Integrating terminology for integrated care

Abstract

Introduction: Our aging population, with more vulnerable people with complex needs, is the context in which the Catalan Government has created the PIAISS plan (Interdepartmental Plan for Health and Social Care and Interaction). The plan is to transform a fragmented and largely uncoordinated model into a multidimensional care model that takes into consideration different kinds of personal needs in conjunction, integrating social care systems with health care systems. To achieve this integration successfully, a strong conceptual framework must be constructed, in which terminology will play an important part. For example, which term should be used: self care or self-management? Or, more importantly, what do terms such as care management, transitional care, home care services or complex situation mean in an integrated care model? Agreement on the definition of the basic terms of integrated health and social care is seen as a key element for combining two different points of view to create a single vision of the new care model. Since language mediates a particular vision of reality, when creating a new care model it seems important to focus on terminology.Methods: Given this context, the different parties involved in the care model transformation have been invited to take part in a dialogue to reach consensus on the basic Catalan terminology of integrated care, led by PIAISS and TERMCAT, the centre for terminology of the Catalan Government. Like the integrated care model itself, this project involves integration based on collaboration between the different parties, and takes an integral approach, as the integrated care terminology will be examined from multiple angles. The methodology used is inspired by a previous experience in which different professionals and institutions established the basic terms and definitions of chronic care. However, the current challenge is greater, as it is necessary not only to join up the terminology from different health sectors but also to integrate the terminology from the different health sectors and from the health and social sectors.Results: The result will be a free online dictionary of approximately 100 terms in Catalan with equivalents in English and Spanish, and with the definitions in Catalan agreed upon by leading experts from the different parties involved in the new care model. The process of producing the dictionary, as already mentioned, will help in the care model transformation, but it is also thought the dictionary itself will be a useful tool for people working in these professions. It is expected that a working version of the dictionary will be ready to present in May 2016.Discussion: In the dictionary’s current phase of production, experts from PIAISS and external consultants have been involved in a selection of the basic terminology. Each has proposed 25 key terms, and overlaps between the proposals are being used to select the most popular terms in integrated care the dictionary’s basis highlighting terms such as atenció integrada (‘integrated care’) atenció integral (‘integral care’), atenció centrada en la persona (‘person-centred care’), apoderament (‘empowerment’), fragilitat (‘fragility’), complexitat (‘complexity’), pla d’atenció compartit (‘shared care plan’) and cuidador (‘carer’). Next, references from the bibliography which includes two previous online dictionaries produced by TERMCAT* will be used to classify the terminology into three groups:- New terms;- Terms traditional in one of the two care systems, health care or social care, for which it will be necessary to extend the definition in use;- Terms typical in both sectors, for which it will be essential to integrate the two definitions.Reaching a consensus on the terms in the third group will probably be the aspect that requires most attention, so it is planned that the definitions of these terms will be discussed and agreed upon in a special work session with the presence of the experts that best represent each sector and various specialists in terminology from TERMCAT. The agreements from this meeting will be raised to the final decision of the Supervisory Council, the official body responsible for the establishment of Catalan Terminology.Conclusion: To conclude, the collaborative, person-centred character of the integrated care model is also key to the integration-based terminology work that will help build a strong conceptual framework to enable care transformation. Moreover, even though the object of this project is Catalan terminology, the agreements for Catalan terminology should be useful for other contexts, as the discussion is not based on linguistic questions but primarily on the concepts that are central to integrated care, which should be established in all instances of care transformation.