New Models Of Integrated Care Research Articles

Integrating hepatitis C treatment into multidrug-resistant TB care.

Direct-acting antivirals (DAAs) are not widely used for patients with chronic hepatitis C virus (HCV) infection and multidrug- or rifampicin-resistant TB (MDR/RR-TB). We describe the implementation aspects of a new integrated model of care in Armenia and the perceptions of the healthcare staff and patients. We used qualitative methods, including a desktop review and semi-structured individual interviews with healthcare staff and with patients receiving HCV and MDR/RR-TB treatment. The new integrated model resulted in simplified management of HCV and MDR/RR-TB at public TB facilities. Training on HCV was provided for TB clinic staff. All MDR/RR-TB patients were systematically offered HCV testing and those diagnosed with HCV, offered treatment with DAAs. Treatment monitoring was performed by TB staff in coordination with a hepatologist. The staff interviewed had a positive opinion of the new model. They suggested that additional training should be provided. Most patients were fully satisfied with the care received. Some were concerned about the increased pill burden. Integrating HCV treatment into MDR/ RR-TB care was feasible and appreciated by patients and staff. This new model facilitated HCV diagnosis and treatment among people with MDR/RR-TB. Our results encourage piloting this model in other settings.

A new model of Integrated care for rural and remote people impacted by renal disease

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

How Warrington has created a new integrated model of care that has been designed and implemented seamlessly by multiple partners across a system

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

SHORT-TERM IMPACT OF AN INTEGRATED MULTIDISCIPLINARY PATIENT-CENTERED COORDINATED CARE TREATMENT IN OSA

SESSION TITLE: Sleep Disorders SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Obstructive sleep apnea (OSA) is a common chronic condition with public health consequences which is characterized by breathing cessation and impaired oxygenation during sleep resulting in sleep fragmentation and impaired daytime activities; and is associated with cardio-metabolic diseases and mortality. Its treatment is multi-disciplinary. However, its current mode of care delivery is often fragmented with various disciplines operating in isolation. We aim to determine the impact of a novel integrated outpatient OSA care model using a care pathway which incorporates evidence-based management guidelines involving a multi-disciplinary team of healthcare professionals. We hypothesize that the integrated care model will be associated with improved outcomes as compared to current routine care. METHODS: This is a prospective randomized controlled trial comparing a new integrated model of care for OSA with routine practice in patient-reported outcomes, CPAP adherence and waiting time to receiving definitive OSA treatment. In the integrated care model, providers from various key disciplines (sleep medicine, otolaryngology and dentistry) convene to assess the patient and develop the best preferred treatment plan based on shared decision making with the patient using a common care pathway in a multidisciplinary clinic; compared to the conventional model where patients are cross-referred and seen by each discipline in isolation. RESULTS: The trial enrolled 220 patients. About three-quarters were males (73%) and were Chinese (72%). Mean age was 47.6 ± 14.4 years and mean body mass index (BMI) was 31.1 ± 7.4 kgm-2. Mean Epworth Sleepiness Scale (ESS) and Functional Outcome Sleep Questionnaire (FOSQ) score were 11.2 ± 4.9 and 15.4 ± 4.0 respectively. Median AHI was 36.6 ± 39.7 h-1 and 82% had moderate to severe OSA. Vast majority (84%) opted and received CPAP treatment. There was no difference in the proportions of patients receiving CPAP in both arms (62% vs. 57%, p=0.83). At 1 month post treatment, there was an improvement in FOSQ scores in the integrated care arm compared to the routine care arm (-1.5 ± 5.1 vs. -0.60 ± 4.7, p=0.01). However, there was no significant change in the ESS scales (-2.0 ± 4 vs. -0.5 ± 3.1, p=0.32) and difference in the median hours of CPAP use per used day between the 2 groups (4.65 ± 2.58 vs. 4.30 ± 1.60, p=0.82). The average waiting time between undergoing sleep study procedure and receiving definitive OSA treatment in the integrated care arm was significantly lower than in the routine care arm (13.1 vs 27.3 days, p=0.03). CONCLUSIONS: At short term follow-up, an integrated multidisciplinary OSA management care model in the outpatient clinic achieved better sleep functional outcomes and shorter clinic appointment waiting time than routine care among OSA patients. CLINICAL IMPLICATIONS: This may pave way for a new model of care delivery in the outpatient clinic setting for OSA. DISCLOSURES: No relevant relationships by Munirah Abd Gani, source=Web Response No relevant relationships by Shaffinaz Abd Rahman, source=Web Response No relevant relationships by Ai-Ping Chua, source=Web Response No relevant relationships by WENJIA GUO, source=Web Response no disclosure on file for Tun-Oo Han; no disclosure on file for yin maw hsann; no disclosure on file for Esther Hui–Ting Koh; No relevant relationships by Maria Victoria Jane Parot, source=Web Response No relevant relationships by Sue Rene Soon, source=Web Response No relevant relationships by Sridhar Venkateswaran, source=Web Response No relevant relationships by Adrian Yap, source=Web Response

