Care Delivery Models Research Articles

Preferences for innovations in healthcare delivery models in the Swiss elderly population: a latent class, choice modelling study.

With the increasing number of people affected by multiple chronic conditions, it is essential for public-health professionals to promote strategies addressing patient needs for coordinated care. We aim to explore preference heterogeneity for better-coordinated care delivery models in Swiss older adults, and identify profiles of individuals more open to healthcare reforms. A DCE (discrete choice experiment) survey was developed online and on paper for the Swiss adults aged 50+, following best practice. To elicit preferences, we estimated a latent class model allowing grouping individuals with similar preferences into distinct classes, and examined what background characteristics contributed to specific class membership. The optimal model identified three classes with different openness to reforms. Class 1 (49%) members were concerned with premium increases and were in favour of integrated care structures with care managed by interprofessional teams. Individuals in class 2 (19%) were younger, open to reforms, and expressed the needs for radical changes within the Swiss healthcare system. Class 3 respondents (32%) were strongly reluctant to changes. Our study goes beyond average preferences and identifies three distinct population profiles, a majority open to reforms on specific aspects of care delivery, a smallest group in favour radical changes, and a third strongly against changes. Therefore, tailored approaches around healthcare reforms are needed, e.g. explaining the role of interprofessional teams in coordinating care, electronic health records and insurance premium variation.

Cardiac Rehabilitation Enabled With Health Technology: Innovative Models of Care Delivery and Policy to Enhance Health Equity.

Cardiac Rehabilitation Enabled With Health Technology: Innovative Models of Care Delivery and Policy to Enhance Health Equity.

Digital Care Program for Urinary Incontinence in Females: A Large-Scale, Prospective, Cohort Study.

Female urinary incontinence (UI) is highly prevalent in the US (>60%). Pelvic floor muscle training (PFMT) represents first-line care for UI; however, access and adherence challenges urge new care delivery models. This prospective cohort study investigates the feasibility and safety of a remote digital care program (DCP) combining education and PFMT with real-time biofeedback with an average duration of 10 weeks. The primary outcome was the change in the Urinary Impact Questionnaire-short form (UIQ-7) from baseline to program-end, calculated through latent growth curve analysis (LGCA). Secondary outcomes included the impact of pelvic conditions (PFIQ-7), depression (PHQ-9), anxiety (GAD-7), productivity impairment (WPAI), intention to seek additional healthcare, engagement, and satisfaction. Of the 326 participants who started the program, 264 (81.0%) completed the intervention. Significant improvement on UIQ-7 (8.8, 95%CI 4.7; 12.9, p < 0.001) was observed, corresponding to a response rate of 57.3%, together with improvements in all other outcomes and high satisfaction (8.9/10, SD 1.8). This study shows the feasibility and safety of a completely remote DCP with biofeedback managed asynchronously by a physical therapist to reduce UI-related symptoms in a real-world setting. Together, these findings may advocate for the exploration of this care delivery option to escalate access to proper and timely UI care.

Leveraging Digital Workflows to Transition the Orthotics and Prosthetics Profession Toward a Client-Centric and Values-Based Care Model.

The orthotics and prosthetics (O&P) profession has a history of responding to market demands in a reactive rather than proactive manner. This has created significant impacts including shrinkage in scope of practice and constraint in remuneration for professional services due to a fee-for-device third party payer system. Rapid changes in technology and healthcare combined with an outdated device-centric reimbursement system are creating unprecedented challenges that threaten sustainability of the O&P profession. Hence, a reassessment of the value of O&P care, and the O&P workflow process is necessary to inform an update to the value proposition and practice model for sustainability. This article reviews key factors contributing to the current state of O&P, and potential solutions involving an update in practitioner competencies, and the care delivery model (from device-centric to client-centric and values-based). Updates could be achieved by leveraging the use of digital workflows that increase efficiencies and enhance the value of clinical outcomes. Eventually, these updates could enable the O&P profession to elevate the value proposition that aligns with its most important stakeholders: client-patients and third-party reimbursement agencies in a rapidly changing technology and healthcare landscape.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ОРГАНИЗАЦИИ И ОПЛАТЫ МОДЕЛИ ПЕРВИЧНОЙ МЕДИКО-САНИТАРНОЙ ПОМОЩИ С МУЛЬТИДИСЦИПЛИНАРНЫМ ПОДХОДОМ В РЕСПУБЛИКЕ КАЗАХСТАН И РОССИЙСКОЙ ФЕДЕРАЦИИ

