Abstract
Background : Persisting systems gaps and fragmented care within and between primary and secondary healthcare teams are key national and international issues. For patients, this fragmentation is compounded by poor communication. Continuity and coordination of patient-centred care requires effective communication, coordination, teamwork, and judicious use of eHealth tools within a medical home and across the health neighbourhood. This Integrated Healthcare Homes and Neighbourhood (IHHN business model and sustainability; multiple ethical perspectives; and cognitive load on patients and clinicians from managing multi-morbidity. Conclusion & recommendations : IHH&N and integrated care requires integrated health data and systems, with local customisations and a sociotechnical approach to implementation. Governance, clinical, managerial and evaluation matters must be addressed through partnerships of local health districts, primary health networks and academic institutions.
Highlights
Integrated Healthcare Homes & Neighbourhoods: governance, clinical, managerial & evaluation matters
; Background: Persisting systems gaps and fragmented care within and between primary and secondary healthcare teams are key national and international issues
Setting and context: A network of general practice- and hospital-based services in SW Sydney established by the UNSW/SWSLHD Academic General Practice Unit to support its health services research and development (R&D) program
Summary
Integrated Healthcare Homes & Neighbourhoods: governance, clinical, managerial & evaluation matters 1: UNSW Medicine, Australia; 2: SW Sydney Local Health District, Australia; 3: Ingham Institute of Applied Medical Research, Australia; 4: SW Sydney Primary Health Network, Australia; Background: Persisting systems gaps and fragmented care within and between primary and secondary healthcare teams are key national and international issues. Continuity and coordination of patient-centred care requires effective communication, coordination, teamwork, and judicious use of eHealth tools within a medical home and across the health neighbourhood.
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