Integrated Healthcare Model Research Articles

42.2 ENGAGEMENT OF PEDIATRIC PRIMARY CARE PROVIDERS WITH COLLABORATIVE AND INTEGRATED MODELS OF CHILDREN'S MENTAL HEALTH CARE

The cultivation of engaged relationships with pediatric primary care providers (PCPs) is a foundational aspect of the operation of collaborative and integrated models of child and adolescent mental health care. Conversely, inadequate engagement of pediatric PCPs is associated with poor utilization of program resources, jeopardizing program sustainability and resulting in limited clinical impact.

The Children and Young People’s Health Partnership Evelina London Model of Care: process evaluation protocol

IntroductionChildren and young people (CYP) in the UK have poor health outcomes, and there is increasing emergency department and hospital outpatient use. To address these problems in Lambeth and Southwark...

Toward Comprehensive Patient-Centric Care by Integrating Digital Health Technology With Direct Clinical Contact in Australia.

BackgroundThere is an escalating crisis in health care, locally and internationally. The current health care model is unable to meet the increasing health care demands.ObjectiveThe aim of this study was to reconceptualize the provision of health care to produce better outcomes at no greater cost, by placing individuals in the position of authority to direct their own care, in a personalized, integrated health care system.MethodsIn this study, we used the Australian health care system as a model. We reviewed the current landscape of digital health in Australia and discussed how electronic medical records (EMRs) can be further developed into a personalized, integrated health care system.ResultsSome components of an EMR and digital health system are already being used in Australia, but the systems are not linked. A personalized, integrated health care model that is responsive to consumer needs requires not just a passive repository of medical information; it would require a team approach, including the government, health care funders, industries, consumers and advocacy groups, health care professionals, community groups, and universities.ConclusionsImplementation of a personalized, integrated health care system can result in reduced pressure on the current health care system, and it can result in the delivery of best-practice health care, regardless of location. Importantly, a personalized, integrated health care system could serve as an education platform, “upskilling” not only clinicians but also, more importantly, patients and carers by providing them with accurate information about their condition, treatment options, medications, and management strategies. By proposing personalized, integrated health care, we offer an intelligent model of health care that is ubiquitous, efficient, and continuously improving.

Integrated healthcare models for rheumatoid arthritis: A descriptive systematic review

Introduction Integrated people-centred care is a modern approach for addressing healthcare issues related to demographic changes, increasing prevalence of chronic diseases, and restricted resources. By providing an overview of integrated care models for patients with rheumatoid arthritis, we aimed to offer insight into the strategies and interventions that are being used for designing and implementing integrated models of care for this patient group, and their outcomes. Methods We conducted a systematic literature search of peer-reviewed literature available in English and published between 2013 and 2018, using three databases: Cochrane, PubMed and EMBASE. We analysed the publications based on the Framework on integrated people-centred health services and the Triple/Quadruple Aim framework. Results We identified 1271 records. After screening, 50 articles met the criteria for inclusion in the review. Approaches for improving patient empowerment, engagement and experience of care were most prevalent in the identified care profiles. Similarly, frequently reported outcomes were related to improvements in patients’ experience of care and their health status. Most of the studies we reviewed did not demonstrate notable improvements from the perspective of cost-effectiveness or benefits for the healthcare workforce. Conclusions Our findings suggest that for rheumatoid arthritis, integrated care is in the early stages of development. Strategies focusing on patient outcomes and patient satisfaction were found to be prioritised. Future initiatives aiming to redesign rheumatology care should adopt systems thinking perspective to better address all of the building blocks of people-centred integrated care.

Integrated Health Care and mHealth: A Model of Care for Refugees with Complex Health Conditions

ABSTRACTHigh rates of comorbid physical and mental health conditions are documented among refugee populations. A dearth of evidence exists on the use of mHealth technologies to support integrated health care models, with interprofessional mental and physical healthcare teams, within the field of refugee health, despite the potential for mHealth technologies to reduce barriers to health care access for vulnerable populations. This conceptual article illustrates how mHealth can facilitate integrated health care models with refugees with comorbid conditions. Implications are made to support the application of mHealth technologies within integrated health care models serving at-risk refugee populations.