Significance. The need for practical implementation of new models of organization of the primary health care system is due to demographic, social, epidemiological, technological and economic factors. Promising practices of medical care delivery have been formed in the world, both on the basis of interdepartmental interaction of medical and social workers, and in the form of a teamwork of specialists, including general practitioners, as well as specialists providing social and psychological assistance. The experience of Kazakhstan in organizing multidisciplinary teams has shown high efficiency, including decreased hospitalization rates, increased involvement and patient satisfaction. The purpose of the study is to conduct a comparative analysis of current models of organization of primary care delivery based on a multidisciplinary approach in the Republic of Kazakhstan and the Russian Federation. Material and methods. The authors analyzed results of domestic and foreign scientific research confirming effectiveness of the organization model of primary health care delivery based on a multidisciplinary approach in the Republic of Kazakhstan, as well as normative legal documents of the Republic of Kazakhstan and the Russian Federation regulating primary care organization and reimbursement. Results. The comparative analysis of the normative-legal base in health care system of the Republic of Kazakhstan and the Russian Federation shows common for both countries approaches to the primary care organization and reimbursement, while in the Russian Federation the provision of social and psychological assistance within the framework of the multidisciplinary approach is regulated only for individual categories of patients (children, elderly citizens, pregnant women). Conclusion. The introduction of multidisciplinary teams increases medical and social efficiency of primary care delivery and quality of life of the population attached to medical organizations on the district-based principle. In order to substantiate feasibility of a large-scale implementation of the multidisciplinary approach to primary care organization and reimbursement in the Russian Federation, it is necessary to test it in individual constituent entities of the Russian Federation in medical organizations with adult and pediatric polyclinics, as well as women's consultation.

Attitude of district doctors, nurses and patients to the organizational model of primary health care delivery with redistribution of functions between medical and non-medical personnel

Attitude of district doctors, nurses and patients to the organizational model of primary health care delivery with redistribution of functions between medical and non-medical personnel

Uptake and associated factors of six multi-month scripting/appointment spacing differentiated service delivery model of care among stable clients on antiretroviral therapy in Southern Ethiopia.

Differentiated service delivery models have been developed to accommodate the rising number of stable antiretroviral therapy clients and to maintain improvements in health outcomes and care retention. Ethiopia adopted the appointment spacing model and has had notable successes in implementing it. However, with the implementation of the six multi-month scripting/appointment spacing model in Ethiopia, little is known about the uptake and its associated factors. Therefore, this study aimed to assess the uptake and associated factors of the six multi-month scripting/appointment spacing differentiated service delivery model of care among stable clients on antiretroviral therapy in Southern Ethiopia. A hospital-based cross-sectional study was conducted among 419 stable clients on antiretroviral therapy in southern Ethiopia from June 22 to September 29, 2023. A systematic sampling technique was used to select the study participants. Using a structured questionnaire, socio-demographic, health service delivery, behavioral, and clinical-related data were collected. The collected data were entered into Epi Data version 3.1 and analyzed using Stata version 14. Variables with a P-value <0.05 in the multivariable logistic analysis were considered statistically significant. Multicollinearity and model fitness were checked using the variance inflation factor and the Hosmer and Lemeshow goodness of fit tests, respectively. The uptake of the six multi-month scripting/appointment spacing differentiated service delivery model of care was 63.25% (95% confidence interval (CI): 58.61%, 67.88%). Missed appointment (Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.13, 3.25)), distance to antiretroviral therapy facility (AOR: 2.90 (95% CI: 1.67, 5.04)), duration on antiretroviral therapy (AOR: 2.21 (95% CI: 1.34, 3.64)), and intermediate social support (AOR: 2.02 (95% CI: 1.29, 3.17)) and strong social support (AOR: 2.71 (95% CI: 1.23, 5.97)) were factors significantly associated with the uptake. The uptake of six multi-month scripting/appointment spacing differentiated service delivery models of care was six out of ten clients on antiretroviral therapy. To further improve the uptake, a precise intervention on the identified associated factor is required.

