Integrated Elderly Care Research Articles

Analysis of the Problem of “Multi-Party Cooperation” in Solving Elderly Care and Suggestions for Elderly Care in China Under the Model of Integrated Elderly Care and Medical Services

Analysis of the Problem of “Multi-Party Cooperation” in Solving Elderly Care and Suggestions for Elderly Care in China Under the Model of Integrated Elderly Care and Medical Services

Exploring the Sustainability of Integrated Elderly Care and Medical Services Policies in China from the Perspective of Policy Tools

The trend of increasing population aging has led to an international and Chinese domestic consensus on the need to integrate elderly care and medical services. Against this background, China's existing policies address the integration of elderly care and medical services (IECMS) successively. However, it is worth pondering whether China's policies on the IECMS have been effectively developed. Previous studies on the IECMS policies in China have mostly focused on the national level, and the evaluation dimensions of these studies are not comprehensive enough. Based on this, this study took the policy tools as primary perspective, constructed a three-dimensional analysis framework that included time and specific models of IECMS, and used content analysis to analyze and evaluate the policy texts related to the IECMS in Jinan City. The aim is to explore policy tools to improve integrated elderly care and medical services, promote the sustainable development of integrated elderly care and medical services in China, and provide Chinese experience for other countries. This study found that the use of policy tools in Jinan City had a trend toward comprehensiveness and diversification, but there is still room for further comprehensiveness and diversification. Moreover, there is an apparent preference in the use of policy tools, as evidenced by the most frequent use of environmental policy tools, and at the same time an imbalance in the internal structure of the three types of policy tools. Furthermore, the policies of Jinan City were not sufficiently targeted to operationalize policy tools into specific models of IECMS. Accordingly, we provide corresponding recommendations, including stating that the IECMS policies should be multifaceted and innovative, even-handed, precise, and timely to restore policy order in the aftermath of the COVID-19 pandemic.

Health Informatics and Technology for Integrated Elderly Care in the Context of Hong Kong: A Case Study.

The aging population creates tremendous pressure to healthcare. To resolve, scholars recognized the solution to this challenge is integrated care. To facilitate integrated care, health information technologies (HIT) is a critical enabler. This paper will first review how technology enhanced integrated care, and review on the existing literatures in system effective use and the three key external factors that enable HIT implementation. Applying Burton-Jones and Volkoff's contextualized theories of effective use of HIT to understand the role of health informatics and technology in the unique context of Hong Kong, we have conducted a case study research to identify the levers for improving HK integration of care through HIT.

Advantages of person-centered and integrated care service: results of Mixed Method Research on Embrace

Introduction : Health care systems are challenged by the changing demands for care and support of older adults. Integrated care models may provide a solution for these transformations. Embrace is a recently developed population-based, person-centered, and integrated care service for community-living older adults. It was implemented in the Netherlands in 2012. Currently, 2600 older adults from 29 general practitioner (GP) practices are participating. We evaluated the effects of Embrace regarding patient outcomes and experiences, quality of care, and service use and costs using Mixed Methods Research. Theory/Methods: Intervention. Embrace combines the Chronic Care Model with risk profiles based on a population health management model. A multidisciplinary Elderly Care Team – consisting of a GP, an elderly care physician, and two case managers (district nurse and social worker) – provide care and support. The intensity level, focus, and individual or group approach of the care and support depends on an older adults’ risk profile. Design. We used different measurement instruments, e.g. the specifically developed GeriatrICS (a geriatric core set based on the ICF) and the Patient Assessment of Integrated Elderly Care (PAIEC), to assess the effects of Embrace after twelve months using Mixed Methods. A Randomized Clinical Trial and cost-effectiveness study was conducted to assess the effectiveness of Embrace on patient outcomes for older adults, their perceived quality of care, and service use and costs. Qualitative studies were performed to determine the experiences of older adults and professionals with Embrace. One group pre-post studies were conducted to evaluate professionals’ perceived quality of care, effects of Embrace on health-related problems, and goal attainment scores. Furthermore, the long term effects of Embrace will be assessed. Results : (Patient outcomes and experiences) The RCT showed no clear advantages of Embrace regarding the domains health, well-being, and self-management. The qualitative study showed that older adults felt safe and secure and had the confidence to remain living at home. The preliminary findings of the pre-post study indicated that the number and severity of perceived health-related problems decreased. Quality of care. Results of the RCT showed that older adults in the Embrace group reported greater improvement in quality of care compared to care as usual (CAU). In addition, professionals reported a significant increase in the level of integrated care. A qualitative study showed that case managers identified problems early, took preventive actions, and felt more competent to meet their clients’ needs. Service use and costs. Findings of the cost-effectiveness study will be available in May 2016. Discussion : Embrace care and support has several advantages compared to CAU. Quality of care improved, older adults felt safe, secure, and in control, case managers felt that they were able to connect fragmented and discontinuous elderly care, and the number and severity of perceived health-related problems decreased. Embrace yielded greatest improvement in the “Frail” risk profile, a subgroup of older adults “at risk” of poor health outcomes with no immediate need for professional care yet. This specific group is usually not eligible for integrated care services even though these could be increasingly effective for their health outcomes in the long run. Lessons learned: Complex interventions such as Embrace require a multimethod evaluation to obtain a complete overview of the effects. Focusing only on a RCT would lead to limited conclusions. Furthermore, commonly used measurement instruments for health and well-being may not have been sufficiently sensitive to change to detect advantages of Embrace in clinical practice. This may explain why we only found effects using the specifically developed measurement instruments (GeriatrICS and PAEIC). Limitations : A limitation of this study is that we randomized participating older adults within the GP practices. This may have led to some contamination of CAU via the members of the Elderly Care Team. In addition, we had no control groups for the studies on professionals’ perspectives on quality of care and on older adults’ health-related problems. Future research : Future research should focus on the long-term effects of Embrace and on evaluating the process of care provision. Furthermore, the effects of Embrace in other geographical areas and in other cultures with different healthcare systems should be explored. Conclusion : Mixed Methods Research showed that receiving care and support by Embrace for twelve months resulted in several advantages compared to care as usual.

Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace

BackgroundAll community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care.ObjectiveTo examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care.DesignStratified randomized controlled trial.ParticipantsIntegrated care and support according to the “Embrace” model was provided by 15 general practitioners in the Netherlands. Based on self-reported levels of case complexity and frailty, a total of 1456 community-living older adults were stratified into non-disease-specific risk profiles (“Robust,” “Frail,” and “Complex care needs”), and randomized to Embrace or control groups.InterventionEmbrace provides integrated, person-centered primary care and support to all older adults living in the community, with intensity of care dependent on risk profile.MeasurementsPrimary outcome was quality of care as reported by older adults on the Patient Assessment of Integrated Elderly Care (PAIEC). Effects were assessed using mixed model techniques for the total sample and per risk profile. Professionals’ perceived level of implementation of integrated care was evaluated within the Embrace condition using the Assessment of Integrated Elderly Care.Key resultsOlder adults in the Embrace group reported a higher level of perceived quality of care than those in the control group (B = 0.33, 95 % CI = 0.15-0.51, ES d = 0.19). The advantages of Embrace were most evident in the “Frail” and “Complex care needs” risk profiles. We found no significant advantages for the “Robust” risk profile. Participating professionals reported a significant increase in the perceived level of implementation of integrated care (ES r = 0.71).ConclusionsThis study shows that providing a population-based integrated care service to community-living older adults improved the quality of care as perceived by older adults and participating professionals.

Development and psychometric evaluation of a measure to evaluate the quality of integrated care: the Patient Assessment of Integrated Elderly Care.

BackgroundNovel population‐based integrated care services are being developed to adequately serve the growing number of elderly people. Suitable, reliable and valid measurement instruments are needed to evaluate the quality of care delivered.ObjectiveTo develop a measure to evaluate the quality of integrated care from the perspective of elderly people, the Patient Assessment of Integrated Elderly Care (PAIEC), and then to assess its psychometric properties.Methods/DesignAfter the Patient Assessment of Chronic Illness Care was adapted to the PAIEC, a cross‐sectional postal‐survey study was performed among 223 elderly people who received integrated elderly care and support. We assessed the factor structure, internal consistency, known groups and divergent validity using robust nonparametric tests.ResultsMean age of participants was 83 years (standard deviation 4.7), and 69% was female. The original five‐factor model was rejected; a good fit was found for a three‐factor model, when excluding the item on patients' satisfaction with care. The PAIEC and its subscales showed good internal consistency (ordinal alphas > 0.90). Known‐groups validity was supported regarding number of medications, prevalence of chronic conditions and home care received. No differences were found between groups based on sociodemographic aspects. Divergent validity was supported by low correlations (Spearman's rank correlation coefficients < 0.30) between PAIEC scales and measures of quality of life, complexity of care needs and frailty.ConclusionThe PAIEC seems to have considerable potential as a reliable and valid measurement instrument that evaluates quality of integrated care and support from the perspective of elderly people.

Effects of Service Quality on Intention to Reuse -Focusing on Integrated Elderly Care Service-

Effects of Service Quality on Intention to Reuse -Focusing on Integrated Elderly Care Service-

Embrace: a population based Integrated Elderly Care model showed improved results and saves costs

Background Embrace is a population based Integrated care model for elderly people living in the community, and is a combination of the chronic care model (CCM) and the Kaiser Permanente (KP) triangle. Methods Embrace was designed by translating all CCM key elements to the Dutch situation and by specifying these elements for elderly people. The KP- …