Study protocol for a quasi-experimental claims-based study evaluating 10-year results of the population-based integrated healthcare model ‘Gesundes Kinzigtal’ (Healthy Kinzigtal): the INTEGRAL study

IntroductionPatients often experience interface problems when treated by different specialists and in different healthcare sectors. Integrated care concepts aim to reduce these problems. While most integrated healthcare models focus on...

The Generation of Integration: The Early Experience of Implementing Bundled Care in Ontario, Canada.

Policy Points Policymakers interested in advancing integrated models of care may benefit from understanding how integration itself is generated. Integration is analyzed as the generation of connectivity and consensus—the coming together of people, practices, and things.Integration was mediated by chosen program structures and generated by establishing partnerships, building trust, developing thoughtful models, engaging clinicians in strategies, and sharing data across systems.This study provides examples of on‐the‐ground integration strategies in 6 programs, suggests contexts that better lend themselves to integration initiatives, and demonstrates how programs may be examined for the very thing they seek to implement—integration itself. ContextBy bundling services and encouraging interprofessional and interorganizational collaboration, integrated health care models counter fragmented health care delivery and rising system costs. Building on a policy impetus toward integration, the Ministry of Health and Long‐Term Care in the Canadian province of Ontario chose 6 programs, each comprising multiple hospital and community partners, to implement bundled care, also referred to as integrated‐funding models. While research has been conducted on the facilitators and challenges of integration, there is less known about how integration is generated. This article explores the generation of integration through the dynamic interplay of contexts and mechanisms and of structures and subjects.MethodsFor this qualitative study, we conducted 48 interviews with program stakeholders, from organization leaders and managers to physicians and integrated care coordinators, across the hospital‐community spectrum. We then used content analysis to explore the extent to which themes were shared across programs and to identify idiosyncrasies, followed by a realist evaluation approach to understand how integration was produced in structural and everyday ways in local program contexts.FindingsIntegration was generated through the successful production of connectivity and consensus—the coming together of people, practice, and things, as perceived and experienced by stakeholders. When able, the programs harnessed existing cultures of clinician engagement, and leveraged established partnerships. However, integration could be achieved even without these histories, by building trust, developing thoughtful models, using clinicians’ existing engagement strategies, and implementing shared systems and technologies. The programs’ structures (from their scale to their chosen patient population) also contextualized and mediated integration.ConclusionsThis article has both practical and theoretical implications. It provides transferable insights into the strategies by which integration is generated. It also contributes conceptually to realist approaches to evaluation by advancing an understanding of mechanisms as contextually and temporally contingent, with the capacity to produce new contexts, which in turn generate new sets of mechanisms.

Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care.

Despite growing concerns for the mental health of the older generation most studies focus on mental health care for younger people and there is a lack of knowledge about helpful treatment approaches and models of care for older people. Therefore, the purpose of this review was to answer the question what health care approaches are most helpful for older people experiencing mental health problems. Databases from 2000 to July 2017 were searched with focus on outcome studies, experts' opinions and treatment descriptions. Critical interpretive synthesis was used to analyse and interpret the findings. Four main models of care were found: the medical-psychiatric model which mostly focuses on antipsychotic medication for the treatment of symptoms. Psychotherapeutic and social interventions take into consideration the psychosocial perspectives of mental health problems, but little research has been done on their lasting effect. Research indicates that psychotherapy needs to be adapted to the special needs of older people. Few old people have access to psychotherapy which limits its usefulness. Holistic or integrated models of health care have emerged in recent years. These models focus on both physical and psychosocial well-being and have shown promising outcomes. To reduce antipsychotic medication older people need to be given better access to psychotherapy and social interventions. This presupposes training health care professionals in such treatment methods. The holistic models need to be developed and studied further and given high priority in health care policy.