EConsent administered by Community Health Workers in a study using the Trials within Cohorts (TwiCs) design-Experiences from the Community-Based chronic Care Lesotho (ComBaCaL) project.

Improving access to essential health services requires the development of innovative health service delivery models and their scientific assessment in often large-scale pragmatic trials. In many low- and middle-income countries, lay Community Health Workers (CHWs) play an important role in delivering essential health services. As trusted members of their communities with basic medical training, they may also contribute to health data collection. Digital clinical decision support applications may facilitate the involvement of CHWs in service delivery and data collection. Electronic consent (eConsent) can streamline the consent process that is required if the collected data is used for the scientific purposes. Here, we describe the experiences of using eConsent in the Community-Based chronic Care Lesotho (ComBaCaL) cohort study and multiple nested pragmatic cluster-randomized trials assessing CHW-led care delivery models for type 2 diabetes and arterial hypertension using the Trials within Cohorts (TwiCs) design. More than a hundred CHWs, acting both as service providers and data collectors in remote villages of Lesotho utilize an eConsent application that is linked to a tailored clinical decision support and data collection application. The eConsent application presents simplified consent information and generates personalized consent forms that are signed electronically on a tablet and then uploaded to the database of the clinical decision support application. This significantly streamlines the consent process and allows for quality consent documentation through timely central monitoring, facilitating the CHW-led management of a large-scale population-based cohort in a remote low-resource area with continuous enrollment-currently at more than 16,000 participants.

The Personalized Pain Program: A New Transitional Perioperative Pain Care Delivery Model to Improve Surgical Recovery and Address the Opioid Crisis.

The Personalized Pain Program: A New Transitional Perioperative Pain Care Delivery Model to Improve Surgical Recovery and Address the Opioid Crisis.

Registered Nurses and Practical Nurses Working Together: An Institutional Ethnography

In Canada, different categories of nursing professionals, including registered nurses and practical nurses, often “collaborate” to provide care to patients. How their collaboration is currently conceptualized in the literature varies; and these conceptualizations are not always contextualized by the complex sociopolitical environment in which nursing professionals work. The purpose of this study was to explicate how different categories of nursing professionals (registered nurses and practical nurses) worked together to provide patient care after a provincial health authority implemented a new nursing care delivery model to “optimize” patient care. The authors used Smith’s institutional ethnography to guide the study, and data collection methods included observing, conducting interviews, and identifying the texts activated through the nursing professionals’ work. Data analysis focused on the social organization of the nursing professionals collaboration, while keeping the complex contexts within they completed their daily work in view. The article concludes with recommendations for future research.

Telemedicine Practice and Perceived Skills Among Primary Healthcare Physicians in the Riyadh Second Health Cluster, Saudi Arabia

Background and Aims: Telemedicine is increasingly being adopted by primary care professionals in Saudi Arabia, necessitating the development of new skills and approaches in this field. The aim of this study is to evaluate the utilization and perceived skills of primary care physicians in telemedicine within the Riyadh Second Health Cluster in Saudi Arabia. Methods: A cross-sectional study was conducted among physicians using a self-administered electronic questionnaire from April to October 2022. The questionnaire, developed by the research team, encompassed socio-demographic information, prior experience and future intentions regarding telemedicine, and perceived proficiency using a 5-point Likert scale. Descriptive statistics, frequencies, percentages, and statistical tests (Chi-square and Fisher’s exact tests) were employed for data analysis, with a significance level of p&lt;0.05. Results: A total of 130 valid responses were received, with an average age of 40.6. Most participants reported prior experience with telemedicine (74.6%), with Sehhaty (36.2%) and Anat (23.8%) being the most frequently utilized applications, while telephone and email (4.6%) were used the least. The intention to adopt telemedicine in the future was high, at 86.2%. The perceived confidence in utilizing telemedicine skills was generally high among the surveyed physicians. Conclusions: The study revealed that primary care physicians possessed a high level of telemedicine practice and confidence in their teleconsultation abilities. This presents an opportunity to advance care delivery models based on telemedicine technology. The widespread use of Sehhaty and Anat indicates increasing acceptance of telemedicine among the population, underscoring the need for expert support to meet the expected demand.

