Integration Of Health Care Services Research Articles

A need to integrate healthcare services for HIV and non-communicable diseases: An Indian perspective.

With the decline in HIV mortality, a concomitant increase in morbidity and death not directly related to HIV has been witnessed. Consequently, many countries especially low- and middle-income countries (LMICs) are now facing the dual burden of HIV and non-communicable diseases (NCDs). 2.3 million people living with HIV in India are at a higher risk of developing NCDs due to ageing, which can be attributed to the additional impact of long-standing HIV infection and the side-effects of antiretroviral therapy. This has led to a rise in demand for a combined health system response for managing HIV infection and co-existing NCDs, especially in LMICs such as India. The health and wellness centres (HWCs) envisioned to provide an expanded range of preventive and curative services including that for chronic conditions may act as a window of opportunity for providing egalitarian and accessible primary care services to these individuals. The reasons for integrating HIV and NCD care are epidemiological overlap between these conditions and the similar strategies required for provision of healthcare services.

Serving Those Who Served: Enhancing Colorectal Surgery Care for Veterans

AbstractThe Department of Veterans Affairs (VA) is the largest provider of integrated health care services in the United States and its mission is to honor veterans by providing timely, effective, and high-quality health care that improves individuals' health and functionality. The VA provides comprehensive primary and specialty care, including colorectal surgery services, to eligible veterans who suffer from a disproportionately high burden of medical comorbidities and often belong to vulnerable populations, including individuals of low socioeconomic status, those who identify as lesbian, gay, bisexual, transgender, and questioning, racial minorities, and those suffering from severe mental health illness. There are many challenges to caring for a population of veterans with benign and malignant colorectal disease due to both patient and system level factors. Despite these challenges, the VA has demonstrated a commitment to ensuring culturally competent, equitable, and inclusive care and to conducting research that establishes evidence-based best practices in the management of colorectal diseases. These efforts have led to outcomes for patients undergoing care for colorectal diseases within the VA that are par with or better than civilian outcomes. The VA is uniquely positioned on a system level to provide nationwide efforts that improve care delivery and serve those who served.

The Effect of Coordinating the Outpatient Treatment across Medical Specialities for Patients With Multimorbidity.

Patients with multimorbidity attend multiple outpatient clinics. We assessed the effects on hospital use of scheduling several outpatient appointments to same-day visits in a multidisciplinary outpatient pathway (MOP). This study used a quasi-experimental design. Eligible patients had multimorbidity, were aged ≥18 years and attended ≥2 outpatient clinics in five different specialties. Patients were identified through forthcoming appointments from August 2018 to March 2020 and divided into intervention group (alignment of appointments) and comparison group (no alignment). We used patient questionnaires and paired analyses to study care integration and treatment burden. Using negative binomial regression, we estimated healthcare utilisation as incidence rates ratios (IRRs) at one year before and one year after baseline for both groups and compared IRR ratios (IRRRs). Intervention patients had a 19% reduction in hospital visits (IRRR: 0.81, 95% CI: 0.70-0.96) and a 17% reduction in blood samples (IRRR: 0.83, 0.73-0.96) compared to comparison patients. No effects were found for care integration, treatment burden, outpatient contacts, terminated outpatient trajectories, hospital admissions, days of admission or GP contacts. The MOP seemed to reduce the number of hospital visits and blood samples. These results should be further investigated in studies exploring the coordination of outpatient care for multimorbidity. Can an intervention of coordinating outpatient appointments to same-day visits combined with a multidisciplinary conference influence the utilisation of healthcare services and the patient-assessed integration of healthcare services and treatment burden among patients with multimorbidity?

How healthcare entrepreneurship enhances ecosystem outcomes: the relationship between venture capital-funded start-ups and county-level health

