Assessing Factors that Influence the Implementation of Technologies Enabling Integrated Care Delivery for Older Adults with Complex Needs: A Systematic Review

The U.S. population of older adults living with dementia is projected to double by 2060. They rely on over 16 million family and unpaid caregivers to provide for their increasingly complex needs and care transitions. Caregivers frequently feel underprepared and without adequate support or access to resources. This systematic review seeks to identify the needs of family and unpaid caregivers of older adults living with dementia across various care settings in the U.S. A systematic search was conducted to identify articles pertaining to the needs of caregivers of older adults living with dementia. The data extraction tool was developed using aspects from the Care Transitions Framework and the Family Caregiver Alliance. Data were organized based on 3 domains of caregiver needs and the care setting(s) of the older adults living with dementia and their caregivers. A total of 31 articles were eligible for inclusion. The majority met the MMAT screening criteria, but more than half only met 2 or less of the 5 quality criteria. Caregivers’ needs were identified in the care settings of home/community-residing, assisted living, long-term care, skilled nursing, and memory care. Most articles either did not specify a care setting or included more than 1 and did not report the findings separately. Caregivers in each care setting, except memory care, identified needs in all 3 of the following domains: (1) social support—formal and informal, (2) confidence, competence, and strengths in the caregiving role, and (3) values and preferences.

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What Works in Integrated Care Programs for Older Adults with Complex Needs? A Realist Review

International Journal of Integrated Care ◽

10.5334/ijic.3412 ◽

2017 ◽

Vol 17 (5) ◽

pp. 107

Author(s):

Jennifer Im ◽

Maritt Kirst ◽

Tim Burns ◽

Jodeme Goldhar ◽

Patricia O'Campo ◽

...

Keyword(s):

Older Adults ◽

Integrated Care ◽

Realist Review ◽

Complex Needs ◽

What Works

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What works in implementation of integrated care programs for older adults with complex needs? A realist review

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzx095 ◽

2017 ◽

Vol 29 (5) ◽

pp. 612-624 ◽

Cited By ~ 26

Author(s):

Maritt Kirst ◽

Jennifer Im ◽

Tim Burns ◽

G. Ross Baker ◽

Jodeme Goldhar ◽

...

Keyword(s):

Older Adults ◽

Integrated Care ◽

Realist Review ◽

Complex Needs ◽

What Works

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Using Medicare Data to Inform Intervention and Care Delivery for the Most Expensive Patients

Innovation in Aging ◽

10.1093/geroni/igaa057.3350 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 911-911

Author(s):

Sam Amodeo ◽

Henrik Kowalkowski ◽

Halley Brantley ◽

Lauren Bangerter ◽

Nicholas Jones ◽

...

Keyword(s):

Older Adults ◽

Chronic Conditions ◽

Care Delivery ◽

Temporal Stability ◽

Medicare Advantage ◽

Complex Needs ◽

Tailored Interventions ◽

Medicare Data ◽

Delivery Models ◽

Global Population

Abstract Older adults with high medical spend require tailored interventions and care delivery models to meet their complex needs. Segmenting high-spend patients is a promising approach to designing such interventions. In this study we explored patient spend across 4 years (2016-2019) using claims from 799,205 patients continuously enrolled in UnitedHealth Group Medicare Advantage (mean age=73.7; S.E.=0.01). Patients with healthcare spend in the top decile were segmented into three subgroups: catastrophic, persistent, and semi-persistent. Catastrophic patients had more acute events (acute myocardial infarction and hip/pelvic fracture) driving their cost. Persistent patients were younger (mean age=67.8; S.E.=0.06) and had significantly more medications. Semi-persistent patients were older (mean age=76.6; S.E.=0.04) and had significantly more chronic conditions and frailty, indicating their cost was driven by medical complexity. These subgroups displayed different temporal stability in their healthcare costs over time. Each year, 79-81% of the catastrophic group dropped out of the top decile. In contrast, nearly 72% of the persistent group remained in the top decile whereas only 37% of the semi-persistent group remained year over year. As the global population continues to age, it will be necessary to design interventions and care delivery models that address the complex needs of older adults in the high-spend patient population. Our study suggests that segmenting high-spend patients into potentially actionable subgroups is an important first step in achieving these goals.

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Virtual Visits in Home Health Care for Older Adults

The Scientific World JOURNAL ◽

10.1155/2014/689873 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 17

Author(s):

Anne Marie Lunde Husebø ◽

Marianne Storm

Keyword(s):

Older Adults ◽

Health Care ◽

Home Health Care ◽

Social Inclusion ◽

Care Delivery ◽

Home Health ◽

Service Users ◽

Complex Needs ◽

Manual Search ◽

Virtual Visits

Background. This review identifies the content of virtual visits in community nursing services to older adults and explores the manner in which service users and the nurses use virtual visits.Design. An integrative literature review.Method. Data collection comprised a literature search in three databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert consultation were performed. A total of 12 articles met the inclusion criteria. The articles were reviewed in terms of study characteristics, service content and utilization, and patient and health care provider experience.Results. Our review shows that in most studies the service is delivered on a daily basis and in combination with in-person visits. The findings suggest that older home-dwelling patients can benefit from virtual visits in terms of enhanced social inclusion and medication compliance. Service users and their nurses found virtual visits satisfactory and suitable for care delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found.Conclusions. The findings can inform the planning of virtual visits in home health care as a complementary service to in-person visits, in order to meet the increasingly complex needs of older adults living at home.