Development of a Universal Advanced Practice Provider Fellowship: A Roadmap to Increase Program Accessibility and Financial Sustainability.

Advanced practice providers (APPs) are a growing and essential component of today's health care delivery models. APP fellowship programs have been developed by health care systems to address APP recruitment, retention, and preparedness. However, APP fellowship programs are not widely accessible to most new graduate APPs or experienced APPs who wish to change their specialty. The development of these programs can be costly for health care systems to initiate and maintain. This article discusses the development of a "universal" APP fellowship program that allows for increased program accessibility and financial sustainability for health care systems. [J Contin Educ Nurs. 2024;55(1):4-6.].

Diabetes and current Indian scenario: A narrative review

Abstract Health needs assessment plays a critical role in identifying priorities and allocating resources to enhance health outcomes and reduce disparities. This write-up focuses on the health priority of diabetic care in India and highlights the challenges faced in its management. The prevalence of diabetes in India is alarmingly high and is projected to increase in the future, making it a significant concern. Key challenges include lack of awareness among the population, poor diagnosis, limited access to quality care, medication adherence issues, and physicians’ limited time and knowledge. Insufficient awareness hampers prevention efforts and understanding of associated complications. Diagnosis and access to quality care remain major challenges, particularly in rural areas, due to various factors such as treatment costs and underdeveloped healthcare infrastructure. Medication adherence is a significant issue influenced by high costs, complex treatment regimens, and limited transportation options. Healthcare professionals face knowledge gaps and time constraints, affecting the optimal management of diabetes. The scarcity of trained professionals exacerbates the situation. The write-up also discusses current policies and programs in India for diabetes care, including the CARRS diabetes care delivery model, the Diabetes Tele Management System, and doctor training programs. While these initiatives aim to improve care, their effectiveness is not extensively evaluated. The conclusion emphasizes the need for increased awareness, improved diagnosis and access to care, medication affordability, enhanced healthcare professional training, and effective policy implementation to address the challenges in diabetic care in India.

A Systematic Review of Telehealth Applications in Endocrinology.

The prevalence of telehealth has witnessed a significant increase in various medical domains, especially in endocrinology. Telehealth brings about considerable advantages for both patients and health care professionals. However, despite these positive aspects, the growing prominence of telehealth is accompanied by certain challenges. This systematic review aims to assess the role of telehealth in endocrinology, including its applications, effectiveness, challenges, and implications for patient care. This study involved a thorough search using comprehensive techniques across databases such as PubMed/Medline, Embase, and Scopus. The studies were selected for a tailored adaptation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to enhance the clarity of our systematic review's reporting. This systematic review explores global telemedicine applications in endocrinology. Addressing various endocrine conditions, interventions utilize technology tools such as smartphones and applications, offering multifaceted utility from education and data gathering to screening and treatment. Notably, these interventions demonstrate adaptability during the COVID-19 pandemic. Positive outcomes include enhanced patient education, disease self-management, reduced complications, and improved glycemic control. However, drawbacks include the need for technical proficiency, perceived lower care quality, and potential privacy risks. These nuanced findings contribute to the discourse on telemedicine efficacy and limitations. In conclusion, telehealth holds significant potential in transforming endocrine care. While there are challenges to its implementation, the benefits it offers underscore its value as a health care delivery model.