PurposeResearch has examined how new ventures strengthen local economic outcomes; however, limited research examines health-oriented ventures and their impact on social outcomes, including health outcomes. Increased VC investment in healthcare service start-ups signals more activity toward this end, and the need for further academic inquiry. We examine the relationship between these start-ups and county-level health outcomes, health factors, and hospital utilization.Design/methodology/approachData on start-ups funded via institutional venture capital from PitchBook were merged with US county-level outcomes from the County Health Rankings and Area Health Resources Files for 2010 to 2019. We investigated how the number of VC-funded healthcare service start-ups, as well as a subset defined as innovative, were associated with county-level health measures. We used panel models with two-way fixed effects and Propensity Score Matched (PSM), controlling for demographics and socioeconomic factors.FindingsEach additional VC-funded healthcare service start-up was related to a significant 0.01 percentage point decrease in diabetes prevalence (p < 0.01), a decrease of 1.54 HIV cases per 100,000 population (p < 0.1), a 0.02 percentage point decrease in obesity rates (p < 0.01), and a 0.03 percentage point decrease in binge drinking (p < 0.01). VC-funded healthcare service start-ups were not related to hospital utilization.Originality/valueThis work expands our understanding of how industry-specific start-ups, in this case healthcare start-ups, relate to positive social outcomes. The results underscore the importance of evidence-based evaluation, the need for expanded outcome measures for VC investment, and the possibilities for integration of healthcare services and entrepreneurship ecosystems.

Competition, quality and integrated health care

Integration of health care services has been promoted in several countries to improve the quality and coordination of care. We investigate the effects of such integration in a model where providers compete on quality to attract patients under regulated prices. We identify countervailing effects of integration on quality of care. While integration makes coordination of care more profitable for providers due to bundled payments, it also softens competition as patient choice is restricted. We also identify circumstances due to asymmetries across providers and/or services under which integration either increases or reduces the quality of services provided. In the absence of synergies, integration generally leads to increases in quality for some services and reductions for others. The corresponding effect on health benefits depends largely on whether integration leads to quality dispersion or convergence across services. If the softening of competition effect is weak, integration is likely to improve quality and patient outcomes.

Acute kidney injury and its predictors among HIV-positive patients in Africa: Systematic review and meta-analysis.

cute kidney injury(AKI) is a rapid loss of the kidney's excretory function, resulting in an accumulation of end products of nitrogen metabolism. The causes of AKI in HIV-positive patients are not well investigated, but it may be associated with antiretroviral drug side effects and HIV itself. Even though there were studies that reported the prevalence of AKI among HIV-positive patients in Africa, their findings were inconsistent across the studies. We searched on PubMed, Embas, Ebsco, OVID, Cochrane Library, and other supplementary search engines, including Google and Google Scholar. Articles published upto July 2023 were included in this review study. The quality of the study was assessed using the Newcastle-Ottawa Scale for cross-sectional, case-control, and cohort studies. The data were extracted using a Microsoft Excel spreadsheet and exported to Stata version 14 for analysis. A random effect meta-analysis model was used to estimate the pooled prevalence of AKI among HIV-positive patients. Heterogeneity was evaluated using Cochrane Q statistics and I squared (I2). Furthermore, the graphic asymmetric test of the funnel plot and/or Egger's tests were computed to detect publication bias. Sensitivity analysis was computed to see the effect of a single study on the summary effects. To treat the publication bias, a trim and fill analysis was carried out. The protocol of this review has been registered in an international database, the Prospective Register of Systematic Reviews (PROSPERO),with reference number CRD42023446078. A total of twenty-four original articles comprising 7913HIV-positive patients were included in the study. The pooled prevalence of AKI among HI-positive patients was found to be 23.35% (95% CI: 18.14-28.56%, I2 = 97.7%, p-value <0.001). Low hemoglobin (Hgb <8mg/dl) was found to be the determinant factor for AKI among HIV-positive patients (AOR = 2.4; 95% CI:1.69-3.4, I2 = 0.0%, p-value = 0.40). In meta-regression analysis, sample size was the possible source of variation among the included studies (AOR = 3.11, 95%CI: 2.399-3.83). The pooled prevalence of AKI among HIV-positive patients was high. HIV-positive patients with low hemoglobin levels are at risk of developing AKI. Hence, regular monitoring of kidney function tests is needed to prevent or delay the risk of AKI among HIV-positive patients. Healthcare workers should provide an integrated healthcare service to HIV-positive patients on the prevention, treatment, and reduction of the progression of AKI to advanced stages and complications.

