Hoarding disorder: overview

Recommendations about publishing and publication procurement practices across the health and social care system

Introduction: Information technology in health care, also referred to as eHealth technology, may offer a promising solution to the provision of better care and support for people who have multiple conditions and complex care needs and their caregivers. In particular eHealth technologies such as electronic medical records, telemonitoring systems, web-based portals and mobile health (mHealth) can enable information sharing between providers, clients and their families to improve integration of care across health and social care systems. Description of policy context and objective: eHealth technology often acts as an enabler of improved care delivery, rather than being an intervention per se. But how are different countries seeking to leverage adoption of these technologies to support people who have chronic conditions and complex care needs? Through a comparative cross-case analysis of Ontario, Canada, Scotland and Kaiser Permanente Colorado in the United States the strengths, weaknesses, opportunities, threats (SWOT) with regard to adoption of technology to address the challenge of multi-morbidity and increasing complexity is explored. Targeted Population: The focus on this presentation is on adoption of technologies that can best support care delivery across health and social care systems for persons with complex chronic disease and disability. This population can be characterized as having multiple chronic conditions (multimorbidity) as well as social/contextual challenges which make management of their health difficult. Highlights: (innovation, impact and outcomes) While each jurisdiction presents a unique policy context and health and social care system environment, there are a number of key similarities. Common strengths include: increasing governmental and organizational commitment and investment in technology, new innovations and system capabilities being adopted and explored, and a general increased awareness of the challenge of complexity and the need for person-centred solutions. This final strength also marks an important opportunity across jurisdictions for new investment in technologies to support this population. Although each jurisdiction is poised to leverage eHealth technologies, lack of integration and interoperability between systems used across health and social care systems, as well as a general fragmentation within and between health and social care systems marks a significant shared weakness. Furthermore, lack of sustainable resources, issues with demonstrating value for money, and data privacy and security challenges pose ongoing threats to adoption of new technologies across all three jurisdictions. Comments on transferability: The comparative analysis presented demonstrates how very different jurisdictions can face similar challenges when seeking to adopt eHealth solutions, suggesting that findings may be transferable to other countries. Conclusions: The cross-case analysis suggests a series of recommendations for organizational and governmental decision-makers with regard to adopting eHealth technologies to support persons with complex care needs. Supporting interoperability, adopting user-centred design and development approaches, and adoption of national-level strategies are identified as important enablers to wide adoption of solutions that can improve care delivery for persons with complex care needs and multimorbidity.

This review, commissioned by the Research Councils UK Living With Environmental Change (LWEC) programme, concerns research on the impacts on health and social care systems in the United Kingdom of extreme weather events, under conditions of climate change. Extreme weather events considered include heatwaves, coldwaves and flooding. Using a structured review method, we consider evidence regarding the currently observed and anticipated future impacts of extreme weather on health and social care systems and the potential of preparedness and adaptation measures that may enhance resilience. We highlight a number of general conclusions which are likely to be of international relevance, although the review focussed on the situation in the UK. Extreme weather events impact the operation of health services through the effects on built, social and institutional infrastructures which support health and health care, and also because of changes in service demand as extreme weather impacts on human health. Strategic planning for extreme weather and impacts on the care system should be sensitive to within country variations. Adaptation will require changes to built infrastructure systems (including transport and utilities as well as individual care facilities) and also to institutional and social infrastructure supporting the health care system. Care sector organisations, communities and individuals need to adapt their practices to improve resilience of health and health care to extreme weather. Preparedness and emergency response strategies call for action extending beyond the emergency response services, to include health and social care providers more generally.