Medicaid ACOs on MH care outcomes for Massachusetts children to be examined

A University of Massachusetts Amherst public health researcher has been awarded a five‐year, $2.2 million grant from the National Institutes of Health (NIH) to examine the impact of Medicaid accountable care organizations (ACOs) on the quality and outcomes of behavioral/mental health care for children in Massachusetts, a news release stated. ACOs are the value‐based health care delivery model designed to reduce Medicare and Medicaid costs while improving coordination and quality of care. “Fundamental changes in health care are needed to address socioeconomic and racial/ethnic disparities in behavioral health care quality and outcomes for children in vulnerable populations,” the grant summary states. In the past decade, the prevalence of mental health disorders among children has climbed in Massachusetts, said lead investigator Sarah Goff, M.D., Ph.D., a practicing pediatrician and internist and associate professor/chair of health promotion and policy in the UMass Amherst School of Public Health and Health Sciences. The researchers will use an innovative mixed methods approach to investigate how the launching of 17 new Medicaid ACOs in Massachusetts in 2018 may have impacted mental health care for children. Findings from the study are expected to inform providers, payers and policymakers responsible for the care of vulnerable populations of children with mental health disorders.

Phone Versus In-Person Navigation of Social Needs and Caregivers’ Desire for Resources in the Pediatric Emergency Department

ObjectiveTo determine the association between in-person versus telephone-based contact by a resource navigator and caregivers’ expressed desire for community-based resources to meet social needs in a pediatric emergency department (PED). MethodsThis retrospective observational study used data from the PED in a large, metropolitan, academic children’s hospital. Families were approached by resource navigators and offered community-based resources either in-person or by phone during waiting periods in the PED exam room. We used descriptive statistics and chi-square analysis to summarize demographics and mode of contact, and simple and multivariable logistic regression to estimate the association between desire for resources and mode of contact. ResultsContact was attempted among 4902 caregivers, with 2918 (59.5%) caregivers approached in-person, 1913 (39.0%) approached by phone, and 71 (1.5%) with no mode of contact recorded. Resource navigators successfully reached 2738 (93.8%) caregivers approached in-person and 1432 (74.9%) caregivers approached by phone. Of caregivers successfully reached, 782 (18.8%) desired resources; 526 (19.2%) in-person, and 256 (17.9%) by phone. Caregivers contacted by phone were no more or less likely to desire resources than caregivers contacted in-person in unadjusted (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.78–1.08) and adjusted analyses (OR = 0.92, 95% CI = 0.77–1.09). ConclusionsWithin a large, urban PED, caregivers’ expressed desire for community-based resources was no different whether a caregiver was engaged in-person or by phone. This suggests caregivers may be equally receptive to discussing social needs and community-based resources remotely versus in-person. More work is needed to examine if rates of resource connection differ by mode of contact.

It Takes a Village: Coordinating and Streamlining Access to Palliative Care Resources through a Centralized Referral and Contact

Introduction/Background: The Couchiching Ontario Health Team (COHT) is a first-round health team in rural Ontario, Canada, designed as part the Provincial Government’s new model of health care delivery that puts patients, families and caregivers at the center of the health care system. The COHT members include Family Health Teams, primary care physicians, home care support services, an acute care hospital, Indigenous healing providers, community housing support services, a fulsome Patient and Family Advisory Council and many others. As part of the year-one priority population strategy, improving resource allocation and multi-provider care delivery for Palliative Patients was identified as of utmost importance. &#x0D; The COHT Palliative Care Network identified multiple doors of resource access, multiple referrals and a variety of disparate services available, but not formally connected, for one of the most vulnerable populations. We heard from patients, families and caregivers that they were confused about who to contact first, specifically those without a Primary Care Provider, and would often turn to acute care services as a result.&#x0D; Engagement – Shared Values and Vision: The Palliative Care Network Working Group brought together a fulsome compliment of multi-sectoral, interdisciplinary team members, on a monthly basis, to work towards a common goal; ensuring one-door access to all palliative care services within the Couchiching area.&#x0D; After a gap analysis identified not only gaps in the system, but also instances where work was being duplicated (from a lack of shared care plans and standardized communication), the group started to focus on identifying the needs for the palliative population, and their caregivers to access a fulsome resource complement, geared to every stage of their care journey, by ensuring no door would be the wrong door.&#x0D; This led to the creation of One-number and One-referral accessed by Primary Care, Nurse Practitioners, Nurses and even community members themselves, for the purpose of accessing and navigating necessary services. By completing one referral form and answering a few simple questions a patient or their caregiver can be directed to Nursing Services for symptom relief or end of life goals, Hospice to inquire about a bed, Social Work for grief and bereavement services, volunteer or faith groups and even connected with Primary Care.&#x0D; System Wide Governance and Leadership: By assigning governance through shared accountability agreements, to a multi-organizational OHT, each group member feels responsible for the outcomes of the population as a whole, providing a team-based approach to care delivery. While still working within the constraints of traditional funding principles, organizations are dividing up work, and creatively finding ways to ensure care is provided to patients in their preferred setting, which is often their own home. With human health resource scarcity, and burnout at the forefront of healthcare, the centralized referral’s ability to triage patients with the greatest needs, and share that responsibility with other Working Group members has been incredibly impactful and has allowed for the navigation, and coordination of integrated services to be seamlessly delivered by a varied group of providers to offer wraparound care for the most vulnerable population.

Parent attitudes and perceptions of integrated behavioral health care delivery for pediatric patients

Introduction: Patient access to high-quality behavioral health services has been a well-documented problem that has only been further complicated by the COVID-19 pandemic, especially within the pediatric population. Although integrated models of care have demonstrated efficacy for improving access, there is little research examining parents’ preferences for key elements of integrated practice, which now include increased utilization of virtual care. Parent/caregiver perspectives are essential to understand and enhance behavioral health service delivery within an integrated model of care because they are largely responsible for initiating, facilitating, and intimately participating in their children’s behavioral health care.&#x0D; Methods and Aims: The Parent Acceptance of Pediatric Integrated Care Survey Revised (PAPICS-R) was developed by a multidisciplinary panel of integrated care experts to evaluate caregiver perceptions of behavior health care delivery models for pediatric patients. A major component of the revised survey was a focus on virtual care, which has become ubiquitous since the beginning of the Covid-19 pandemic. Eight hundred thirty-four parents from diverse backgrounds across the United States who had children under 18-years old completed the revised survey online. Survey responses were analyzed using various statistical modeling techniques. Detailed demographic data was collected and associations of demographic variables with item responses were assessed using ANOVA and Chi-square tests.&#x0D; Results: Results indicated parent support for core components of integrated care such as co-location of medical and behavioral health care, interactive communication between providers, and shared access to health records. Parents also tended to prefer to be involved in their child’s therapy and indicated acceptability of virtual behavioral health care. Significant differences in parent responses were evident across several demographic variables such as race/ethnicity, parent age, child age, number of children and parent education. Notably, patient privacy and stigma were primary concerns for certain groups. These key findings will be shared to explore how specific demographic differences affect parent integrated care perspectives and how best to address these differences in practice.&#x0D; Conclusions: Results from the PAPICS-R provide valuable insight into parent perceptions of integrated behavioral health care. Notably, parent attitudes toward the integrated model of care (including virtual healthcare delivery methods) are largely positive. The findings have directly impacted multiple key aspects of the IBH program including future format of care delivery, trainee education, program expansion, and quality improvement. These adaptations will be discussed along with broader implications.&#x0D; Future Directions: Additional data are being gathered to examine the impact of various parent demographic variables on perspectives of an integrated primary care model. We are also currently working to disseminate results from the PAPICS-R survey to health care providers and organizations as the data are expected to provide valuable insight for those looking to establish integrated pediatric primary care clinics or improve their current model of care. Applicability of implementation within a diverse range of communities and regions will be discussed.&#x0D;

The VALUECARE Model for value-based, integrated health and social care services delivery supported by ICT for older adults: participatory research in 6 European countries

