Integrated Care Network Research Articles

Academic Essay On Equitable Access To Mental Health Services In Brazil

Equitable access to mental health services in Brazil faces complex and interconnected challenges. Among the main issues are regional inequalities, socioeconomic barriers, and the stigma associated with mental disorders. Regional inequality results in significant differences in the quality and availability of mental health services between urban and rural areas. While large cities such as São Paulo and Rio de Janeiro have advanced infrastructure and qualified professionals, rural areas and urban outskirts suffer from a lack of resources and professionals, limiting access to necessary care. Socioeconomic barriers also play a crucial role. Low-income populations face additional difficulties, such as lack of transportation and inadequate health insurance, which restrict access to mental health services. The lack of information and the stigmatization of mental disorders worsen the situation, discouraging individuals from seeking treatment due to fear of discrimination and prejudice. To address these challenges, it is essential to adopt integrated strategies. Expanding mental health infrastructure in underserved areas and creating integrated care networks are fundamental. Public policies should reduce socioeconomic inequalities by providing financial support and improving transportation. Awareness campaigns about mental health can overcome informational barriers and stigma. Continuous training of health professionals and community participation are also crucial to ensure inclusive and locally adapted care. With a coordinated effort, it is possible to promote more just and comprehensive access to mental health services in Brazil.

Community-based person-centred integrated care (PIC) networks for healthy ageing in place: a scoping review protocol

IntroductionThe economic case for preventive care delivered in or near citizens’ homes is strong, and there is growing evidence of the role of local-level support in supporting people’s health and...

Communities of Care Approach: Developing a Place-based Model of Care and Building Partnerships in the Communities in Central Singapore.

The population in Singapore is ageing, adding pressure to community care as the health and social needs of its residents increase. This has accelerated the pace at which Regional Health Systems adopt and deliver its population health strategies from early prevention, chronic disease management, crisis care to end-of-life care. To this end, the Central Health Integrated Care Network (ICN) began its journey to develop Communities of Care (CoCs) with other health and social care partners to meet the needs of residents in the Central Zone of Singapore. This paper describes the processes and steps taken by Central Health ICN to build partnerships with other agencies and organisations to build place-based models of care in the local neighbourhoods. The faciliating factors and the barriers faced in the implementation of CoCs were described to allow sharing of such learnings on large scale change. Strategies in overcoming some of the challenges were also presented to demonstrate the iterative processes required in building integrated place-based models of care to meet the needs of the residents in different communities.

Innovative Supervision on Organizational Networks: finding the suitable scale.

Introduction: Organizing integrated care in networks of collaborating care organizations is a complex challenge. One of the aspects of this challenge concerns determining the suitable scale of such networks. Scale is not a simple question of macro/meso/micro but an outcome of the interplay between many different interests, values and perceptions of organizations participating in a network. Another aspect of the challenge of integrated networks is the organization of the supervision of these networks. Contemporary arrangements and instruments for supervision are mostly aimed at individual organizations and not aimed at a integrated network of organizations and the specific functioning of such a network. Supervision on a network as-a-whole instead of individual participant, could make it more feasible for those participants to overcome their own specific interest in order to strive for the common interest of the network.
 Organizing innovative supervision on networks and determining the suitable for networks are two connected and interfering challenges. Our workshop will inform about this challenge and on our first research findings from the extensive research program “External and Internal Supervision Methods and Modalities for Organizational Networks Addressing Complex Societal Issues (EISON)”, developed by Professor Minkman, amongst others.
 Context & problem: Integral care networks are already always searching and negotiating for het most suitable scale for there endeavors. What are the borders of the network, which organizations should be included? There are several factors in play to determine the suitable scale, in dynamic and complex ways. Meanwhile, when a network is formed, both internal and external supervision of the network should be organized in an innovative manner. This is in itself a puzzling task, and the dynamic and negotiation of finding a suitable scale makes it even harder. 
 Target audience: We aim to check and validate our initial findings, valuable to improve the discussion about the appropriate scale of integrated care network, and what this means for the supervision of the network-as-a-whole. Our primary target audience consists of participants in long term care organizations operating in integral networks and directors of those participating organizations. However, all professionals involved in integrated care networks can participate.
 Facilitation: The workshop will be facilitated by Sander Merkus, senior researchers at Vilans. He will be accompanied by two other researchers from the EISON project - these are yet to be determined, but would probably be Roman Pankow (Tilburg University) and Marjolein Camphuijsen (VU Amsterdam). 
 
 They will first give and introduction (10 minutes), then continue with a case study example and preliminary findings (20 minutes). Then we will engage in active interaction with the audience, in order to reflect on the findings: are they recognizable, are there any examples from other networks that the members of the audience can give (20 minutes), and we will finish with 5 minutes of feedback and closing, summarizing the key learnings to take home: an increased consciousness for the importance of innovative network supervision, while increasing the sensitivity for matters of scale in integrated care networks. 