It Pays to be Well Connected - Delivering an integrated system of care in Western New South Wales, Australia

Introduction: Western NSW is one of the most vulnerable regions in Australia with a fractured service network and poor health outcomes. A strategy to transform current services into a patient centred, coherent system of care is well into its 4th year. A range of locality-based initiatives are being implemented to better connect health and social care providers to improve health outcomes for the region. Methods: The Western NSW Integrated Care Strategy (Strategy) is being implemented using a collaborative partnership approach between the LHD, the Western Primary Health Network, and Bila Muuji Aboriginal Health Service. The vision for the Strategy: To transform existing services into an integrated Western NSW system of care that is tailored to the needs of our rural and remote communities, and improves access to care and health outcomes, with particular focus on closing the Aboriginal health gap. A key element of the Strategy was the establishment of local demonstrator sites to test new integrated models of care at a locality level. Features of the models include: Primary care led team based care Risk stratification Comprehensive assessment Shared care planning Health and social care coordination Multi-disciplinary case conferencing in primary care Results: Over 4 years the Strategy has: Enrolled 1500 people across 12 local demonstrator sites focusing on chronic disease management, the first 2000 days of life and Aboriginal Health. Strengthened the connection between care providers to provide team based care Appointed local Health and Social Care Coordinators Introduced primary care based multidisciplinary case conferencing Established a change team to enable rapid transfer of integrated models across the region Evaluation of the Strategy is indicating an improved health journey, improved health outcomes and a reduction in acute care utilisation. Discussion: We consider the learnings from our experience transferable to other environments, with suitable local tailoring.

Responding to the needs of all Queenslander - the refugee health and wellbeing journey

Introduction : In response to the growing number of new refugees settling in Queensland and the well documented challenges this population experiences in accessing the right care, at the right time, in the right place, a coordinated partnership approach was initiated. This was supported by engaging key partners, including the refugee communities themselves, new integrated models of care, a Refugee Health Network Qld and a refugee health and wellbeing policy for Queensland . The paper will address the key elements of the partnership, lessons learned, outcomes of the collaboration and implications for transferability. Policy Context and objectives : A lack of policy in refugee health was identified as a key barrier to improving access to care for this population. Language and cultural barriers, low health literacy, unfamiliarity with the Australian health system and access to health professionals with the experience in refugee health all contributed to the complexity. Over a three year period the Partnership Advisory Group (Qld) (PAG Q) comprising of Primary Health Networks, Hospital and Health Services, NGOs, General Practices, refugee background communities and Universities, worked towards developing new models of care and policy change. This culminated in the launch by the Minister for Health Hon Cameron Dick of the first ’Refugee Health and Wellbeing: A policy and action plan for Queensland 2017-2020’ and the funding of the inaugural Refugee Health Network Qld. The action plan provides a platform for achieving better health outcomes through modifying usual practice to meet the needs of this population. Targeted population : People from a refugee background, including asylum seekers, who settle in Queensland. Highlights (innovation, Impact and outcomes) : Some of the many initiatives and outcomes of the PAG Q include; - an innovative community engagement framework with the consistent input by the Refugee Health Advisory Group made up of 11 (G11) consultants from diverse refugee background; - Refugee Health Connect (RHC), a care provider contact point for refugee health issues; - the Refugee Health Network and website as the one point of reference for refugee health resources; and, - Refugee Health Clinical leads. The coordinated approach has assisted in raising awareness of the issues for people of refugee background and has been a vehicle for harnessing new health professionals, services and policy makers in this space. Comments on transferability : The model including the partnership and community engagement frameworks have high transferability for all hard to reach population. Other integrated models of care across tertiary and primary sectors will be able to use some of the key findings to inform sustainability and engagement strategies. Conclusions (comprising key findings, discussion and lessons learned) : A coordinated partnership approach with all key stakeholders, including communities, is essential for informing good practice, developing and sustaining integrated models of care, and policy support reflective of the issues and needs of a hard to reach population.

The Patient Narrative Project - Phase One

In 2012 the Irish Department of Health set the agenda[1] in Ireland for the creation of ‘a new integrated model of care that treats patients at the lowest level of complexity that is safe, timely, efficient, and as close to home as possible’. To enable the delivery of integrated models of care five Integrated Care Programmes are being established within the Irish Health Service Executive under the office of the Clinical Strategy and Programmes Division (CSPD) Although ‘integrated care’ has many definitions, it is commonly agreed that its realisation has to result in better outcomes and experience of health services for the individuals who use them, whereby services are well co-ordinated around the needs of the user. In addition, discussions on the development and delivery of services must hold the voice of the user at its core and seek ‘to impose the patient perspective as the organising principle of service delivery’.[2] The ‘Patient Narrative Project’ was initiated in late 2016 to, for the first time in the Republic of Ireland, deliver the patient / service user perspective on what should be expected from person-centred coordinated care and to guide the development of current and future services and strategy through the office of the CSPD. The Irish Platform for Patients’ Organisations, Science & Industry (IPPOSI)[3], with their proven experience and expertise in harnessing a coherent and critical voice of service users has led the first of three phases of the project. This paper describes phase one of the project (which ends in April 2017) in which service users and their organisations will co-produce: a set of generic descriptors for what person-centred co-ordinated care looks and feels like from the Irish service user perspective and a definition for ‘person-centred co-ordinated care’ that is shared, understood and used by service users and staff at all levels of the health service in Ireland IPPOSI has lead an evidence-based, narrative enquiry methodology to hear and collate experiences of service users and patients in Ireland who need care over time from multiple services, as well as their carers and families and the health staff relating to their experiences. The experiences will be translated into descriptors and a definition of person-centred co-ordinated care that will be written not just for the experts, but for patients, people, families and carers. The goal is that the descriptors and definition of what good integrated care and support looks and feels like for people will be adopted nationally. They will be used to guide policy, strategy and design, and as a guide to what teams at local levels should be aiming to achieve practically, in their efforts to integrate services around patient, family and carer needs. Phase two of the project will use the generic descriptors to develop a standard process of engagement with service users that will allow a higher volume of their narratives and experiences to be heard and used to benchmark, guide and develop health services.

Virtually Integrated Care: A New Paradigm in Patient Care Delivery.

Current trends, including an aging population; the impact of the Affordable Care Act; increased complexity and acuity of patient needs; shorter hospital stays; and higher patient expectations have resulted in a significant demand for reconfiguration of the bedside nursing model. The health care system is further complicated by a shortage of highly trained nurses, challenging financial incentive models, and inefficient traditional staffing models. These challenges have increased the urgency for designing a more efficient, cost-effective care delivery model. One large national system is redefining how it cares for patients in the acute care setting in preparation for the Next Era. Catholic Health Initiatives is developing a new integrated model of care that combines advances in technology with a restructuring of nursing roles for significantly more efficient and effective care. The model is person-centered and allows team members to practice to the full extent of their education and training. The model emphasizes care from the right skill level, for the right patient need, at the right time. This article begins to describe the planning and implementation of the Virtually Integrated Care Team (VIC) pilot project on 2 medical-surgical units within the Catholic Health Initiatives system.

