Testing integrated care service models for patients with complex care needs using simulation modelling / Pruebando modelos integrados de servicios de atención con pacientes con complejos cuidados de atencion usando modelos de simulación

Background: The Multicenter Youth Flexible ACT Study is an ongoing observational prospective cohort study that examines the effects of Youth Flexible ACT (Assertive Community Treatment) on young people with complex care needs who are difficult to engage in traditional (office-based) mental health services. However, a clear and detailed description of this patient group is lacking. In the current paper, we present baseline characteristics and psychosocial outcomes of the Youth Flexible ACT target group and explore the existence of underlying specific patient subgroups.Methods: Sixteen Youth Flexible ACT teams from seven mental healthcare institutes in the Netherlands participated in the study. Research participants were monitored for 18 months and administered questionnaires measuring psychiatric- and social functioning every 6 months, yielding four measurements. Baseline data were obtained from 199 adolescents, their mental health workers, and parents/carers. Latent Class Analysis based on HoNOSCA scores (measuring psychosocial and daily functioning) was conducted to identify underlying subgroups.Results: The target group of Youth Flexible ACT mainly consisted of patients older than 15 years of age with a history of (specialized) mental healthcare. They face many complex problems, including trauma; developmental, mood, and anxiety disorders; and problems with school attendance, family life, and peer relationships. Other frequently reported difficulties were substance misuse, the involvement of the legal system or police, problems with intellectual functioning, and personal finance. Patients were classified into four distinct classes: the “internalizing,” “externalizing,” “non-specific,” and the “overly impulsive” subgroup. Each subgroup had its unique pattern of difficulties and focus, respectively, high levels of depression and anxiety, disruptive behavior, unspecific difficulties, and substance misuse.Conclusions: As expected, patients in Youth Flexible ACT experienced many severe problems, rendering them vulnerable to fragmented and, thus, ineffective care. Our findings underscore the need for an integrated care approach with a multidisciplinary team of skilled professionals that can bridge these wide-ranging psychosocial problems, as each class of participants experienced a different set of difficulties. Youth Flexible ACT teams need to adjust their care services accordingly.

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SUSTAIN: IMPROVING INTEGRATED CARE DELIVERY FOR OLDER PEOPLE WITH COMPLEX CARE NEEDS ACROSS EUROPE

Innovation in Aging ◽

10.1093/geroni/igy023.1464 ◽

2018 ◽

Vol 2 (suppl_1) ◽

pp. 392-393

Author(s):

S R de Bruin ◽

R Schreiber

Keyword(s):

Older People ◽

Integrated Care ◽

Care Delivery ◽

Complex Care ◽

Care Needs ◽

Complex Care Needs

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Self-management in older adults: how to delineate self-management ability, self-management behavior, and self-management support?

10.21203/rs.3.rs-19860/v1 ◽

2020 ◽

Author(s):

Klaske Wynia ◽

Karin Veldman ◽

Sophie Spoorenberg ◽

Maarten Lahr ◽

Menno Reijneveld

Keyword(s):

Older Adults ◽

Integrated Care ◽

Elderly Care ◽

Self Management ◽

Complex Care ◽

Management Support ◽

Care Needs ◽

Risk Profiles ◽

Management Ability ◽

Complex Care Needs

Abstract Background: Self-management is a key element in person-centered and integrated care. It involves several related concepts, such as self-management ability, behavior, and support. These concepts are poorly delineated. The aim of this study was to examine hypothesized associations between self-management ability, behavior, and support in older adults (taking their frailty and complexity of care needs into account) and to examine underlying aspects of these concepts, if these hypotheses lacksupport.Methods: Cross-sectional data from the Embrace study, a stratified randomized controlled trial, evaluating person-centered and integrated care in Dutch community-living older adults, were used. Participants (n=537) were aged 75 and older, assigned to health-related risk profiles based on self-reported frailty and complexity of care needs. Ability was assessed with the Self-Management Ability Scale, behavior with the Partner in Health Scale for Older Adults, and support with the Patient Assessment of Integrated Elderly Care.Results: Ability and behavior were positively associated for participants with the risk profiles “Robust” and “Complex care needs” (betas are 0.38 and 0.46). Coping (an aspect of behavior) turned out to be a key element for participants with risk profiles “Robust” and “Complex care needs” (betas ranging from 0.13 to 0.45). Support was associated with aspects of behavior, varying per risk profile.Conclusion: We found no associations for self-management on the conceptual level, but the aspect coping did appear to play a major role. Improving coping strategies of older adults may be a promising way of enhancing self-management ability, and of reducing the need for self-management support.

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INTEGRATED CARE FOR PEOPLE WITH COMPLEX CARE NEEDS: PAST, PRESENT, AND FUTURE

Innovation in Aging ◽

10.1093/geroni/igx004.408 ◽

2017 ◽

Vol 1 (suppl_1) ◽

pp. 98-99

Author(s):

J.M. Wiener ◽

W.L. Anderson ◽

J. Chen Hansen

Keyword(s):

Integrated Care ◽

Complex Care ◽

Care Needs ◽

Complex Care Needs

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129Collaborative and Integrated Care and its Role in Reducing Acute Hospital Admission for Nursing Home Residents with Complex Care Needs

Age and Ageing ◽

10.1093/ageing/afy140.100 ◽

2018 ◽

Vol 47 (suppl_5) ◽

pp. v13-v60

Author(s):

Aoife Fallon ◽

Jonathon O’Keeffe ◽

Diarmuid O’Shea

Keyword(s):

Nursing Home ◽

Hospital Admission ◽

Integrated Care ◽

Nursing Home Residents ◽

Acute Hospital ◽

Complex Care ◽

Care Needs ◽

Acute Hospital Admission ◽

Complex Care Needs

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Complex care needs and devolution in Greater Manchester: a pilot study to explore social care innovation in newly integrated service arrangements for older people

Australian Health Review ◽

10.1071/ah19168 ◽

2020 ◽

Vol 44 (6) ◽

pp. 838

Author(s):

Baber Malik ◽

Jude Wells ◽

Jane Hughes ◽

Paul Clarkson ◽

John Keady ◽

...

Keyword(s):

Older People ◽

Integrated Care ◽

Social Care ◽

Complex Care ◽

Care Providers ◽

Care Needs ◽

Health And Social Care ◽

Complex Care Needs ◽

Home Care Providers

ObjectiveThe aim of this study was to describe emergent approaches to integrated care for older people with complex care needs and investigate the viability of measuring integrated care. MethodsA case study approach was used. Sites were recruited following discussion with senior staff in health and social care agencies. Service arrangements were categorised using a framework developed by the researchers. To investigate joint working within the sites, the development model for integrated care was adapted and administered to the manager of each service. Data were collected in 2018. ResultsSix case study sites were recruited illustrating adult social care services partnerships in services for older people with home care providers, mental health and community nursing services. Most were established in 2018. Service arrangements were characterised by joint assessment and informal face-to-face discussions between staff. The development of an infrastructure to promote partnership working was evident between adult social care and each of the other services and most developed with home care providers. There was little evidence of a sequential approach to the development of integrated working practices. ConclusionComponents of partnerships promoting integrated care have been highlighted and understanding of the complexity of measuring integrated care enhanced. Means of information sharing and work force development require further consideration. What is known about the topic?The devolution of health and social care arrangements in Greater Manchester has aroused considerable interest in much wider arenas. Necessarily much of the focus in available material has been upon strategic development, analysis of broader trends and mechanisms and a concern with changes in the healthcare system. What does this paper add?The findings from this study will enable emerging approaches to be described and codified, and permit the specific social care contribution to the new arrangements to be discerned. The findings are relevant beyond the immediate context of Greater Manchester to wider integrated care. The evidence can be used by commissioners and services, providing a sound basis for further work as service systems develop. What are the implications for practitioners?This research is important because it is one of the first pieces of work to examine the new integrated care arrangements in Greater Manchester. By providing guidance to promote evidence-based practice, this study contributes to service development in Greater Manchester and the achievement of the broad national service objectives of improving user and carer experiences and ensuring value for money.

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