Report of the Lancet Commission on the Value of Death: bringing death back into life

The substantial growth in health expenditures in European countries over recent decades has brought about serious problems for health care management (Burau, 2007; Dixon and Mossialos, 2002; Thomson et al., 2009) and finance (Directorate-General for Economic and Financial Affairs, 2002a, b; Economist Intelligence Unit, 2011), especially in Mediterranean countries. In 2008, European Union (EU) countries devoted 8.3 per cent of their GDP on average (Spain 9 per cent and Finland 8.4 per cent) to health spending, which was up from 7.3 per cent in 1998 (OECD, 2010). This situation can be explained by the concomitance of demographic, social and cultural changes in Europe (Jackson and Howe, 2003; Lee et al., 2010) as well as by the principles that have guided health care policy over the past 40 years. In Spain, for instance, one of the reasons for the sharp increase in health expenditure — with a total outlay on health that increased from 5.3 per cent of GDP in 1980 to 9.2 per cent in 2009 — is the increasingly arbitrary distinction made between health and social care systems and the lack of long-term care (LTC) services, which is typical not only for Mediterranean welfare systems (García-Armesto et al., 2010; OECD, 2011).

Background: Health care systems in Western countries are increasingly pressured by population changes and labor market shortages. In response, Dutch health authorities and interest groups agreed on a reform agenda in 2018. A key reform principle is 'the right care in the right place': the regional coordination of initiatives to prevent, substitute, or relocate health and support services across health and social care systems in order to better meet the needs of residents and to improve their functioning. However, diverging stakeholder perspectives on this reform challenges regional partnerships to select useful indicators to determine local needs and improvement areas. We therefore aimed to facilitate academic and field expert consensus, and propose useful indicator sets in supporting the regional discussion about delivering 'the right care in the right place'. Methods: Modified Delphi and nominal group techniques were used. Invited experts included representatives from interest groups (patients, vulnerable residents, and care professionals), knowledge institutes, regional partnerships, municipalities and private health insurers. First, from published international research about measures used in the context of population health management, researchers identified indicators, clustered them in themes, which they then pre-selected for potential relevance. Second, a web-survey and validated scoring methods were used to establish expert consensus about relevant themes. Third, experts voted on themes, discussed initial voting results, and – if desired – changed votes during online meetings. Fourth, for the 25 prioritized themes, researchers identified available indicators from data collections in the Netherlands. Fifth, another web-survey was used for expert voting on indicator usefulness per theme. Sixth, indicator sets were presented, and next steps were discussed with experts. During rounds 2-6, experts added indicators, shared arguments on their selections, or both. These qualitative data were thematically coded. Results: Contributions by 40 experts resulted in: 1) a base set with available indicators with the highest aggregated score for the 25 prioritized themes, 2) a ‘optional set’ with other ‘not-low-scoring’ indicators, and 3) an indicator development agenda. Amongst themes with the highest priority, those about structure (e.g., ‘collaboration across health and social care systems’) and processes (e.g., ‘inflow, throughflow and outflow within care chains’) generally received more votes than those about outcomes (e.g., ‘healthy weight’). Experts argued mostly against the usefulness of available indicators for the highest prioritized themes. Arguments raised were often about ability to influence the indicator or whether the indicator says something about multi-system developments, e.g., both in health and social care. For twelve themes, experts did not comment on the indicators chosen for the base- and optional-set. Learned lessons and next steps: Consensus techniques facilitated the establishment of common ground for selecting useful indicators about regional health and social care integration. Although available indicators appeared acceptable for almost half of the prioritized themes, open and routinely collected data provide limited opportunities to indicate integrative regional reform as stakeholders intend. Prioritized and accepted indicators will be made accessible in an existing online data tool. Execution of the development agenda starts with instrument development for indicating cross-system regional collaboration.