The co-development of a mobile navigation app in an integrated care network in Ontario, Canada

Introduction: The complexity of navigating health and social care services is a common challenge to both providers and patients and their families. In the nineties, navigation programs arouse to assist cancer patients accessing services. Since then, those programs expanded to additional patient populations. Navigation programs can take various forms including virtual navigation. Virtual navigation in healthcare is a proactive process by which patients obtain information and support via internet resources to manage their illness demands.
 Approach: With a commitment to facilitate 24/7 access to its attributed population, Burlington Ontario Health Team (BOHT)-an integrated care network in Ontario- developed a mobile navigation app. Developing this app utilized experienced-based co-design approach. This approach took place via organizing a working group that included all stakeholders within the BOHT network of organizations and patient/caregiver partners. Over several months, the working group built potential personas of users, mapped their system navigation needs, created an inventory of navigation services within the network and designed the navigation app. Creation of the app was an iterative process including several testing and feedback loops to improve content and usability.
 Results: The first iteration of Burlington Navigation app was launched in Fall of 2021 accompanied by a comprehensive communication plan. The plan included digital signals at the hospital and primary care offices, social media posts and presentations to local providers including primary care physicians, community navigators. The first iteration focused on linking to health, social and community services offered by BOHT’s members and collaborators, and also services that were widely used in the community. Based on the feedback we received afterwards, the second iteration included links to provincial services. The third iteration includes capability to create a trusted account verified in the background by the same technology Interac uses. This will allow secure and seamless access to integrated services without a need for a separate username and password as well as access to the provincial patient portal
 Implications/highlights: Burlington Navigation app was the first community-based navigator app co-designed with patient partners, providers and community volunteers with lived experiences within the health and social care systems in Ontario. It resonated well with the users (providers and patients/caregivers) as local information became available at their fingertips. The success of the app allowed it to guide other OHTs on a similar digital navigator design journey. It also became the blueprint for a provincial solution for a multi-tenant navigator, which would allow multiple OHTs to showcase the local navigation information (based on geolocation) as well as provincial offerings.
 Conclusion: Sharing our journey co-developing the Burlington navigation app demonstrates that when local health integrated care networks utilize experienced-based co-design approaches to planning healthcare interventions, this has the potential to a) develop solutions that are well perceived by patients and providers and b) scale and spread these local solutions to larger-scale solutions that can improve the experiences of a wider spectrum of providers and patients.

Creating a global learning environment to promote integrated care.

Introduction: While the concept of integrated care has evolved considerably, there is general agreement that the competences necessary to co-create, implement, work in, and evaluate integrated care are only taught and practiced piecemeal. There is a hunger for more information, training and exchange of knowledge and experiences. In general, performance and outcome measurement is lacking, resulting in gaps between implementation in theory and practice. This workshop will discuss how we can bring community members, professionals and policymakers together in a meaningful way to learn and grow together.
 Why are you conducting a workshop? The existing offers of degree and certificate programmes, targeted training by organisations or learning by doing, do not foster sustainable change in competences of the workforce, system leaders or the wider communities. Often that is because the focus is still on a specific context, competence, or profession. But evidence and experience underline how important it is for everyone to understand the principles of integrated care, including e.g. social determinants of health, co-creation or cross-sectoral, inter-organisational team work. In this workshop, we want to build on our collective intelligence to discuss, define and design a global learning platform, which complements and builds on existing offers to connect people on different levels and in different languages. The key questions to answer are:
 •What the key barriers for learning and practicing integrated care?
 •How we can foster the next generation to become true integrated care proponents?
 •What are current performance and outcome measures that can be implemented immediately?
 •What are gaps in outcome assessment that must be prioritized to ensure equity and health justice for all?
 •Who is missing from training discussion/ forums that would help advance integrated care?
 Who is it for? The workshop is for people with lived experience of health and social care (including family carers) and professionals, policy makers, evaluation and performance experts, managers and academics who are committed to joint learning as the basis of integrated care implementation.
 10 minutes introduction & collaborative definition of aims and outcomes of the workshop
 5 minutes explanation of the fish bowl discussion and introduction to the starting discussants
 20 minutes fish bowl discussion round 1
 20 minutes small-group discussions
 20 minutes fish bowl discussion round 2
 10 minutes summary and wrap-up
 Participants will have the opportunity to participate in the fish bowl discussions and in the following small-group discussions they can move around from topic to topic. A facilitator will remain at each flip chart to encourage discussion and foster actionability of ideas. The discussion will be visually recorded to enable participants to build on what has come before to enable a rich and diverse conversation.
 How are you going to summarize the take home messages?There will be a short feedback from each flip chart facilitator on main points discussed – the facilitation team will then write up the discussions into a short and accessible summary which will be shared through social media, integrated care networks and relevant organisational routes.

Bridging the gap between the conceptual and the practical – reflections on the opportunities and challenges of meaningful engagement of people with lived experience in the context of integrated community care.