Introduction: In 2006, Michael Porter and Elizabeth Teisberg introduced the concept of value-based health care delivery by presenting a new framework for health system design. They proposed a fundamental unifying goal for health care: maximizing value for patients. Value is defined as the health outcomes achieved in response to the needs of a patient relative to the costs of delivering these outcomes. Consequently, understanding patient goals and values is integral to delivering high value. Participatory approaches are a key element in defining the care delivery model according to the patients’ needs and contribute to the sustainability of the care delivery. This study presents the VALUECARE model co-designed with older adults, care team members, health and social service managers and ICT experts to adapt the ValueCare concept supported by technology to the community context and end-users needs.&#x0D; Target group: Older people 65 years and older with comorbidity from 6 European countries (Croatia, Ireland, Portugal, Italy, Spain &amp; The Netherlands) facing different health challenges (cardiovascular disease, cognitive decline, frailty, and stroke).&#x0D; Participants engaged in the co-design of the value based integrated care: A total of 369 participants were involved in participatory activities with the purpose of co-designing the VALUECARE care model and supportive digital solution (n= 127 older adults, n=86 caregivers, n=109 health and social care practitioners, n=7 ICT experts, n=34 service managers, n=3 policy makers, n=3 municipality providers).&#x0D; Co-design activities implemented: Qualitative data was collected using focus groups and interviews, combining face-to-face and online means with the participants trying to adapt the methodology foreseen in the project to the pandemic situation. The eHealth Enhanced Chronic Care Model was used as a heuristic tool to integrate the discourses of the different stakeholders including older adults and those involved in the delivery of health and social care for them and featuring the guiding principles and the core elements for value-based, integrated health and social care for this group supported by ICT solutions. &#x0D; Results: VALUECARE model highlights best practice value-based, integrated care delivery through the application of a set of 6 guiding principles for the model (i.e. quality and safety, technology as supportive tool) across 7 different key core elements (i.e. health and care decision support, comprehensive support and monitoring). Applying these principles and elements, better health outcomes and care experience for older adults are expected and an improvement in the care team wellbeing. &#x0D; Next steps: Based on the co-design sessions, the co-designed VALUECARE model is being implemented and tested in 6 pilot sites. Continuous and periodic feedback is being collected from participants (older people and care team members) to refine the model and ensure quality care delivery, at the end of the project, a validated model of value-based and integrated care supported by technology.&#x0D;

Using Integrative Thinking Techniques to Design Integrated care Programming in Ontario, Canada

Integrated Care connects care providers across sectors and often from different agencies or organizations to deliver more effective, efficient and client centered care. Creating new or redesigned programs to achieve these goals typically requires new care models delivered by a range of providers who have varying experiences and mental models about what is required for effective care. Effective care designs must also consider factors such as variations in populations, available services, and resources. Thus, creating care models for integrated care can be challenging, creating conflicts that can undermine efforts to arrive at effective delivery models. Ontario Health Teams (OHTs), a new model for integrating care, launched in staged cohorts across the province in 2019, are developing new population health-focused care delivery models for specified target populations, and, eventually, for the 15 million people of Ontario, Canada. OHT leaders and staff come from a variety of agencies with varying care models, and, in some cases, limited prior collaborations with a mandate to integrate service delivery. Leaders in each OHT can design services to fit local needs, and their performance will be assessed on specified metrics. To assist in the design of new care models that meet patient needs and support providers from multiple and different agencies, a team from the ADVANCE program at the Dalla Lana School of Public Health and the Rotman School of Management at the University of Toronto have used Integrative Thinking approaches to help leaders to select and combine elements of opposing care designs to create more effective strategies for integrated care. Integrative Thinking is an innovative method developed by Roger Martin and Jennifer Riel that helps decision-makers to reframe decisions by shifting efforts away from seeking compromises among competing approaches, and, instead helps decision-makers to identify the core elements of each potential model and then reassemble these components into a new, even better design. Integrative Thinking thus helps decision makers combine seemingly competitive solutions into a stronger option through a carefully structured, facilitated process. This presentation will describe the methods used for Integrative Thinking within the context of integrated care, and home care programming specifically, to better serve local populations in different care environments.&#x0D; &#x0D;