Implementing new innovations across the health and social care system is complex, involving many factors that in recent years have been compounded by Covid-19. While a plethora of implementation tools and frameworks are available, there are limitations in terms of their design and accessibility. Co-production is a valuable mechanism for developing tools that have utility and accessibility for those tasked with using them in health and social care organisations and there is growing acknowledgement of increasing the role of co-production in implementation science. This paper provides novel insight into co-production practices and relevance to implementation science by reporting findings from a study to co-produce a web-based implementation toolkit (WIT) that is accessible, usable and designed to support adaptive implementation across health and social care systems. Key themes relating to the process of co-production are outlined and the value of using co-production in implementation processes are discussed. A web-based survey (n = 36) was conducted with a range of stakeholders across health and social care. Findings identified a need for WIT. Survey respondents were invited to express interest in becoming part of a co-production group and to take part in three online interactive workshops to co-produce WIT. Workshops took place with the group (n = 12) and focused on key developmental stages of WIT. Online co-production workshops were integral to the development and refinement of WIT. Benefits of using this process identified three interrelated themes: (i) Co-designing key features of the toolkit, (ii) Co-producing a toolkit with utility for users across health and social care settings, (iii) Co-producing a toolkit to support the implementation journey. Our approach of undertaking co-production as a dialogic process enabled generation of these themes. To illuminate discussion of these themes we draw upon iterative co-development of the "active ingredients" of key components (e.g., interactive Implementation Wheel) and functions (e.g., interactive "pop-up" definitions of keyword) and features (e.g., case studies) of WIT. Using a co-production approach with a range of end-users across health and social care systems, highlights the benefits of understanding implementation processes for users in these settings. User-centred design and processes for ensuring accessibility readily support the translation of implementation into rapidly changing health and social care systems to benefit outcomes for patients, their families, carers, service users and practitioners.

This report summarises the findings of a systematic review of the best, available scientific evidence on how home adaptations can contribute to improving later life. Living in a suitable home is crucially important to a good later life. The right home environment can maintain or improve people’s physical and mental health, wellbeing and social connections,enable them to carry out day-to-day activities safely and comfortably, and help them to do the things that are important to them. More than 90% of older people in England live in mainstream housing, as opposed to specialist housing or residential care. However, current UK housing stock is often not accessible or adapted to meet people’s needs as they get older, with small room sizes, steep internal stairs, baths rather than showers and steps outside. While many people will maintain good health and fitness for much of their later years, the likelihood of having one or more long-term condition, physical impairments,disabilities and frailty that make day-to-day life at home more difficult does increase with age. The percentage of people who have difficulty with at least one activity of daily living (basic routine activities like eating, bathing and dressing) increases dramatically from 16% at age 65 to around half of those aged 85. By people’s late 80s, more than one in three people have difficulty undertaking five or more activities of daily living unaided (Marmot et al 2016). Installing aids and adaptations into people’s homes, such as grab rails and level access showers, can improve the accessibility and usability of a person’s home environment, maintaining or restoring their ability to carry out day-to-day activities safely and comfortably. The last comprehensive review of the evidence on home adaptations was published in 2007. Since then, there has been increasing policy attention paid to the benefits of home adaptations, particularly in relation to how they can reduce health and social care costs, many of which are outlined in this review. However, there should be much greater focus and action given to the widely acknowledged and unsustainable pressures on our health and social care systems, coupled with the fact that we are living for longer and the proportion of older people in our society is growing. In the last Spending Review, the budget for the Disabled Facilities Grant was increased to enable greater access to home adaptations for more people, yet there is still an unacceptable and under-reported number of people not getting the equipment and support they need. This review aims to provide an up-to-date analysis of evidence of the importance and effectiveness of home adaptations.

BackgroundCrises, such as the COVID-19 pandemic, risk overwhelming health and social care systems. As part of their responses to a critical situation, healthcare professionals necessarily improvise. Some of these local...

