Abstract
To explore the impact of structural integration on homecare quality. A case study in an organisation comprising a before-after comparison with baseline and four follow-up measurements during 1994-2009, using interviews with clients (n=66-84) and postal inquiries to relatives (n=73-78) and staff (n=68-136). Despite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up. According to the clients, it even slightly improved in some homecare areas. The results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level. Assuming that the potential confounders did have inhibiting effects, the results suggest that structural integration had a positive impact on homecare quality. To obtain firmer evidence to support this tentative conclusion, further research with a randomised comparison design is needed.
Highlights
A lack of and need for integration of homecare for older people is widely acknowledged in policy and research in many countries [1,2,3,4]
Despite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up
The results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level
Summary
A lack of and need for integration of homecare for older people is widely acknowledged in policy and research in many countries [1,2,3,4]. Above all to service providers and financiers, who in a tax-based funding system comprise all tax-paying citizens These benefits are assumed to be the consequences of decreased use of hospital and other services together with increased system efficiency and cost-effectiveness [8,9,10,11]. Our literature review shows that in the research on integrated homecare, the quality of life, functional ability, cost-effectiveness [8, 9], use of hospital and other health services [8, 9, 13, 14], and reduction of costs or cost containment [14] have received much more attention as outcome indicators than quality of homecare
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