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Cultural Competence Interventions for Health Professionals Working with Racialized Foreign-born Older Adults: Protocol for a Systematic Review (Preprint)

10.2196/preprints.31691 ◽

2021 ◽

Author(s):

Diya Chowdhury ◽

Leonardo Baiocco-Romano ◽

Veronica Sacco ◽

Karen El Hajj ◽

Paul Stolee

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cultural Competence ◽

Health Professionals ◽

Care Delivery ◽

Future Research ◽

Culturally Competent ◽

Foreign Born ◽

Person Centered Care ◽

Centered Care

BACKGROUND Integrating culturally competent approaches in the provision of healthcare services is recognized as a promising strategy for improving health outcomes for racially and ethnically diverse populations. Person-centered care, which ensures patient values guide care delivery, necessitates cultural competence of healthcare providers in order to reduce racial/ethnic health disparities. Previous work has focused on interventions to improve cultural competence among healthcare workers generally; however, little investigation has been undertaken regarding current practices focused on racialized foreign-born older adults. OBJECTIVE We seek to synthesize evidence from existing literature in the field to gain a comprehensive understanding of culturally competent interventions for health professionals who work with racialized foreign-born older adults. The aim of this paper is to describe the protocol for this review. METHODS Our protocol will follow the PRISMA guidelines (PRISMA-P) for systematic review protocols. We will conduct a systematic search for relevant studies from three electronic databases that focus on health and social sciences (PubMed, CINAHL, and Scopus). After selecting relevant papers using the inclusion and exclusion criteria, data will be extracted, analyzed, and synthesized to yield recommendations for practice and for future research. RESULTS The systematic review is currently at the search phase where authors are refining the search strings for the selected databases. We expect that the systematic review will be completed within 18 months from the publication of the protocol paper. CONCLUSIONS This study will inform future development and implementation of interventions to support culturally competent, person-centered care of racialized immigrant older adults.

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The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs

BMC Health Services Research ◽

10.1186/s12913-020-05917-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Thomas Czypionka ◽

Markus Kraus ◽

Miriam Reiss ◽

Erik Baltaxe ◽

Josep Roca ◽

...

Keyword(s):

Integrated Care ◽

Care Delivery ◽

European Countries ◽

Care Process ◽

Care Needs ◽

Thick Description ◽

Holistic View ◽

Complex Needs ◽

Contact Points ◽

Health And Social Care

Abstract Background As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers). Methods Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery. Results Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery. Conclusions We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.

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SUSTAIN: A EUROPEAN PROJECT ON INTEGRATED CARE DELIVERY FOR OLDER ADULTS LIVING AT HOME

Innovation in Aging ◽

10.1093/geroni/igy023.1465 ◽

2018 ◽

Vol 2 (suppl_1) ◽

pp. 393-393

Author(s):

S R de Bruin ◽

J Billings ◽

A Stoop ◽

M Lette ◽

G Nijpels ◽

...

Keyword(s):

Older Adults ◽

Integrated Care ◽

Care Delivery ◽

European Project ◽

At Home

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Increasing the Focus on Children's Complex and Integrated Care Needs: A Position Paper of the European Academy of Pediatrics

Frontiers in Pediatrics ◽

10.3389/fped.2021.758415 ◽

2021 ◽

Vol 9 ◽

Author(s):

Maria Brenner ◽

Josephine Greene ◽

Carmel Doyle ◽

Berthold Koletzko ◽

Stefano del Torso ◽

...

Keyword(s):

Integrated Care ◽

Care Delivery ◽

Complex Care ◽

Care Needs ◽

European Academy ◽

Complex Needs ◽

Health And Social Care ◽

Multidisciplinary Working ◽

Initial Work ◽

Effective Development

There is wide variation in terminology used to refer to children living with complex needs, across clinical, research and policy settings. It is important to seek to reconcile this variation to support the effective development of programmes of care for this group of children and their families. The European Academy of Pediatrics (EAP) established a multidisciplinary Working Group on Complex Care and the initial work of this group examined how complex care is defined in the literature. A scoping review was conducted which yielded 87 papers with multiple terms found that refer to children living with complex needs. We found that elements of integrated care, an essential component of care delivery to these children, were repeatedly referred to, though it was never specifically incorporated into a term to describe complex care needs. This is essential for practice and policy, to continuously assert the need for integrated care where a complex care need exists. We propose the use of the term Complex and Integrated Care Needs as a suitable term to refer to children with varying levels of complexity who require continuity of care across a variety of health and social care settings.

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