Background: Individuals with complex care needs (CCNs) require more health and social care services than the average population. These individuals have better outcomes if they have access to integrated services across settings and sectors. One solution to address the multifaceted care needs of this population is patient navigation (PN). This model is increasingly being used across North America and abroad and is defined as a patient-centred approach intended to proactively guide, support, and orient patients through health and social care systems, matching patientsunmet needs to appropriate resources. Our research team at the Centre for Research in Integrated Care (CRIC) has developed, implemented, and evaluated PN programs in New Brunswick (NB) for two populations commonly experiencing complex care needs: children/youth with chronic and/or complex conditions and older adults living with dementia. Approach: At CRIC, we use a patient-oriented research approach, which engages patient partners throughout the entire research process. For example, when implementing and evaluating our PN programs, we did so in partnership with patient and family advisory councils. NaviCare/SoinsNavi was a research-based PN program for children/youth with complex care needs (CCNs), their families, and the care team. One bilingual navigator and one lay navigator were housed at an academic institution and provided in-person and virtual navigation services to participants across NB. Navigating Dementia NB/Naviguer la dmence NB was a research project that piloted a PN program for people with dementia (PWD), their care partners, and the care team. Six patient navigators (4 anglophone and 2 francophone) were embedded in preexisting primary care clinics/health centres in urban and rural settings across NB. Results: NaviCare/SoinsNavi served 62 families and 42 care providers between January 207 and May 2020. Navigating Dementia NB/ Naviguer la dmence NB served 50 participants between July 2022 and July 2023. Interviews with caregiver clients from both PN programs highlighted that caregivers frequently reported feeling overwhelmed and isolated. However, patient navigation offered a solution to meet patient and caregiver needs by promoting more convenient and integrated care and enhancing access to education, support, and resources. Additionally, patient navigators delivered crucial emotional support to both patients and caregivers. These results support that PN is a flexible model of care and can be easily adapted to different populations and settings to promote positive experiences with health and social care systems and promote person-centred, integrated care. Implications: Next steps involve developing, implementing, and evaluating a PN program specifically tailored for youth with addictions and mental health needs, identified as a priority population in New Brunswick. CRIC ultimate goal is to enhance the experiences of individuals with complex care needs (CCN), along with their care partners and providers, within health and social care systems. By improving communication pathways and fostering better integration of care, we aim to create more cohesive and supportive care environments, thereby promoting more positive health outcomes for this vulnerable group.

Family caregivers are the largest care workforce. Besides providing 90% of the care, they are conduits of critical information about the patient and the de facto care coordinators in siloed health and social care systems. It is well established that family caregivers require support to reduce stress, anxiety, and burden caused by caregiving demands and that health providers should consistently recognize and include family caregivers as partners on the healthcare team. However, few healthcare professionals receive caregiver engagement training or person-centered care for family caregivers. Often, they don't engage caregivers due to lack of confidence, uncertainty about how to assist, or limited time in patient care settings.This gap highlights a critical area for improvement and learning in integrated care. With a co-design process, we developed and evaluated, and released Competency-based Foundational and Advanced Caregiver Centered Education for the Health Workforce to Engage and Support Family Caregivers. Critical research approaches like co-design are recommended to improve and optimize healthcare users' experience and prepare health providers to effectively learn from and collaborate with people with lived experience. We expected the co-design process and educating health and social care providers to be critical steps to shifting the culture to including family caregivers as partners in care. From November 2019 to December 2023, three levels of education, foundational, advanced, and champions were co-designed by multilevel, interdisciplinary stakeholders including family caregivers and evaluated at three levels of the Kirkpatrick Barr Healthcare Education Evaluation Framework (Level 1 Satisfaction with education delivery; Level 2 Changes knowledge, skills, and attitudes, pre and post education; Level 3 Behavior and Practice Changes) available free online. Over 6000 providers have taken the Foundational education (online November 2020), 450 the Advanced Education (May 2023) and 60 the Champions modules (October 2023). T-tests of the Foundational and Advanced education show significant improvements in participants' ratings of their knowledge and skills to work with family caregivers despite participants' high pre-test ratings. Qualitatively, participants indicated they were more responsive to caregivers and more likely to ask caregivers about their needs. The next step is to measure impacts of our Caregiver-Centered Care education on caregivers' perceptions of providers' communication, assessment of their needs, and navigation assistance. This novel education is a step towards changing the culture and context of healthcare to recognizing family caregiver's role as a partner on the care team and truly valuing the work they are doing for their care recipient, health and social care systems, and society. The co-design process created space for educational designers, educators, researchers, health and social care providers and leaders to work with and learn from family caregivers. Family caregivers emphasized they felt they had a valued role in the co-design process. Worldwide family caregivers have been invisible in the health care system. The shortage of healthcare providers, increasing need for care, and people’s desire to age-in-place make ways to recognize and support caregivers particularly crucial now.

PurposePerformance measures are an important mediating mechanism that influences the design and delivery of care. Unfortunately, it is still commonly the case that acute care indicators are employed to assess the efficacy of integrated care. This hinders the ability to accurately assess and continuously improve integrated care efforts for priority populations, including older persons who live with complex health and social care requirements. A core set of indicators is needed from which to assess the quality and impact of integrated care on these older persons and care partners.Design/methodology/approachA modified Delphi process was employed that comprised of the following steps: (1) selection of an indicator inventory (2) defining criteria for ranking and achieving consensus, (3) recruiting participants, (4) iterative voting rounds and analysis and (5) selection of a core indicator set.FindingsThe study produced a core set of 16 indicators of integrated care that pertain to older persons who live with health and social care requirements. The set can be applied by health and social care organizations and systems to assess the quality and impact of integrated care for this population across the continuum of care.Research limitations/implicationsAlthough the gap in the availability of relevant indicators was the impetus for the study, this also meant there was a dearth of validated indicators to draw from. There are significant gaps in commonly used data sets with respect to indicators of integrated care as it relates to older persons and care partner.Practical implicationsThe indicator set is intended to follow the older person and care partner throughout their health journey, enabling a whole systems view of their care. The set can be used in full or in part by health and social care systems and organizations across various primary, acute, rehabilitative and community settings for program development and evaluation purposes.Social implicationsThe core set of indicators that emerged out of this study is a first step toward ensuring that older persons who live with complex health and social care requirements and their care partners receive quality integrated care across the continuum of care.Originality/valueThe findings are informed by the perspectives of older persons, care partners and healthcare professionals. Future research is needed to test, validate and potentially expand the indicator set.

The COVID-19 pandemic generated a series of profound and unprecedented challenges for health and social care systems and those frontline clinicians responsible for delivering services including nurses. One consequence has been the rapid and widespread introduction of a range of digital tools, solutions, and initiatives. In the United Kingdom, this has required clinical leadership to drive implementation and adoption of digital innovations across the system, ranging from those in senior executive board level positions to those on the frontline. This commentary presents a framework highlighting the breadth of digital transformations which emerged as a consequence of the U.K. health and social care systems' response to the COVID-19 crisis. The framework outlines the different levels of digital transformation, ranging from what we have termed "ceremonial adoption" to isolated automation, organizational integration, and full systems integration. We reflect on the nursing leadership practices that need to be in place to support these changes. Whilst acknowledging the extraordinary results achieved by the COVID-19 driven tsunami of digital transformation, we reflect on the essential steps required to translate these nascent, isolated efforts into fully integrated, long-term solutions. We also offer recommendations for clinical digital leaders and suggest steps that will be crucial to translate the temporary and/or limited interventions into effective, permanent features of our health and social care systems, while also providing a platform on which to build future digital capabilities. We will inevitably continue to see an increase in the use of technology in everyday clinical practice, and nurses are well positioned to take a lead in its widespread adoption.

The objective of the THCS Knowledge Hub is to facilitate and implement effective knowledge sharing and capacity-building activities for the transformation of health and social care systems in Europe, tailored to the users’ needs and local context in order to prepare the ground for the transformation of health and social care systems. The Hub acts as personalised and interactive “matchmaking” platform which will allow the potential users to (a) access, provide and search for personalised and tailored resources generated in the THCS community but also beyond, reflecting the local maturity and conditions enabling the transformation of health and social care systems; (b) facilitate a support for the potential adaptation and transferability of these resources across the European health and social care settings through the functional use of THCS Innovation Transferability Framework; (c) enable the policy dialogue and capacity-building support for policy-makers in order to enhance their skills, knowledge and experience in health and social care transformation; (d) access and engage with THCS community of experts and ecosystems in order to maximise the access and use of the exiting knowledge and expertise for the transformation of health and social care systems; (e) signpost to existing evidence and resources related to health and social care transformation to enable effective knowledge sharing (educational webinars, peer review activities, study visits, training workshops), exchange of good practices and experience in transforming health and social care systems.

Health and Social Care Delivery Research (HSDR) Programme is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by funding evaluative research projects that have the potential to improve the quality, accessibility and organisation of health and social care services by providing useful outputs for decision-makers, staff, service users, academic, and public audiences. More information about the programme can be found on the NIHR website. A logic model is a visual way of showing how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can be used to support programme planning, implementation, and evaluation. NIHR logic models presentin a linear flow diagramthe key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps.