽

Age Related ◽

Government Health Expenditure

Objective Australian government health expenditure per capita has grown steadily across the past few decades, but little is known about trends in the age distribution of health expenditure. Methods In this paper, the Australian Bureau of Statistics (ABS) fiscal incidence studies, which track expenditure at the household level between 1984 and 2010, are used to shed light on this topic. Results The main finding was that spending has shifted focus from the younger half to the older half of the population. This shift is evident in three areas: (1) acute care (hospitals); (2) community health services (doctors); and (3) pharmaceuticals. Together, these areas account for approximately 88% of expenditure. The trend is independent of demographic aging. It is unlikely to reflect changes in population health. Its explanation is open to debate. Conclusions Growth in expenditure per household has been more than threefold faster for elderly than young households. Across this period, expenditure per household per week has increased by 51% for the young, by 79% for the middle aged and by 179% for the elderly. This age-related growth is most prominent in expenditure on acute care, community health services and pharmaceuticals. What is known about the topic? The Productivity Commission has published figures that relate age and Australian heath expenditure. However, there has been no published study of age-related trends in Australian health expenditure. What does this paper add? In addition to tracking age-related trends across 26 years, this paper adds a breakdown of those trends into four categories of expenditure, namely acute care, community health services, pharmaceutical benefits, and other. This breakdown shows that the trends vary by expenditure type. What are the implications for practitioners? The paper shows that forward projections in health expenditure need to take into account age-related trends as well as demographic trends.

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