A Review on Design of Integrated Healthcare Model through Performance Excellence Methodologies

Cost based care is evolving as a resolution to address increasing Healthcare costs, and to address the problem of clinical inefficiencies. ‘Cost based care’ therefore is designed to be patient centric. While ‘Cost based care’ helps in addressing the challenge of rising costs and making the care more affordable, it comes with its own set of challenges for providers as they are paid for better patient outcomes in an evidence based way. In the regimen of ‘Cost based care’ providers are grappling with reduced reimbursements. Providers are also required to track wide variety of measures to make the care more evidence based. Operations transformation for a healthcare systems means that it makes the processes, efficient, flexible and innovative to suit patient centric treatment models. To achieve this transformation by excluding wastes out of system, make the processes much more efficient, implementation of digital systems across the value chain of the hospital have become the area of focus. Shared Services alteration is a subclass of administrational transformation. It is has a lot of potential to smoke out costs, making operational processes much more efficient by rationalizing functions, like Human Resources, Pathology, Radiology, IT and Supply chain services at Hospitals. Administrational transformation aims to flush out costs, bring transformation in revenue cycle, and focus on Patient centric treatment modules. By implementing data visualization dashboards across the services would enable transparency and trust for patients.

Care Coordination of Services for People Living with HIV: A Case Study of a Rural Clinic

The healthcare landscape is changing with the development of integrated health care models across the country. Counseling is uniquely positioned to add to the continuum of services of integrated health by providing counseling and case management services through advocacy for clients. One particular chronic illness that remains highly stigmatized is HIV, which is slowly becoming more integrated into the larger healthcare system. This pilot study documents the process and experience of a hospital-based midwestern AIDS service organization in the development of innovative and unique services to address the needs of the HIV population in a rural midwestern state.

Examination of an Integrative Health Care Model for Social Work Practice.

Social work professionals would benefit by including integrative medicine programs and practices in their framework of practice and service delivery to clients. In our rapidly changing health care environment, using a model that provides a more comprehensive and empowering approach to addressing the medical and psychological needs of our clients is warranted. Discussion of holistic social work practice and implications for social work education and training will be examined through a review of the research and clinical application of a mind-body program titled the Relaxation Response Resiliency Program (3RP). This client-centered, strengths-based program can be used in conjunction with traditional therapies to empower clients to take part in their own health care by teaching noninvasive, self-care, and user-friendly techniques. New research from the Benson-Henry Institute for Mind Body Medicine has demonstrated a reduction in service utilization and cost savings from participation in 3RP. Research on this resiliency health care model will be of interest to social work practitioners, educators, and policymakers alike.

Integrated primary care‐behavioral health program development and implementation in a rural context

Objective Despite the known benefits of integrated primary care and behavioral health services, integrated behavioral health services have not been readily used in medical clinics in interior Alaska. With minimal resources, we recently developed an integrated primary care–behavioral health program in a medical clinic in interior Alaska to meet clinic and community needs. The objective of this study was to explore initial program outcomes and determine the feasibility of program development and implementation. Methods We initially conducted a needs assessment for integrating behavioral health services into primary care. Program development was informed by specific clinic needs. Following program implementation, initial program outcomes were tracked with use of data from the electronic health record and patient and provider use and satisfaction surveys. The level of integration of primary care and behavioral health services was evaluated with the Practice Integration Profile. Results A total of 188 patients were seen by behavioral health consultants during the initial pilot phase, including 44.0% referred for mental health symptoms, 33.1% referred for physical health issues, and 22.3% referred for both mental and physical health issues. The initial program outcomes indicate modest clinical improvement (measured by the nine-item Patient Health Questionnaire) as well as patient and provider satisfaction with the model, and a moderate level of practice integration. Conclusion On the basis of the initial findings, it appears that our integrated primary care–behavioral health program has the potential to serve an important role in addressing the behavioral health needs of the local population. Our implementation procedure and initial program outcomes suggest that such models are feasible in rural and small-scale settings with minimal overhead costs. Significance statement Integrating behavioral health services into primary care medical settings offers a variety of benefits, including improved continuity of care and access to service, more effective health prevention and management, and clinical cost-effectiveness. Integrated models have not been readily used in rural US settings. With minimal resources, we developed an integrated primary care–behavioral health program in the family medicine department of a semirural medical clinic in Alaska to meet clinic and community needs. The initial program outcomes suggest that this integrated primary care–behavioral health program is helping to address the behavioral health needs of the local population. Our findings suggest that integrated healthcare models are feasible in rural or small-scale settings.

Comorbidities and Consequences in Hospitalized Heart Failure Patients with Depression.

ObjectiveTo evaluate the demographic predictors of major depressive disorder (MDD) in hospitalized congestive heart failure (CHF) patients and measure the differences in hospital stay and cost per comorbidities and the associated risk of in-hospital mortality.MethodsThis retrospective cross-sectional study used nationwide inpatient data from the healthcare cost and utilization project (HCUP). We identified patients with CHF as the primary diagnosis and MDD as the secondary diagnosis using ICD-9-CM codes and compared with the CHF patient without MDD. The differences in comorbidities were quantified using chi-square tests and the logistic regression model was used to evaluate mortality risk among comorbidities using odds ratio (OR).ResultsElder CHF patients, 36–50-year-old (OR: 1.324) and whites (OR: 1.673), have a higher likelihood of a co-diagnosis of MDD. Females with heart failure have two-fold higher odds of MDD (OR: 2.332). Majority of the medical comorbidities were seen in a higher proportion of CHF patients without MDD. Hypothyroidism (10.2%) and drug abuse (15.2%) were seen more in depressed patients comparatively. Among substance use disorder, patients with drug abuse stayed longer and had a higher hospitalization total cost ($51,828). And, hypothyroidism was associated with longer inpatient stay (5.6 days) and cost ($64,726), and four-fold higher odds of in-hospital mortality (OR: 4.405). Though alcohol abuse was seen only in 7.4% of CHF patients with MDD, it was associated with the three-fold higher likelihood of deaths during hospitalization (OR: 3.195).ConclusionA middle-aged, white female with comorbid depression has a higher risk of hospitalization for heart failure. Depressed CHF patients with comorbid hypothyroidism were hospitalized for a longer duration with higher inpatient cost and four times higher risk of mortality during hospitalization stay. Further studies are required to evaluate the underlying cause of worse hospital outcomes in depressed CHF patients with alcohol abuse and hypothyroidism. An integrated healthcare model is required for early diagnosis and treatment of depression and associated comorbidities in CHF patients to reduce mortality and improve post-CHF outcomes.

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

BackgroundInformation communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption.MethodsWe take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis.ResultsDespite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability.ConclusionsEven in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.

Integrated Behavioral Health and Social Work: a Global Perspective

Mental health and substance use disorders, in combination referred to as behavioral health, significantly impact lives across the world and represent a considerable proportion of the global disease burden. The intent of integration of physical and behavioral health is to increase access to services while promoting treatment of the whole person. Because many countries are undergoing transformation of their healthcare systems, this paper offers a comparative analysis of integrated models of behavioral healthcare between the USA, the UK, and China. Integrated care occurs on a spectrum, and therefore, this paper outlines micro-, mezzo-, and macro-level systems that illustrate both opportunities and challenges in integrated healthcare systems in the context of the three countries. Further, the authors provide evidence of the ways in which social work professionals are deployed in certain settings as part of the trained workforce that provides integrated behavioral health services. The discussion examines ways of leveraging the strengths of the social work workforce to improve holistic well-being worldwide.

Refining training opportunities for pediatric and psychiatric residents and fellows within an integrated healthcare model

Refining training opportunities for pediatric and psychiatric residents and fellows within an integrated healthcare model

Depressive symptoms and psychological distress among rural African Americans: The role of material hardship and self-rated health

BackgroundDespite experiencing conditions associated with higher risk for depression and psychological distress, the mental health of rural African Americans remains understudied. This brief report examines the association between sociodemographic characteristics, self-rated health, and material hardship, and depressive symptoms and psychological distress among rural African Americans. MethodData are from the rural African American subsample (N = 250) of the National Survey of American Life (NSAL; 2001–2003). The Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depressive symptoms. Psychological distress was measured using the Kessler 6 (K6). Negative binominal regression analyses were performed. ResultsRural African Americans reporting more material hardship and poorer self-rated physical health had higher levels of depressive symptoms and psychological distress compared to counterparts with less hardship and better self-rated health. Findings also suggest rural African American women had more depressive symptoms compared to male peers. Older rural African Americans and African Americans with fewer years of education had more symptoms of psychological distress than their respective counterparts. LimitationsThough the NSAL represents the only national probability survey on African Americans’ mental health; the timeliness of the data, collected between 2001 and 2003 is a limitation. ConclusionsMaterial hardship and worse self-rated health emerged as risk factors for depression and psychological distress among this population. This suggests the need for systems of care and integrated healthcare models across service providers within rural African American communities to promote adequate screening, intervention, and referrals related to economic, physical, and mental health needs.

Public Health System-Delivered Mental Health Preventive Care Links to Significant Reduction of Health Care Costs.

The objective was to estimate the association between health care expenditures and implementation of preventive mental health programs by local health departments (LHDs). Multilevel nationally representative data sets were linked to test the hypothesis that LHDs' provision of preventive mental health programs was associated with cost savings. A generalized linear model with log link and gamma distribution and state-fixed effects was used to estimate the association between LHDs' mental illness prevention services and total health care expenditures per person per year for adults aged 18 years and older. The main outcome measure was the annual total health care expenditure per person. The findings indicated that LHD provision of population-based prevention of mental illness was associated with an $824 reduction (95% confidence interval: -$1,562.94 to -$85.42, P < 0.05) in annual health care costs per person, after controlling for individual, LHD, community, and state characteristics. LHDs can play a critical role in establishing an integrated health care model. Their impact, however, has often been underestimated or neglected. Results showed that a small investment in LHDs may yield substantial cost savings at the societal level. The findings of this research are critical to inform policy decisions for the expansion of the Public Health 3.0 infrastructure.

Addressing Mental Health Needs for Deaf Patients Through an Integrated Health Care Model.

Deaf individuals struggle with accessing mental health services because of language and cultural discordance. Our project's purpose was to design and pilot an accessible, integrated mental health program for the Deaf population, scalable for other health centers interested in serving these individuals. Our team addressed several identified barriers to care. The addition of a language-concordant mental health clinician and telemental health appointments helped us better manage Deaf patients' mental health needs. Individual and clinic level data were collected and analyzed. Results demonstrated a significant improvement in the patients' depression and anxiety scores from their baseline to their last documented visit. Patient satisfaction overall was high. Telemental health appears to be a feasible tool to address some of the mental health gaps in the Deaf community. Further studies are needed to demonstrate how this program can be effective within a larger geographical area.

Evolution of ‘radical convenience’ delivered in an integrated healthcare model

Healthcare providers face unprecedented pressure in delivering primary care services at a reduced cost. At the same time, we face increased expectations from our patients related to access, convenience, quality and service. Henry Ford Health System, a large integrated health system in Detroit, Michigan, looked to attract additional patients to its primary care services. In 2014, Henry Ford made an operational commitment to provide patients with convenient and affordable access to primary care in ways that went beyond those traditionally offered by healthcare providers. An internal initiative called ‘radical convenience’ was adopted to attract patients to its primary care services and reduce unnecessary and costly utilisation of emergency departments and Urgent Care. Patients were introduced to radical convenience through a branding campaign called ‘Call, Click or Come In’. Radical convenience was extended to include the development of an innovative, retail healthcare solution called QuickCare. A QuickCare Clinic was launched in August 2015 to meet the needs and expectations of a growing workforce in downtown Detroit comprising technology-driven Millennials and Gen X-ers.