Introduction: Participants will explore the opportunities and challenges of meaningful engagement of people with lived experience in the context of integrated community care (ICC), through a dialogue with up to three innovative ICC practices whose central premise is the co-production of wellbeing. The dialogue will be further nourished through consideration of the recently co-developed World Health Organisation (WHO) Framework for Meaningful Engagement of People with Lived Experience of Non-Communicable Diseases (NCDs), Mental Health and Neurological conditions.
 Context: There is ample evidence that integrated care is best suited to support those living with long-term chronic NCDs, mental health conditions and to those with medically complex needs. At the very core of ICC, lies the principle of co-developing health and wellbeing. Despite broad agreement around the benefits, there is a lack of clarity on how this is achieved and few examples of what this looks like in practice.
 The WHO is currently in the process of co-developing a Framework for Meaningful Engagement of People Living with NCDs, Mental Health and Neurological conditions. Complementing this is practical guidance being produced by the Transnational Forum for ICC (TransForm) based on a collection of experiences and reflections of innovative ICC practices around Europe and Canada on the meaningful engagement of people with lived experience.
 Key learning: The Framework will contribute to the advancement of understanding, knowledge and action on meaningful engagement and other related participatory approaches. The evidence base has been and will continue to driven by individuals with lived experience. The TransForm guidance on engaging people with lived experience will further help bridge the gap between the conceptual and the practical.
 
 Audience: All those seeking to better engage and co-produce services with people with lived experience but are not sure how to start and what this looks like in practice.
 Plan:
 
 10 mins – Setting the scene
 
 Joint presentation (WHO/TransForm)
 
 15 mins – Overview of three TransForm changemakers
 
 Brief presentations on each ICC practice, focusing on how they engage people with lived experience.
 
 20 mins – Participants dialogue with the TransForm changemakers
 
 Participants will choose one of the three Changemakers to discuss opportunities and challenges of meaningful engagement of people with lived experience
 
 5 mins – Summary feedback from each table
 
 Each group reports back the main opportunities and challenges identified through discussion
 
 10 mins – Opportunities and challenges in the context of the WHO framework
 
 Jack Fisher will close the session tying back the opportunities and challenges to the WHO Framework
 How are you going to engage with the audience? Each group would have one Changemaker and one facilitator to ensure conversation centres around the question of: How can the WHO Framework and TransForm’s legacy support your practice?
 How are you going to summarize the take home messages? There will be short feedback from each table on main points discussed – the facilitation team will then write up the discussions into a short and accessible summary which will be shared through social media and integrated care networks.

A Toolkit to facilitate the implementation of an Integrated Care Network for People living with Parkinson: A Codesign Approach

Background: In response to the critical health care situation faced by People living with Parkinson’s (PwP), a group of experts decided to develop and implement a care model (iCARE-PD project) for addressing the complex care needs in Parkinson’s disease (PD). As part of this multidisciplinary and international project, a codesign approach was implemented to identify the central pillars of the care model, namely: home-based care delivery; integrated care; self-management support and technology-enabled care. For the success of this patient-centered model in a varied social, cultural and economic landscape, we need to develop a tool that facilitates the implementation of an integrated care network across different social contexts. 
 Purpose & Method: The codesign approach, implemented in this study, consisted of four linked steps that were coordinated among 5 countries: (1) Preparation (2) Capture patients’ experiences by using narrative interviews and understand the patients’ trajectory; (3) Design scenarios for an integrated care delivery network with patients, care partners (CP), and health care providers (HCP) and (4) Co-produce solutions by identifying key requirements for designing a roadmap and toolkit to facilitate the implementation of an integrated care network in various social contexts. As part of the iCARE-PD project, this communication presents the findings of the final phase of the codesign approach which brought together researchers, clinicians, nurses and patient advisors in May 2022 for a workshop aimed at collectively co-defining the key elements to be included in an integrated care toolkit. Scenarios identifying key components for designing an integrated care network for PD were created by PwP, CP and HCP during previous workshops. Based on these scenarios designed previously, a workshop was conducted and recorded in order to produce a roadmap and toolkit that takes into consideration the unique challenges faced by PwP in each country, and the need for an integrated care delivery network that can be personalized and malleable to evolving and changing needs over time. 
 Results: We will present the results of the thematic analysis of the transcript of the workshop. In order to improve person centeredness, tailor and personalize care and propose a holistic approach of PD in integrated care, a roadmap including three features needs to be integrated into a toolkit: (a) Identify ‘boundary spanners’ such as key individuals people or tools to support patient-centered care, (b) select mediators to connect various actors in the networks and create informational and technological infrastructure to facilitate access to tailored information and resources and, (c) create and share tools, data and resources to improve communication processes and coordination of care. Each of the design features involves various practical solutions shared and co-created during the workshop that could be useful to develop an integrated care toolkit. 