Pioneering outcomes based innovation in general practice

Introduction: There is increasing interest in the role of general practice as a vehicle of integration. This relates to its potential for direct delivery of an enhanced range of services, its role in the co-ordination of care for those with multiple morbidity and in its relationships with other services and organisations who work in primary and community care. A key issue in realising these aspirations is how to motivate and enable practices to take on these enhanced responsibilities and be willing to work differently with other professionals and services.In England there has been a reliance on financial rewards to ensure that general practice responds to new ways of working and provides the required breadth of services. The nature of these rewards, and the improvements that they relate to, have been set by central government policy makers and local purchasers of primary care. Whilst this approach has led to some positive improvements, there has been inconsistency in the level and quality achieved, and the tight specification of the process to be followed has been seen to restrict opportunity for other innovations. There are also concerns that it has resulted in many general practitioners being deterred from identifying and developing their own creative responses to local needs.Change in practice: This project was introduced within a clinical commissioning group (CCGs) responsible for an urban population of 300,000. CCGs are membership organisations which commission primary and acute health care services for the patient population registered with their member practices. The ‘pioneer project’ aimed to introduce a new purchasing approach which would motivate and liberate general practices to develop and adopt new integrated models of care through providing a more ‘enabling environment’. The key elements of this approach were -- Requiring practices to work in groupings rather than as single practices- Providing funding up front rather than in arrears on completion of required activity or quality- Determining success by achievement of outcomes rather than by implementing process- Embedding a culture of joint learning and reflection between the practices and with the commissionerKey stakeholders were the staff working within the general practices, the commissioners, provider of community nursing services, acute hospitals and the adult social work division within the local authority. The university were funded to undertake an 18 month mixed methods action research project which would provide emerging data for discussion and a final summative assessment of what was achieved.Key findings: The evaluation will be completed in December 2015. Emerging findings are:- All groupings of practices have been able to provide enhanced diagnostics and treatment for key conditions such as diabetes. This has enabled diversion of these activities from acute to primary care and provided care closer to patients’ homes.- The groupings have provided a firm base from which general practice can consider an enhanced depth and breadth of services, and have also resulted in a raising of quality within members of the groupings.- The majority of groupings have developed new ways of working which respond to the needs of their local populations – these include the development of innovative model of shared care between acute and primary care regarding people with diabetes from south asian communities, the introduction of new joint protocols with accident and emergency, and community link workers to connect people with complex social needs with appropriate support from statutory and voluntary sector servicesHighlights of learning- The practice leads confirmed that the previous arrangements had stifled innovation and led to them not feeling able or motivated to suggest or lead more radical improvements. Adjusting to the new expectations and freedoms involved a significant paradigm shift for them (and the commissioner)- Learning sets which brought together the pilot leads and commissioner were seen as key opportunities to share practice and challenges, albeit it with considerable opportunities for further strengthening of this reflective approach- There was greater success in engaging with key services in the acute sector through engaging with key professionals – community health and adult social care were harder to influence due to lack of personal connection and alternative initiatives being pursued- Conceptualisation of outcomes within the commissioner has changed over time and been subject to internal tensions.Conclusion:- The pioneer project facilitated a more collaborative relationship between purchaser and general practice which encouraged and facilitated greater clinical leadership. For these groups of practices funding was an enabler rather than an incentive, providing ‘capacity and flexibility’ rather than ‘motivation and reward’.- The final data gathering will seek to establish improvements in outcomes and quality, and the extent to which changes have been sustained when the project phase is completed.

Waluwin - an integrated approach towards health and wellbeing in Western NSW, Australia

Introduction : Waluwin - Health and Wellbeing in Aboriginal Language Wiradjuri The Western NSW region is one of the most vulnerable localities in Australia with a fractured service network, a strategy to transform current services into a patient centred, coherent system of care is well into its second year. The Western NSW Local Health District (LHD) is leading the way as one of three NSW Integrated Care LHD Demonstrators as part of the NSW State Government’s Integrated Care Program. A range of district-wide and locality-based integrated care initiatives are being implemented to bring together health and social providers across the continuum of care to lift health outcomes for the resident population in a large and sparsely populated area - 271,000 people in 250,000 sq km. Key drivers for change : A Western NSW health needs assessment developed in 2013 highlighted: - Significant health inequalities experienced by Western NSW’s Aboriginal population (11% of the total population) - A pressing need to redesign models of care to address projected growth in demand associated with population ageing and increasing prevalence of long term conditions, particularly given an already high hospitalisation rate for the district’s population - Opportunities to improve patient experience and value for money through addressing the current service configuration of multiple small provider entities delivering fragmented and ‘siloed’ primary, community and specialist outpatient health services. The health needs assessment received wide public interest, and resulted in health organisations in the district recognising that only through collective action could population health outcomes be lifted. The Western NSW Integrated Care Strategy : The Strategy is one of the major collaborative actions Western NSW stakeholders are undertaking to address health needs across the district. The Strategy is founded on a district-wide partnership between the LHD, the Western Primary Health Network, and and the Bila Muuji collective of Aboriginal Medical Services. The vision of the Strategy is: To transform existing services into an integrated Western NSW system of care that is tailored to the needs of our rural and remote communities, and improves access to care and health outcomes, with particular focus on closing the Aboriginal health gap. A key element of the Strategy is establishment of a ‘first wave’ of five local demonstration sites to test new models of care at a locality level. Core features of the demonstration site models of care include: - Defining priority locality target population groups - A standardised risk stratification process - A standardised enrolment process including obtaining consent to share information across providers - GP-led multi-disciplinary care teams - Shared care planning utilising an electronic shared care platform - Multi-disciplinary case conferencing. Local leadership groups and care navigators including social care co-ordination are key features of the delivery model. A second wave of demonstrator sites are currently being recruited. Highlights : Year one results of the three-year program include: - Establishment of district-wide program and project structures including locality based leadership structures and a district-wide Clinical Leadership Committee - Establishment of the HIU providing a one-stop-shop for access to health care data, analysis, advice and support for interpretation of health statistics - Establishment and implementation of five first wave local demonstrator sites over 500 patients enrolled receiving shared care planning and multi-disciplinary care - Development and implementation of a risk stratification tool - Selection and implementation of an electronic shared care planning tool - Collecting and tracking real time patient feedback to receive insight into the patient experience. Key learnings : - The time and effort required to deliver lasting change should not be underestimated - A partnership approach and constructive collaboration has been paramount for developing and implementing the Strategy - Experience with the demonstration sites has reinforced the importance of readiness and commitment to develop and progress implementation of new integrated models of care, and the intensity of resources required to support local planning and action - A key critical factor for success is establishing local multi-disciplinary clinical leadership groups committed to innovative service redesign. Conclusions : A group of 5 first wave sites has developed a successful locally led model of care which has been refined and is being implemented in a second wave of sites. The strategy beyond local demonstrator sites is leading the transformation of a whole region's health service delivery with some underpinning enablers and district wide strategies which are making good traction.

Integrated Depression Management: A Proposed Trial of a New Model of Care in a Low Vision Rehabilitation Setting

Purpose: Depression is a common problem among people with visual impairment and contributes to functional decline. This article presents a study protocol to evaluate a new model of care for those patients with depressive symptoms in which psychological treatment is integrated into low vision rehabilitation services. Low vision staff will be trained to deliver “problem solving therapy for primary care” (PST-PC), an effective psychological treatment developed specifically for delivery by non-mental health care staff. PST-PC is delivered in 8 weekly telephone sessions of 30–45 minutes duration and 4 monthly maintenance sessions. We predict this new integrated model of care will significantly reduce depressive symptoms and improve the quality of life for people with visual impairment.Methods and Design: A randomized controlled trial of PST-PC will be implemented nationally across low vision rehabilitation services provided by Vision Australia. Clients who screen positive for depressive symptoms and meet study criteria will be randomized to receive PST-PC or usual care, consisting of a referral to their general practitioner for more detailed assessment and treatment. Outcome measures include depressive symptoms and behaviors, quality of life, coping and psychological adjustment to visual impairment. Masked assessments will take place pre- and post-intervention as well as at 6- and 12-month follow-up.Conclusion: We anticipate that this innovative service delivery model will lead to sustained improvements in clients’ quality of life in a cost effective manner and provide an innovative service delivery model suitable for other health care areas in which depression is co-morbid.

Psychosomatic medicine and inflammatory bowel disease: A new integrated model of care

Psychosomatic medicine and inflammatory bowel disease: A new integrated model of care

Child and adolescent mental health: a new pathway of care to improve access to services

AbstractThe present paper considers the development of a new integrated model of care to improve services aimed at addressing the mental health needs of children and young people after increased staffing levels and other initiatives had failed to bring about the necessary improvements in the service. A different approach, focused on a radical redesign of the pathway for referral and treatment, appears to have been successful in ensuring that children and young people receive a more timely and acceptable service. Copyright © 2003 Whurr Publishers Ltd.

Establishing systems of care in Germany: a long and winding road.

Since 1995/1996 a long-term care insurance (LTCI), which promised to develop new support structures, in particular for the group of potentially frail elderly people, has been implemented in Germany. It will be shown that this LTCI has undoubtedly improved the social situation of the persons in need of care, even if its scheme is only providing basic support with a ceiling in cash-benefits and benefits in-kind, and privileging home care by informal caregivers. But certain misdevelopments in the LTCI have shown that the present scheme requires further effort to cope with these negative effects and to elaborate new integrated models of care that bridge the still existent gap between medical and social support. This article points to long traditions of separating the social and medical dimensions in Germany which have also resulted in divided institutional arrangements. The current scheme of the LTCI, its organizational principles and its entitlements and benefits are outlined, which gives the opportunity to point out certain deficiencies, e.g., the still inappropriate provision for dementia care which is due to the dominant IADL-orientation of the medical assessment procedure and its implicit negligence of social care elements. The public debate about necessary improvements in benefits for the demented aged has already led to slight revisions of the LTCI, and will develop into a more comprehensive movement to path-bridging models of social and medical care in which the quality dimension will play a decisive role.