Evaluation of a One Health Clinic: Enhancing access to healthcare and housing for young adults experiencing homelessness with animals

Abstract The One Health Clinic (OHC) is a transdisciplinary approach to healthcare services delivery, providing low-barrier healthcare and community services for people experiencing homelessness (PEH) and their companion animals that integrate human, animal, and environmental health. This study aimed to determine the effectiveness of an OHC model in a youth and young adult shelter on access to healthcare, housing, and community resources. Researchers conducted semi-structured interviews with six OHC client participants and three provider participants, and a thematic analysis was used to study the effects of the OHC model on two key outcomes: overall health for humans and their companion animal(s), and access to public services for humans and their companion animal(s). Results showed that the OHC model provides multiple services in one place which reduces barriers to accessing health services, housing, and community resources. The integrated healthcare services promote positive interactions with providers and facilitate access to healthcare, housing, and community resources for PEH and their companion animals. Settings with similar goals of client health and access to healthcare, as well as housing services and community resources, can utilize the OHC care model to integrate services for lower barrier access to healthcare and community services to promote health on an individual level and from a One Health perspective. One Health impact statement Our study on the OHC model demonstrates the tangible impact of integrating healthcare services for homeless young adults and their companion animals. In the One Health context, our work addresses the complex interplay between human, animal, and environmental well-being. By bridging healthcare, housing, and community resources, the OHC model enhances access and reduces barriers. The One Health approach enriches impact, as collaboration across sectors yields multifaceted benefits. The transdisciplinary nature of our research fuses academic and non-academic knowledge, ensuring a holistic perspective. Practical solutions emerge from diverse insights, transcending traditional boundaries. This co-produced transformational knowledge facilitates real-world change, impacting lives, promoting resilience, and fostering sustainability. The OHC model exemplifies how cooperative, transdisciplinary efforts yield breakthroughs that elevate health, save lives, and nurture the optimal environment for people and their companion animals to live, work, and play.

Integrated physical and mental management for China's elderly: insights from Long-gang District, Shenzhen.

China is in a period of rapid population aging. The total population of the elderly aged 60 and above in mainland China was 264 million in 2020, and is the country with the largest elderly population in the world, which is home to 1/5 of the world's older people. The urgency of actively coping with the aging population has never been greater, and China has raised it to the height of national strategy. To this end, China has issued several plans and projects on aging work. Many of them include multiple overlapping components. The management of physical illness and mental illness in the elderly is over-differentiated and segmented. However, it is common for older adults with complex health problems. The body and mind are inherently integrated and interact with each other, and should not be separated. There is an urgent need for integrated healthcare services for the physical and mental health of the elderly population. The national basic public health services play an important role in early detection and awareness of health problems for the elderly in community health services. This paper introduces the elderly health management services, one of the national basic public health projects, and the psychological care project for the elderly in Shenzhen, Guangdong Province, China. Taking Long-gang District's exploration of the joint management of physical and mental health of the elderly as an example, this review discusses the difficulties of the elderly health work, and the feasibility of integrating the elderly mental health and physical health in medical care. We outlook to build an integrated platform for physical and mental health of the elderly in China. Focus on the needs of older population, strengthen community health services, build a integrative team, fully publicize and improve health literacy of the elderly, link up and down and work together, improve coordination between providers of medical care and social services. It is of great significance to construct a strong public health system for the elderly and promote the realization of the grand goal of Healthy China.

Comparative Study on the Satisfaction of Healthcare Service Providers with the Synergistic Development of Rural Healthcare Systems in China: Medical Alliance Counties vs. Non-Medical Alliance Counties.

This study aimed to explore whether the establishment of county medical alliances can improve satisfaction with the vertical integration of healthcare systems among rural medical and healthcare service provider managers and service providers. Our study also sought to provide recommendations for the sustainable development of vertical integration in healthcare systems. A semi-structured interview with 30 healthcare service providers was employed in this research, and Nvivo software was utilized to analyze factors that influence vertical integration. From April to July 2021, a multi-stage random sampling method was used to select participants. The sample included two leading hospitals in medical consortia, 15 member units (healthcare service providers and medical staff), two county-level hospitals, and 15 township health centers/community healthcare service centers from non-medical consortia. Questionnaire surveys were conducted with these groups. Factor analysis was used to calculate satisfaction scores for healthcare service providers with the cross-institutional synergistic development of healthcare systems in both medical and non-medical consortia (denoted as M(IQR)). Propensity score matching was employed to reduce confounding factors between groups. The Mann-Whitney U test was used to compare satisfaction differences between groups. The overall satisfaction scores for lead-county hospital managers, member institution managers, medical staff at the lead-county hospital, and medical staff at member institutions were 4.80 (1.00), 4.17 (1.17), 4.00 (1.38), and 4.00 (1.12), respectively. Lead-county hospital managers' satisfaction with cross-institutional collaboration, development capacity enhancement, and structure and resource integration in the Medical Alliance group showed higher satisfaction than the Non-Medical Alliance. Similarly, lead-county hospital medical staff in the Medical Alliance group reported greater satisfaction with collaboration efforts, supportive environment, and development capacity enhancement. Notably, while the Medical Alliance group's satisfaction scores were higher, the differences between the two groups were not statistically significant for lead-county hospital managers and medical staff. The Medical Alliance group did show statistically significant differences in member institution managers' satisfaction with collaboration, development capacity enhancement, and structure and resource integration. Additionally, medical staff of member institutions in the Medical Alliance group reported statistically significant higher satisfaction with collaboration, supportive environment, development capacity enhancement, healthcare service integration, and human resource development. To facilitate the establishment of county medical alliances, managers of leading county-level hospitals should adopt a healthcare system integration strategy. This strategy involves evolution from being a member of a single institution to a coordinator of cross-institutional vertical integration of medical and healthcare services. Additionally, revamping remuneration and appraisal systems for members of county medical alliances is necessary. This will encourage cooperation among healthcare institutions within the three-tiered system and their medical staff, ultimately facilitating the provision of integrated services.

A Health Service Transition to Adult Patient Care for Sickle Cell Disease

This paper explores the challenges related to long-term conditions, focusing on sickle cell disease (SCD) as a case study. Long-term conditions, characterized by the need for ongoing management, present a substantial burden on healthcare systems globally. A careful transition from pediatric to adult healthcare is needed for SCD. The discussion extends to the broader health service transition to adult patient care in SCD, emphasizing the World Health Organization’s definition of care transitions and the necessity for an integrated healthcare service. The emphasis is on a multidisciplinary approach to medical, mental health, and educational problems. A person-centered model of care should be used more consistently to resolve these long-term condition-related challenges. To evaluate the effectiveness of new interventions in improving the transition of care from pediatrics to adult patients with SCD, continuous quality improvement strategies should be implemented and prospectively measured in younger patients. In conclusion, this study highlights the critical importance of an effective transition from pediatric to adult healthcare. The continued research of effective transition practices is essential for the future and there is still a requirement to develop pragmatic approaches to enhance research on the transition to improve the quality of healthcare for patients with long-term conditions.

THE IMPACT OF HEALTH INSURANCE ON THE QUALITY OF HEALTHCARE SERVICES IN GOVERNMENT HOSPITALS IN DAMMAM CITY

This study aimed to investigate the impact of health insurance on healthcare services in Ministry of Health hospitals in Dammam City from the perspective of health insurance beneficiaries. The study examined various aspects, including the integration of healthcare services, the reliability of healthcare services, responsiveness to healthcare services, the treatment by healthcare service providers, healthcare service procedures and systems, and healthcare service awareness. The study also aimed to determine the significance of differences in the impact of health insurance on the quality of healthcare services related to variables such as gender, age, income level, and educational qualifications. The study employed a descriptive-analytical approach, with a sample consisting of 250 individuals selected through convenient sampling from health insurance beneficiaries in Ministry of Health hospitals in Dammam City.The study found statistically significant (p ≤ 0.05) positive impacts of health insurance on healthcare services in Ministry of Health hospitals in Dammam City in terms of integration of healthcare services, reliability of healthcare services, responsiveness to healthcare services, treatment by healthcare service providers, healthcare service procedures and systems, and healthcare service awareness. There were also statistically significant differences (α≤ 0.05) in the impact of health insurance on the quality of healthcare services related to gender (favoring males), monthly income (favoring those with monthly income less than 5000 Saudi Riyals), age (favoring individuals under 30 years old), and educational qualifications (favoring individuals with a high school diploma or lower).

Evidence on bringing specialised care to the primary level—effects on the Quadruple Aim and cost-effectiveness: a systematic review

BackgroundTo achieve the Quadruple Aim of improving population health, enhancing the patient experience of care, reducing costs and improving professional satisfaction requires reorganisation of health care. One way to accomplish this aim is by integrating healthcare services on different levels. This systematic review aims to determine whether it is cost-effective to bring a hospital specialist into primary care from the perspectives of commissioners, patients and professionals.MethodsThe review follows the PRISMA guidelines. We searched PubMed, Scopus and EBSCO (CINAHL and Academic Search Ultimate) for the period of 1992–2022. In total, 4254 articles were found, and 21 original articles that reported on both quality and costs, were included. The JBI and ROBINS-I tools were used for quality appraisal. In data synthesis, vote counting and effect direction plots were used together with a sign test. The strength of evidence was evaluated with the GRADE.ResultsCost-effectiveness was only measured in two studies, and it remains unclear. Costs and cost drivers for commissioners were lower in the intervention in 52% of the studies; this proportion rose to 67% of the studies when cost for patients was also considered, while health outcomes, patient experience and professional satisfaction mostly improved but at least remained the same. Costs for the patient, where measured, were mainly lower in the intervention group. Professional satisfaction was reported in 48% of the studies; in 80% it was higher in the intervention group. In 24% of the studies, higher monetary costs were reported for commissioners, whereas the clinical outcomes, patient experience and costs for the patient mainly improved.ConclusionsThe cost-effectiveness of the hospital specialist in primary care model remains inconclusive. Only a few studies have comprehensively calculated costs, evaluating cost drivers. However, it seems that when the service is well organised and the population is large enough, the concept can be profitable for the commissioner also. From the patient’s perspective, the model is superior and could even promote equity through improved access. Professional satisfaction is mostly higher compared to the traditional model. The certainty of evidence is very low for cost and low for quality.Trial registrationPROSPERO CRD42022325232, 12.4.2022.

Health system strengthening in fragile and conflict-affected states: A review of systematic reviews.

Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature. We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet's 'high-quality health system framework'. Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the 'foundations' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation. The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.

An Integrated Healthcare Service System Based on Blockchain Technologies

An Integrated Healthcare Service System Based on Blockchain Technologies

What is in a space? Exploring experiences providing or receiving patient care in unique spaces for patients waiting to transition to their next point of care in Ontario, Canada

Introduction: Delayed discharge is a key challenge for health systems globally. Pandemic-related capacity pressures on hospitals have increasingly led to patients being moved to unique spaces (overflow units, hotels) while they wait to transition to their next point of care. However, it is unclear how patient care is managed and coordinated in these spaces or how patients and caregivers experience care in these environments.&#x0D; Rationale/Objective: Our study aimed to understand how to optimize care experiences and outcomes for patients with a delayed discharge, their families and care providers. The purpose of our study was to learn about people’s experiences in unique spaces, including what works well and what needs to improve. &#x0D; Methods: Using a qualitative descriptive design, we conducted in-depth, semi-structured interviews with patients/caregivers (n=9) and care providers (n=20; e.g., nurses, rehabilitation therapists, physicians, discharge planners) who had experience with receiving or providing care in a unique space. We interviewed participants from three different unique spaces associated with a hospital across rural and urban health regions in Ontario, Canada: a hotel previously used for patient and caregiver accommodations while receiving care away from home (beside hospital), a structured, heated tent (hospital parking lot) and a clinical building (1 hour away from hospital). Interviews were transcribed and a codebook was developed and applied to all transcripts. Thematic analysis was used to analyze the transcripts, specifically focusing on key challenges and opportunities.&#x0D; Results: Patient, caregiver and care provider experiences in these unique spaces included positive aspects, such as care teams focused on facilitating integrated care transitions, the opportunity to develop a collaborative team culture from the ground up and having increased interdisciplinary patient assessments. Areas of improvement were also described across interviews, such as the need for adequate space and infrastructure for optimal patient care and safety, more integration of information sharing about patient care and journeys between and across providers, patients and caregivers, more resources and support from the associated hospital and clear patient eligibility criteria for care provider referrals.&#x0D; Lessons learned: Unique spaces have the potential to be alternate care settings when hospitals are managing capacity pressures now and in the future; however, hospitals considering moving patients with delayed discharge to these spaces should consider both the opportunities and benefits of providing care within these environments compared to traditional hospital units. It is also important for hospitals to understand the challenges associated with providing care in these settings and develop plans to mitigate these challenges. &#x0D; Next steps: These findings provide learnings to inform a co-design initiative with patients, caregivers and care providers to identify best practices and resources for providing or receiving care in unique spaces that responds to patient needs as the health system continues to look to alternate care settings to ease pressures. This work will have implications on how integrated health care services are implemented in unique spaces so that patients experience a continuum of care both while they wait and as they transition to new points of care.&#x0D;

Integrated Care and Social Protection for Senior Citizens In West Africa: A Scoping Review

Background: West Africa's population is aging at a rapid rate, and the prevalence of older adults with multiple chronic conditions is rising. However, there is little information available about healthcare policies for this age group in this region ten years after the Madrid International Plan of Action on Ageing (MIPAA). To manage the physical and psychosocial needs of senior citizens, a greater integration of healthcare services is required.&#x0D; Methods: A scoping review was conducted adhering to the Joana Briggs Institute’s systematic scoping review protocol guidelines. A simple search strategy was developed to collate relevant articles from PubMed, Google Scholar, and AJOL, as well as policy databases, between 2002 and 2022. Articles were included if published in English and related to primary care, social care, and multi-morbidity among older persons in West Africa.&#x0D; Results: The findings yielded three thematic issues. First, most West African countries have policies on healthy aging; however, only a few have coherent policies on access to healthcare for older people and the availability of social safety nets, highlighting the need for policymakers to provide coherence and avenues for integration. Secondly, while integration of non-communicable disease services focuses on individual-level services rather than multi-sectoral integration, there is also a poor focus on mental health and sexual and reproductive health integration. Finally the inherent capacity development needs and technical up-skilling requirements require a whole-system approach with contextual nuances.&#x0D; Conclusion: The literature is increasingly recognizing an aging population and the prevalence of multi-morbidity in West Africa. Countries in West Africa, in response to the MIPAA, have formulated policies with regards to older persons' healthcare needs; however, improvements in clinical care at the individual setting level may not be sufficient. A deliberate whole-system approach that fosters multi-sectoral collaboration for integrated healthcare might go a long way toward better outcomes for senior citizens and a step forward toward universal health coverage.

Workshop: Research on integrated and personalized care, sharing values and perspectives; a world café method

Introduction/Background: PhD research is one of the directions to contribute to the development of integrated care and contribute to international conferences such as ICIC in. Contributions are made towards the nine pillars of integrated care. Results are added, mostly as part of an individual PhD study, in a wide array of subjects which fits the nine pillars of integrated care. Doing PhD research brings difficulties but also successes. This also applies to PhD researchers and lecturers of the research and education group PIC’T&amp;Re Personalized Integrated Care Teaching &amp; Research of the University of Applied Sciences Utrecht in the Netherlands. The research group aims to contribute to integration knowledge which can facilitate changes towards the customization of integrated healthcare service delivery in the Netherlands on micro, meso and macro level of health and social care.&#x0D; Why a workshop? Using a workshop as a method to share values and perspectives in doing PhD research amongst the diversity of PhD researchers within the integrated care community. Also, to exchange experiences which are of value to all researchers in integrated care. Exchange of knowledge, expertise and experiences of all attendees is central in this workshop.&#x0D; Who is it for? The target audience for this workshop consists of (PhD) students, researchers, educators and professionals in integrated health and social care.&#x0D; Facilitators / speakers &#x0D; Dennis van Kerkvoorden MSc, PhD candidate &#x0D; Ferdy Pluck RN MSc, PhD candidate&#x0D; Dr Roelof Ettema, co-supervisor&#x0D; Dr Ruben van Zelm, co-supervisor&#x0D; What are we going to do? – Workshop 90’&#x0D; a.Introduction and background of the world café method and themes – (15’)&#x0D; b.World cafe: in three rounds of discussion and 5 table discussions based on the themes of the 2023 conference on Integrated care – (3 x 20’): &#x0D; 1.Change management implementation: macro, meso and micro level&#x0D; 2.Person-centered care: focus on integration of goals and needs&#x0D; 3.Collaboration: factor for successful implementation of integrated care&#x0D; 4.Engaging everybody: caring neighborhoods and compassionate communities&#x0D; 5.Population health approach: leverage for integrated care&#x0D; c.Pitches and Conclusions and general reflections (15’)&#x0D; How are you going to engage with the audience? Everybody is an expert in her or his own research, education or practice. In small groups of 5-10 persons, we will discuss one of the five themes mentioned above. We challenge everyone to share their own experiences and ideas. &#x0D; How are you going to summarize the take home messages? All collected results will be summarized by the organizing committee of this workshop. These results will be shared with the participants and IFIC Academy with the intension of a yearly follow-up.&#x0D; Keywords: research, integrated and personalized care, world café

Accountability in integrated healthcare service delivery in the Netherlands: A personalized integrated care approach

Short summary: Are you curious about how accountability in integrated care is developed and applied? How to organize accountability that suit these integrate care services is still work in progress and far from an end conclusion. Would you like to join this progress? Then come to our workshop.&#x0D; Why a workshop? There is still a way to go of developing accountability in integrated care. The international importance of the topic of accountability in integrated care is highlighted by the developments towards integrating healthcare services in several countries. According to International Foundation for Integrated Care (IFIC) Integrated care can be seen from nine pillars. One of the pillars is System wide governance and leadership and connects to the themes of the 2023 conference of Integrated Care.&#x0D; Who is it for? Researchers, Policymakers, Decision-makers and professionals working in the field of integrated care, but also citizens with this interest.&#x0D; What are we going to do? Workshop, 60 minutes, with group work and pitches:&#x0D; a.Introduction and short presentation: Presenting the state of play of accountability in integrated care. Who is involved and what are developments in a variety of countries. (10 minutes).&#x0D; b.Small groupwork: reflect on the findings and explore how the current state of accountability is in your country (15 minutes)&#x0D; c.Collective reflection: What is the current state of art of accountability in different countries (10 minutes)&#x0D; d.Small groupwork: reflect on the findings in reflection phase c. and what are ideas of accountability in integrated care according to the participants (15 minutes)&#x0D; e.Collective reflection: What are ideas and possibilities of accountability in integrated care (8 minutes)&#x0D; f.Closing (2 minutes)&#x0D; How are we going to engage with the audience? Several rounds of interaction is facilitated leading to 45 minutes audience interaction time. In small groups and in the whole group. We challenge everyone to share their own experiences and ideas. Participants write their findings on flip-overs.&#x0D; &#x0D; How are you going to summarize the take home messages? We will write the take-home messages on flip-overs during the collective reflection. We will share the findings with all participants via the (social) media.&#x0D;

Quantitative analysis on dental utilisation in culturally and linguistically diverse mothers.

Culturally and linguistically diverse (CALD) mothers are influential in children's behaviours, yet little is known about this population. Furthermore, insufficient quantitative and context-based studies are available with CALD mothers and their access to oral health care. To address this gap, the study investigates oral health behaviours, psychological factors and remoteness area with dental utilisation in CALD mothers, within the NSW context. Informed by middle-range theory and a CALD-specific rainbow model, the 2013 and 2015 NSW Adult Population Health Survey was analysed. Variables for CALD mothers included household structure, age and language spoken. Multivariable analysis was conducted with oral health behaviours, psychological and remoteness variables, with dental utilisation as the outcome. The sample was weighted (n =190,283). In total, 39.8% did not have a dental visit, and older mothers (aged 36-55 years) sought more dental services than younger mothers (aged 18-35 years). Higher odds for treatment dental care (aOR 2.21, 95% CI 1.12-4.37) than prevention-oriented care were found. Mothers experiencing moderate levels of psychological distress (aOR 0.49, 95% CI 0.31-0.77), or residing in outer regional and remote regions (aOR 0.19, 95% CI 0.04-0.85) were less likely to utilise dental care. Findings underline geographical issues in dental care utilisationand the need for integrated care for CALD mothers experiencing psychological distress, and to encourage uptake of preventive oral health care. Addressing cost barriers necessitates for universal health coverage. Multidisciplinary integration of healthcare services with improved primary sector collaboration between governments and healthcare providers, and the expansion to regional services are required for equity in CALD communities.

How acculturation contributes to a rise of diabetes in Hmong Americans.

This article explores the reasons for the high prevalence of diabetes among Hmong Americans, who are at greater risk for diabetes compared with non-Hispanic White patients and have a higher prevalence of diabetes than other Asian Americans and other races. Knowledge of this issue may allow medical practitioners to identify, screen, and treat Hmong Americans more frequently and at earlier ages. Although better integration of healthcare services, access, and education are needed, earlier screening may help start the diabetes education process sooner; reduce hospital, ED, and office visits; reduce costs; and prevent end-organ damage.