The many roles of people with lived experience and how these can be better supported within integrated care policy and implementation: a world cafe discussion.

Introduction: This workshop will explore the many roles that people with lived experience of health and social care can play in shaping the vision, planning and implementation of integrated care and consider what supports would enable them to fulfil these roles.
 Why are you conducting a workshop? Whilst it is widely accepted that integrated care policy and programmes should be based on the needs and interests of people with lived experience of health and social care and their communities, this is rarely achieved in practice. The workshop team have led two international projects regarding co-production within integrated care ( ‘citizen leader research’ by the Universities of Birmingham, Leiden and Toronto and the Changemakers project within Transform). A common issue identified is that people involved in such activities are asked to take on different roles – for example as a champion, ambassador, advocate, partner, advisor, connector, or leader – with the nature of these roles affecting the expectations of them and the identities that they adopt. We would like to run a workshop to give participants an opportunity to explore what is meant by these roles, how people can be supported to do so effectively, and how organisations and professions can provide a receptive context.
 Who is it for? The workshop is for people with lived experience of health and social care (including family carers) and professionals, policy makers, managers and academics who are committed to co-production as the basis of integrated care.
 What are you going to do?
 8 minutes introduction & overview of the roles that people with lived experience play (as identified in the projects)
 5 minutes response from WHO based on their meaningful engagement framework
 2 minutes explanation of the engagement exercise
 40 minutes (or ideally longer if we are able to have a 90 minute session) world café discussion
 5 minutes summary feedback from each table 
 How are you going to engage with the audience? Participants will have opportunity to move around the world café table – each one will focus on a different role that people take on. A facilitator will remain at each table to encourage discussion on the nature, support, and context for such a role. The discussion will be visually recorded to enable participants to build on what has come before to enable a rich and diverse conversation.
 How are you going to summarize the take home messages?There will be short feedback from each table on main points discussed – the facilitation team will then write up the discussions into a short and accessible summary which will be shared through social media, integrated care networks and relevant WHO routes.

Where are we heading? A network and collaborative workshop to design and shape future activities of the Emerging Researchers and Professionals in Integrated Care network (ERPIC)

ERPIC aims to provide opportunities for emerging researchers and professionals to network, collaborate and engage in peer-to-peer relationships and mentorships, with the aim of advancing the field of integrated and person-centred care, which can improve patient outcomes, experiences of care, efficiency and cost-effectiveness of care delivery and health systems, and the satisfaction of healthcare workforce. The next generation of students, academics, researchers and practitioners is essential in shaping tomorrow’s healthcare systems.
 Since the establishment of ERPIC in 2018, the network has mobilized about 500 followers, working and studying in about 33 countries worldwide and promoted opportunities to engage these early researchers and professionals in the field of integrated care. Aligned with its mission, ERPIC needs to be in continuous movement and adaptive to its members’ needs. 
 During ICIC22, ERPIC initiated a process of continuous improvement by exploring the needs of emerging researchers and professionals. Building on the knowledge generated from the workshop at ICIC22, the ERPIC Executive team now wants to find out whether these needs are still relevant and how we, together, can take the next step in the desire to put the needs into action. 
 Accordingly, this workshop aims to provide an opportunity for conference delegates to contribute to the future plans and activities of ERPIC and network with peers.
 The aims of this interactive workshop activity are to:
 - Meet and connect with other early career researchers and professionals in integrated care
 - Practice networking
 - Share ideas about the future of ERPIC
 - Get involved in designing future activities of ERPIC
 This workshop is designed for current ERPIC-network followers and emerging researchers and professionals in the integrated care field interested in joining a supportive network.
 Senior members of IFIC, professionals in the field of integrated care and participants of ICIC23 who are interested in meeting ERPIC-members are welcome to participate.
 
 Workshop hosts: Sebastian Lindblom, Mark Derks, Paul Wankah
 The workshop starts with a 5 min introduction, preparation and information about the workshop. This will be followed by a 10 min presentation on the result of our exploration of the expressed needs of our EPRIC members. Participants will be divided into groups and have the opportunity to get to know each other and familiarize themselves during a 30 min network session. This will be followed by a 30 min co-creative session where each group will brainstorm about early career researchers and professionals’ needs and how they can be addressed. Together, the group will develop concrete suggestions for activities and a plan to realize them. The session finishes with a 15-minute group presentation and summary.
 Learnings/Takeaway: Participants will:
 - Create new contacts and start building/expanding a network
 - Get insights on early career researchers and professionals’ needs and activities 
 - Gain an understanding of ERPIC and its mission
 - Have the opportunity to influence the future direction and activities of ERPIC
 The results and findings from the workshop will be summarized in a short report and disseminated to the network.

The impact of breast surgeon information on women’s breast outcome: evidence from breast conserving therapy

Introduction: With the increase in life expectancy and the development of medical knowledge, the expectation that individuals will live a quality life till the very last days is becoming the norm. Palliative care is an approach that improves the quality of life of patients and their families facing the issues associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, comprehensive assessment and a management plan that considers, physical, psychosocial and spiritual needs. Despite this wholesome definition, the majority of palliative care interventions remain localized and siloed.
 Context: In 2019, the Ministry of Health in Ontario, Canada, announced the Ontario Health Teams (OHTs) as an innovative integrated care network model to deliver integrated person-centred care to Ontarians across their life trajectory (currently there are 54 teams covering 95% of the population). These teams utilize a population health management philosophy to integrate care in a person-centered manner. Integrating palliative care across care sectors and along the trajectory of the palliative care journey is a priority to many of these teams.
 Approach: In the Spring of 2022, Burlington OHT formed a working group to co-design an integrated palliative care model. This working group included patients, caregivers, palliative care physicians and nurses, primary care physicians and nurses, home and community care providers, hospice care providers, policy makers, researchers and evaluators. A participatory experience-based co-design approach was taken to identify the gaps, determine best practices, design a new care model, create an implementation plan, implement, evaluate and improve.
 The participatory experience-based co-design approach was guided by the 11-step methodology described by O'Cathain A, et al in 2019 when co-designing complex health interventions. We added some additional steps. The modified methodology included 1) planning the co-design process, 2) involving all stakeholders (including those who will implement, deliver, use and benefit from the intervention), 3) bring together a team and establish decision-making processes, 4) needs assessment via multiple engagement tools (surveys and virtual and in-person engagement sessions), 5) review published research evidence, 6) draw on existing theories/frameworks, 7) identify relevant change ideas, 8) articulate programme theory, 9) undertake primary data collection, 10) understand the local context, 11) pay attention to future implementation of the intervention in the real world, 12) design and refine the intervention and finally 13) implement and evaluate.
 The project is in its concluding stages and the final findings including the detailed integrated palliative care model description and the implementation plan will be available for the conference in May
 Implications for applicability/transferability: Designing integrated palliative care programs is a novice area of integrated care across the world. Describing the participatory experience-based co-design approach that we followed to plan our intervention has a great potential of guiding policymakers, planners, funders and implementers on how to plan and implement such interventions by facilitating a work together-plan together approach.

Expansion of Integrated Care in Brazil: the experience of reorganizing the healthcare network in Santana de Parnaíba.

During 2018/2019, the State Department of Health of São Paulo in partnership with the International Center for Integrated Care delivered an integrated care pilot project- Transforming Together. The aim was to co-design and deliver a more integrated system in the North Coast Region and to build the capability of key players in the region and state to sustain the change. The demonstrator project generated knowledge transfer in 2020/2021 through an InterAmerican Development Bank webinar and publications to encourage other municipalities to develop integrated care networks. With their acquired knowledge and experience, a team of local consultants have spread the change methodology to another region.
 In 2022 a new integrated care project was launched in Santana de Parnaíba-SP, a municipality in the metropolitan region of São Paulo with around 145,000 inhabitants, an HDI of 0.814 and GDP per capita of 12.500 dollars. Primary and secondary care services are already strong, referring patients to the regional network only for tertiary services, and a new hospital is scheduled to open in 2023. The project aims to fully integrate this hospital within the healthcare network and with other sectors.
 The work plan, co-designed with the municipality, has three workstreams aligned to provision of services and care for the population: a diagnostic phase; technical support for managers; and a ‘train the trainers’ educational programme to build workforce competencies for integrated care. For the diagnostic phase, municipal services were visited, health and social care service data was analyzed and a novel Day of Care Survey applied to understand the current hospital inpatient profile. Workshops with managers from different sectors explored the concepts of integrated care, supported them to map local care pathways and to self assess the maturity of their network using the Scirocco self-assessment instrument. After agreeing the educational programme outline and selecting participants, learning cycles began in July 2022. Six thematic sessions focus on: Integrated Care and Innovation; Management and Assistance Models; Leadership; Participatory Policies; Effective Work Processes; and Governance. The sessions include masterclasses by international experts via videoconference.
 
 By November 2022, more than 100 health and social care workers have participated. They have had the opportunity to deepen their knowledge on integrated care, strengthen relationships with colleagues from other services/sectors, understanding the importance of working together between all the actors involved in the care of a person to improve their health and well-being. Managers have a growing understanding of how to tackle the main barriers to people centered integrated care, and how working together across sectors is still deficient. Scirocco tool scores reflected knowledge, certainty and readiness for integrated care.
 This initiative highlights how implementation can be transferred successfully from one context to another.
 By using international expertise to build local knowledge and leadership, we have demonstrated a methodology that builds capability for integrated care in the Brazilian system and a support programme that is transferable to different regions in São Paulo state. Scale up of the Transforming Together integrated approach across all states is necessary to strengthen the Brazilian public health system.

Working Together-Planning together. A participatory experience-based co-design approach to build an integrated palliative care model in Ontario, Canada.

Introduction: With the increase in life expectancy and the development of medical knowledge, the expectation that individuals will live a quality life till the very last days is becoming the norm. Palliative care is an approach that improves the quality of life of patients and their families facing the issues associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, comprehensive assessment and a management plan that considers, physical, psychosocial and spiritual needs. Despite this wholesome definition, the majority of palliative care interventions remain localized and siloed.
 Context: In 2019, the Ministry of Health in Ontario, Canada, announced the Ontario Health Teams (OHTs) as an innovative integrated care network model to deliver integrated person-centred care to Ontarians across their life trajectory (currently there are 54 teams covering 95% of the population). These teams utilize a population health management philosophy to integrate care in a person-centered manner. Integrating palliative care across care sectors and along the trajectory of the palliative care journey is a priority to many of these teams.
 Approach: In the Spring of 2022, Burlington OHT formed a working group to co-design an integrated palliative care model. This working group included patients, caregivers, palliative care physicians and nurses, primary care physicians and nurses, home and community care providers, hospice care providers, policy makers, researchers and evaluators. A participatory experience-based co-design approach was taken to identify the gaps, determine best practices, design a new care model, create an implementation plan, implement, evaluate and improve.
 The participatory experience-based co-design approach was guided by the 11-step methodology described by O'Cathain A, et al in 2019 when co-designing complex health interventions. We added some additional steps. The modified methodology included 1) planning the co-design process, 2) involving all stakeholders (including those who will implement, deliver, use and benefit from the intervention), 3) bring together a team and establish decision-making processes, 4) needs assessment via multiple engagement tools (surveys and virtual and in-person engagement sessions), 5) review published research evidence, 6) draw on existing theories/frameworks, 7) identify relevant change ideas, 8) articulate programme theory, 9) undertake primary data collection, 10) understand the local context, 11) pay attention to future implementation of the intervention in the real world, 12) design and refine the intervention and finally 13) implement and evaluate.
 The project is in its concluding stages and the final findings including the detailed integrated palliative care model description and the implementation plan will be available for the conference in May
 Implications for applicability/transferability: Designing integrated palliative care programs is a novice area of integrated care across the world. Describing the participatory experience-based co-design approach that we followed to plan our intervention has a great potential of guiding policymakers, planners, funders and implementers on how to plan and implement such interventions by facilitating a work together-plan together approach.

Dental care for persons with disabilities: discretion on the frontline.

To depict the influence of discretionary actions exercised by frontline professionals and organizations on the implementation of diverse modalities of access to specialized dental care within the Care Network for Persons with Disabilities. A case study conducted in two Brazilian health regions characterized by distinct means of access to specialized dental care employing documentary analysis and interviews with key stakeholders across the period spanning from July to December 2019. In the referenced access region, there was a notable centrality of Primary Health Care (PHC) in caregiving, wherein planning and assessment were integral components of institutional routines. Where spontaneous demand scheduling was accepted, sporadic exchanges of information were evident between PHC units and specialized facilities. The coordination role in caregiving was not vested in PHC teams, and activities such as planning and assessment were not assimilated into organizational routines. The implementation of policies for specialized dental care for persons with disabilities relied on the coordination furnished by PHC and the orchestration of planning and assessment endeavors aimed at establishing an integrated care network. This implementation proved subject to the discretionary authority of frontline professionals and organizations, highlighting the significant role of relational and institutional environments in the context of public policy implementation within a decentralized and regionalized healthcare system.

Efficacy of a Dementia-Friendly Integrated Care Network in Mitigating Cognitive Decline and Alleviating Family Care Burden: Insights from the Gan-Dau Healthy Longevity Plan

Efficacy of a Dementia-Friendly Integrated Care Network in Mitigating Cognitive Decline and Alleviating Family Care Burden: Insights from the Gan-Dau Healthy Longevity Plan

Study design and protocol of a stepped wedge cluster randomized trial using a practical implementation strategy as a model for hypertension-HIV integration — the MAP-IT trial

BackgroundAs people living with HIV (PLWH) experience earlier and more pronounced onset of noncommunicable diseases (NCDs), advancing integrated care networks and models in low-resource-high-need settings is critical. Leveraging current health system initiatives and addressing gaps in treatment for PLWH, we report our approach using a late-stage (T4) implementation research study to test the adoption and sustainability of a proven-effective implementation strategy which has been minimally applied in low-resource settings for the integration of hypertension control into HIV treatment. We detail our protocol for the Managing Hypertension Among People Living with HIV: an Integrated Model (MAP-IT) trial, which uses a stepped wedge cluster randomized trial (SW-CRT) design to evaluate the effectiveness of practice facilitation on the adoption of a hypertension treatment program for PLWH receiving care at primary healthcare centers (PHCs) in Akwa Ibom State, Nigeria.DesignIn partnership with the Nigerian Federal Ministry of Health (FMOH) and community organizations, the MAP-IT trial takes place in 30 PHCs. The i-PARiHS framework guided pre-implementation needs assessment. The RE-AIM framework will guide post-implementation activities to evaluate the effect of practice facilitation on the adoption, implementation fidelity, and sustainability of a hypertension program, as well as blood pressure (BP) control. Using a SW-CRT design, PHCs sequentially crossover from the hypertension program only (usual care) to hypertension plus practice facilitation (experimental condition). PHCs will recruit and enroll an average of 28–32 patients to reach a maximum of 960 PLWH participants with uncontrolled hypertension who will be followed longitudinally for BP outcomes.DiscussionGiven the need for integrated NCD-HIV care platforms in low-resource settings, MAP-IT will underscore the challenges and opportunities for integrating hypertension treatment into HIV care, particularly concerning adoption and sustainability. The evaluation of our integration approach will also highlight the potential impact of a health systems strengthening approach on BP control among PLWH.Trial registrationClinicaltrials.gov (NCT05031819). Registered on 2nd September 2021.

Family physicians collaborating for health system integration: a scoping review

BackgroundIn Canada, Ontario Health Teams (OHTs) are a new model for integrated healthcare. Core to OHTs are family physicians (FPs) and their ability to collaborate with other FPs and healthcare providers. Whereas the factors for intra-organizational collaboration have been well-studied, inter-organizational collaboration between FPs and other healthcare organizations as an integrated care network, are less understood. This paper aims to explore the structural factors, processes, and theoretical frameworks that support FPs’ collaboration for integrated healthcare.MethodsA scoping review was undertaken based on Joanna Briggs Institute (JBI) methodology for scoping review and using the Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Review (PRISMA_ScR) checklist. A search for academic and relevant grey literature published between 2000–2021 was conducted across databases (MEDLINE, EMBASE, EBSCOhost).Thematic analysis was used to identify the key findings of the selected studies.ResultsThirty-two studies were included as eligible for this review. Three structural components were identified as critical to FPs’ successful participation in inter-organizational partnerships: (1) shared vision/values, (2) leadership by FPs, and (3) defined decision-making procedures. Also, three processes were identified: (1) effective communication, (2) a collective sense of motivation for change, and (3) relationships built on trust. Three theoretical frameworks provided insight into collaborative initiatives: (1) Social Identity Approach, (2) framework of interprofessional collaboration, and (3) competing values framework.ConclusionFPs hold unique positions in healthcare and this review is the first to synthesize the best evidence for building collaborations between FPs and other healthcare sectors. These findings will inform collaboration strategies for healthcare integration, including with OHTs.

Shared leadership in integrated care networks: the case of “hub and spoke” networks in oral and maxillofacial surgery (OMFS) in the English NHS

PurposeThe purpose of this paper is to explore leadership in the context of the hub and spoke network in oral and maxillofacial surgery (OMFS) in the English National Health Service (NHS).Design/methodology/approachThis paper is a conceptual paper using literature relating to the antecedents of shared leadership and relevant policy documents pertaining to both NHS policy and the development of OMFS. The paper is informed, theoretically by the conceptual lens of shared leadership.FindingsThe paper identifies the challenges that may be faced by policymakers and those involved in the hub and spoke network in developing shared leadership. It also reveals the implications for policymakers in developing shared leadership.Research limitations/implicationsThe paper is conceptual. It is acknowledged that this is a preliminary study and further work will be required to test the conceptual framework empirically. The paper discusses the policy implications of developing leadership in the hub and spoke network. As networks are of interest internationally this has wider relevance to other countries.Originality/valueThere is limited research on the antecedents of shared leadership. In addition, the conceptual framework is applied to a new policy context.

"It depends on the people!" - A qualitative analysis of contextual factors, prior to the implementation of digital health innovations for chronic condition management, in a German integrated care network.

Integrated care and digital health technology interventions are promising approaches to coordinate services for people living with chronic conditions, across different care settings and providers. The EU-funded ADLIFE project intends to provide digitally integrated personalized care to improve and maintain patients' health with advanced chronic conditions. This study conducted a qualitative assessment of contextual factors prior to the implementation of the ADLIFE digital health platforms at the German pilot site. The results of the assessment are then used to derive recommendations for action for the subsequent implementation, and for evaluation of the other pilot sites. Qualitative interviews with healthcare professionals and IT experts were conducted at the German pilot site. The interviews followed a semi-structured interview guideline, based on the HOT-fit framework, focusing on organizational, technological, and human factors. All interviews were audio recorded, transcribed, and subsequently analysed following qualitative content analysis. The results of the 18 interviews show the interviewees' high openness and motivation to use new innovative digital solutions, as well as an apparent willingness of cooperation between different healthcare professionals. Challenges include limited technical infrastructure and large variability of software to record health data, lacking standards and interfaces. Considering contextual factors on different levels is critical for the success of implementing innovations in healthcare and the transfer into other settings. In our study, the HOT-fit framework proved suitable for assessing contextual factors, when implementing IT innovations in healthcare. In a next step, the methodological approach will be transferred to the six other European pilot sites, participating in the project, for a cross-national assessment of contextual factors.

Real-World Comparison of Time to Next Treatment for Patients with CLL Initiated on First-Line Treatment with Ibrutinib Versus Acalabrutinib

Introduction: Treatment guidelines recommend Bruton's tyrosine kinase inhibitors (BTKi) ibrutinib (once-daily) and acalabrutinib (twice-daily) as preferred regimens for chronic lymphocytic leukemia (CLL); however, there are no studies comparing the effectiveness of ibrutinib and acalabrutinib as first-line (1L) therapy in CLL. This study investigated time to next treatment (TTNT) for patients with CLL initiated on 1L ibrutinib or acalabrutinib in real-world (RW) clinical practice in the US. Methods: Specialty pharmacy electronic medical records from academic integrated care networks (11/21/2018-4/30/2022) were used to identify adults with CLL who initiated ibrutinib or acalabrutinib in 1L (index date) on or after the date of acalabrutinib approval for CLL (11/21/2019). A washout period of ≥12 months without antineoplastic agent use pre-index was required to confirm use as 1L therapy. Patients were excluded if there was concomitant use of another antineoplastic agent during the first 28 days post-index. Characteristics evaluated in the 12-month baseline period were compared between ibrutinib and acalabrutinib cohorts using t-tests for continuous variables and chi-square tests for categorical variables. TTNT was defined as the time from the index date to the initiation a next or additional treatment. Patients without a next/additional treatment were censored at death or end of data (4/30/2022). Patients with a within-class BTKi switch at any time post-index were censored at time of switch, as this may have indicated a switch due to tolerability rather than progression. Patients who added an anti-CD20 antibody or venetoclax to the BTKi within 180 days post-index were censored at time of add-on, as these may not have indicated overt disease progression but rather late initiation of a second anti-cancer agent as a 1L combination treatment strategy. Beyond 180 days, anti-CD20 or venetoclax add-ons were considered as a next/additional treatment. TTNT was described using Kaplan Meier curves and compared between ibrutinib and acalabrutinib using a Cox proportional hazards model adjusted for the following baseline variables: age, gender, region, race, year of index date, Quan-Charlson Comorbidity Index (Quan-CCI), chronic pulmonary disease (CPD), peripheral vascular disease, hypertension, atrial fibrillation (AF), metastatic cancer, use of corticosteroids, and use of antiplatelets. Results: Among 710 and 373 patients in the ibrutinib and acalabrutinib cohorts, respectively, mean age was 71.5 and 72.4 years (P=0.159) and 38.5% and 38.3% were female (P=0.971; Table). Mean baseline Quan-CCI score was similar for ibrutinib and acalabrutinib (3.1 vs 3.0; P=0.597); a higher proportion of patients in the ibrutinib cohort had CPD (13.6% vs 8.8%; P=0.024), peripheral vascular disease (7.8% vs 4.1%; P=0.022), and hypertension (41.4% vs 32.2%; P=0.003) at baseline, while AF was similar (7.0% vs 9.9%, P=0.098). Baseline corticosteroid use was lower in the ibrutinib cohort (14.5% vs 20.1%; P=0.018), but antiplatelet use was higher (7.0% vs 3.5%; P=0.017). Mean (median [range]) follow-up was 17.1 (18.1 [1.0-29.3]) months for the ibrutinib cohort and 12.5 (11.9 [1.0-29.1]) months for the acalabrutinib cohort. Four/710 (0.6%) patients in the ibrutinib cohort and 16/373 (4.3%) in the acalabrutinib cohort added an anti-CD20 antibody to the BTKi within 180 days and were censored at that point. Ten/710 (1.4%) and 8/373 (2.1%) patients added venetoclax to ibrutinib or acalabrutinib within 180 days and were censored at that point. The proportion of patients in the ibrutinib cohort who initiated a next or additional treatment was 5.9% relative to 7.5% for acalabrutinib. After adjusting for baseline characteristics, patients treated with acalabrutinib were 89% more likely to start a next or additional treatment than those treated with ibrutinib (hazard ratio = 1.89 [95% confidence interval] = [1.12, 3.13]; P=0.016; Figure). Results were similar when censoring anti-CD20 add-ons at any time (hazard ratio = 1.82 [95% confidence interval] = [1.08, 3.03]; P=0.025). Conclusions: In this large US RW study, patients with CLL treated with 1L acalabrutinib were significantly more likely to start a next treatment or add/intensify therapy than those treated with 1L ibrutinib. RW treatment patterns also suggest a higher propensity to add an anti-CD20 antibody to acalabrutinib versus ibrutinib in 1L CLL. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal