Rainbow Model Of Integrated Care Research Articles

Kalgal Burnbona: An Integrated Model of Care Between the Health and Education Sector.

Kalgal Burnbona is a framework developed for applying school-based integrated care (SBIC) across Sydney Local Health District (SLHD). Kalgal Burnbona is an innovative and integrative framework developed to provide holistic, integrated, multidisciplinary child and family centred care to school-aged children from priority populations within SLHD, such as those belonging to the Aboriginal community. The expected outcomes include improved health, behavioural, education and social outcomes. This article contextualises the development of the Kalgal Burnbona framework from its beginnings as a pilot site called Ngaramadhi Space (NS) within the Healthy Homes and Neighbourhoods (HHAN) initiative, through to its evolution to an integrated partnership between the New South Wales (NSW) health and education sector. An example of how the framework can be implemented in other settings within SLHD is described. A tiered approach to integrated care across SLHD is postulated based on evidence from a mixed methods evaluation of NS and in line with the Rainbow Model of Integrated Care (RMIC). Kalgal Burnbona is an example of a community-driven response through collaborative partnerships to improve health, education and social outcomes. The framework described provides structure for multisector teams to work within, recognising that each community and school has its own history and needs. The Kalgal Burnbona model can be scaled up to serve a wider network of students across SLHD. The initial successes of the model, which include improving access and engagement for children with unmet physical health, mental health and social needs while being accepted by communities provide evidence for policy changes and advocacy that centre on collaborative cross-sector partnerships.

Assembling a population health management maturity index using a Delphi method

BackgroundAlthough local initiatives commonly express a wish to improve population health and wellbeing using a population health management (PHM) approach, implementation is challenging and existing tools have either a narrow focus or lack transparency. This has created demand for practice-oriented guidance concerning the introduction and requirements of PHM.MethodsExisting knowledge from scientific literature was combined with expert opinion obtained using an adjusted RAND UCLA appropriateness method, which consisted of six Dutch panels in three Delphi rounds, followed by two rounds of validation by an international panel.ResultsThe Dutch panels identified 36 items relevant to PHM, in addition to the 97 items across six elements of PHM derived from scientific literature. Of these 133 items, 101 were considered important and 32 ambiguous. The international panel awarded similar scores for 128 of 133 items, with only 5 items remaining unvalidated. Combining literature and expert opinion gave extra weight and validity to the items.DiscussionIn developing a maturity index to help assess the use and progress of PHM in health regions, input from experts counterbalanced a previous skewedness of item distribution across the PHM elements and the Rainbow Model of Integrated Care (RMIC). Participant expertise also improved our understanding of successful PHM implementation, as well as how the six PHM elements are best constituted in a first iteration of a maturity index. Limitations included the number of participants in some panels and ambiguity of language. Further development should focus on item clarity, adoption in practice and item interconnectedness.ConclusionBy employing scientific literature enriched with expert opinion, this study provides new insight for both science and practice concerning the composition of PHM elements that influence PHM implementation. This will help guide practices in their quest to implement PHM.

Elements of organisation of integrated maternity care and their associations with outcomes: a scoping review protocol

IntroductionIntegrated care is seen as an enabling strategy in organising healthcare to improve quality, finances, personnel and sustainability. Developments in the organisation of maternity care follow this trend. The way...

Construct Validation of the Rainbow Model of Integrated Care Measurement Tool in Dutch Primary Care for Older Adults.

Care integration in primary elderly care is suboptimal. Validated instruments are needed to enable the implementation of integrated primary care. We aimed to assess construct validity of the Rainbow Model of Integrated Care measurement tool (RMIC-MT) for healthcare professionals working in an integrated primary elderly care setting in the Netherlands. In a cross-sectional study, the RMIC-MT, a 36-item questionnaire covering all domains of the Rainbow Model of Integrated Care (RMIC), was sent out to local networks of primary elderly care professionals. Confirmatory factor analysis with maximum likelihood estimation was used for the validation of the factor structure of the RMIC-MT. Model fit was assessed by the chi-square test and fit indices. The RMIC-MT was completed by 323 professionals, primarily general practitioners, community nurses, practice nurses, and case managers. Confirmatory factor analysis and corresponding fit indices showed moderate to good fit, thereby confirming a nine factor model with a total of 36 items. The RMIC-MT is promising for the primary elderly care setting in the Netherlands. It can be used for evaluating integrated care initiatives in a primary care setting, thereby contributing to implementation of integrated primary elderly care.

Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues

PurposePeople experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.Design/methodology/approachThe paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.FindingsSupporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.Research limitations/implicationsThe data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.Practical implicationsIntegration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.Social implicationsAddressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.Originality/valueThis paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.

A Validation Study of the Rainbow Model of Integrated Care-Measurement Tool for Patients in China.

Introduction:The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. The aim of this paper is to modify the original patient version of the RMIC-MT for the Chinese primary care context and validate its psychometric properties.Methods:The translation and adaptation processes were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 386 patients with diabetes attending one of 20 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method was used to assess the construct validity. Confirmation factor analysis was used to evaluate model fit of the modified version. Cronbach’s alpha was used to ascertain the internal consistency reliability.Results:During the translation and adaptation process, all 24 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Five factors (person-centeredness, clinical integration, professional integration, team-based coordination, organizational integration) with 15 items were determined by exploratory factor analysis, accounting for 53.51% of the total variance. Good internal consistency was achieved with each item correlated the highest on an assigned subscale and Cronbach’s alpha score of 0.890. Moderately positive associations (r≥ 0.4, p<0.01) between the score of the scale and these correlations indicate good construct validity.Conclusions:The results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT patient version. Its application in China will promote the development of people-centered integrated primary care. However, future studies with diverse samples crossing regions would be needed to test its psychometric properties for the various Chinese primary care contexts.

Validation of the care providers version of the Rainbow Model of Integrated Care-measurement tool in Chinese primary care systems

BackgroundThe original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. To translate and adapt the original care provider version of the RMIC-MT and evaluate its psychometric properties by a pilot study in Chinese primary care systems.MethodsThe translation and adaptation process were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 1610 community care professionals in all 79 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method and promax rotation was used to assess the construct validity. Cronbach’s alpha was utilized to ascertain the internal consistency reliability. Lastly, confirmation factor analysis was used to evaluate the exploratory factor analysis model fit.ResultsDuring the translation and adaptation process, all 48 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Six factors (person- & community-centeredness, care integration, professional integration, organizational integration, cultural competence and technical competence) with 45 items were determined by exploratory factor analysis, accounting for 61.46% of the total variance. A standard Cronbach’s alpha of 0.940 and significant correlation among all items in the scale (> 0.4) showed good internal consistency reliability of the tool. And, the model passed the majority of goodness-to-fit test by confirmation factor analysis.ConclusionsThe results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT provider version. Its application in China will promote the development of people-centered integrated primary care. However, further psychometric testing is needed in multiple primary care settings with both public and private community institutes.

Validation of the Rainbow Model of Integrated Care Measurement Tools (RMIC-MTs) in renal care for patient and care providers.

IntroductionIntegrated service delivery is considered to be an essential condition for improving the management and health outcomes of people with chronic kidney disease (CKD). However, research on the assessment of integrated care by patients and care providers is hindered by the absence of brief, reliable, and valid measurement tools.ObjectiveThe aim of this study was to develop survey instruments for healthcare professionals and patients based on the Rainbow Model of Integrated Care (RMIC), and to evaluate their psychometric properties.DesignThe development process was based on the US Food and Drug Administration guidelines. This included item generation from systematic reviews of existing tools and expert opinion on clarity and content validity, involving renal care providers and chronic kidney patients. A cross-sectional, multi-centre design was used to test for internal consistency and construct validity.SettingOutpatient clinics in a large renal network.ParticipantsA sample of 30.788 CKD patients, and 8.914 renal care providers.Methods and analysisBoth survey instruments were developed using previous qualitative work and published literature. A multidisciplinary expert panel assessed the face and content validity of both instruments and following a pilot study, the psychometric properties of both instruments were explored. Exploratory factor analysis with principal axis factoring and with promax rotation was used to assess the underlying dimensions of both instruments; Cronbach’s alpha was used to determine the internal constancy reliability.Results17.512 patients (response rate: 56.9%) and 8.849 care providers (response rate: 69.5%) responded to the questionnaires. Factor analysis of the patient questionnaire yielded three internally consistent (Cronbach’s alpha > 0.7) factors: person-centeredness, clinical coordination, and professional coordination. Factor analysis of the provider questionnaire produced eight internally consistent (Cronbach’s alpha > 0.7) factors: person-centeredness, community centeredness, clinical coordination, professional coordination, organisational coordination, system coordination, technical and cultural competence. As hypothesised, care coordination patient and providers scores significantly correlated with questions about quality of care, treatment involvement, reported health, clinics’ organisational readiness, and external care coordination capacity.ConclusionThis study provides evidence for the reliability and validity of the RMIC patient and provider questionnaires as generic tools to assess the experience with or perception of integrated renal care delivery. The instruments are recommended in future applications testing test-retest reliability, convergent and predictive validity, and responsiveness.

Theory and Practice in Digital Behaviour Change: A Matrix Framework for the Co-Production of Digital Services That Engage, Empower and Emancipate Marginalised People Living with Complex and Chronic Conditions

Background: The WHO framework on integrated people-centred health services promotes a focus on the needs of people and their communities to empower them to have a more active role in their own health. It has advocated five strategies including: Engaging and empowering people and communities; co-ordinating services within and across sectors; and, creating an enabling environment. Any implementation of these strategies needs to occur at individual, community, and health service levels. Useful steps to reorganising health service provision are already being guided by existing models of care linked to increased adoption and use of digital technologies with examples including: Wagner’s Chronic Care Model (CCM); Valentijn’s Rainbow Model of Integrated Care (RMIC); and Phanareth’s et al.’s Epital Care Model (ECM). However, what about individuals and the communities they live in? How will strategies be implemented to address known inequities in: the social determinants of health; access to, and use of digital technologies, and individual textual, technical, and health literacies? Proposal of a matrix framework: This paper argues that people with complex and chronic conditions (PwCCC) living in communities that are at risk of being under-served or marginalised in health service provision require particular attention. It articulates a step-by-step process to identify these individuals and co-produce mechanisms to engage, empower and ultimately emancipate these individuals to become activated in living with their conditions and in their interactions with the health system and community. This step-by-step process focuses on key issues related to the design and role of digital services in mitigating the effects of the health service inequity and avoiding the creation of an e-health divide amongst users when advocating digital behaviour change initiatives. This paper presents a matrix framework providing a scaffold across three inter-related levels of the individual; the provider, and the health and care system. The matrix framework supports examination of and reflection on the design and role of digital technologies in conjunction with pre-existing motivational instruments. This matrix framework is illustrated with examples from practice. Conclusion: It is anticipated that the matrix framework will evolve and can be used to map and reflect on approaches and practices aiming to enrich and stimulate co-production activities supported by digital technology focused on enhancing people-centred health services for the marginalised.

Hospital-Led Integrated Care for High need-High Cost Patients: A review of reviews

Introduction: Patients with multiple morbidities and complex needs are putting a strain on the resources of the health system, particularly on hospitals. The current fragmented hospital and disease centric care is unable to cope with the growing healthcare needs facing the modern day health system [1,2]. Therefore, integrated care interventions have been developed to improve the quality and efficiency of care by coordinating healthcare services in a person-centric manner with the aims of reducing health and social burden on the healthcare systems including hospitals [2]. However, the methods and outcomes of interventions used are different and evidence of the effectiveness of the interventions are not consistent. There is also a lack of understanding on why and how integrated care interventions work or do not work under certain circumstances. Based on the CMO (context, mechanism and outcomes) [3] model, we aim to summarise and compare the existing evidence of the context, mechanism and outcomes of hospital-led integrated care interventions from published peer-reviewed systematic reviews. Methods: A review of existing systematic reviews is being conducted to find out what works, for whom, and under what circumstances hospitals can provide effective integrated care interventions. The review will address the following questions: (1) what are the programmes available? (2) Who is the target population? (3) In what respect of integrated care (i.e., patient, system, organisation)? (4) What are the outcomes measured (e.g. healthcare utilizations, healthcare outcomes (QoL, quality of care mortality rates, etc.), costs) and how effective are they? (5) If they are effective, how do they work in different settings and for different populations? (6) What are the underlying mechanisms of these interventions? (7) What causes the heterogeneity in outcomes of hospital-led integrated care programmes? Based on the WHO definition of integrated care [4] and Rainbow Model of Integrated Care (RMIC) definition of system and organisation integration [5], articles are searched through PubMed, Scopus, Web of Science and Cochrane Database of Systematic Reviews for the period 2006-2016 (N=2290). A systematic review is included if it describes hospital-led interventions that involve system or organisation integration, involve an acute care setting as the lead, and have the outcomes of the interventions evaluated. Titles for inclusion are screened independently by three reviewers using predetermined criteria. Data are extracted and quality of review is assessed according to the Joanna-Briggs Institute guidelines.[6] Findings on context and mechanism are analysed to explain about outcomes. Complete findings will be presented during ICIC17. Discussion: The findings from the review will help inform policy-makers and healthcare professionals on the design of integrated care programmes that will most likely yield their desired outcomes, based on their target populations and context of the health system. The review will also provide an overview of how to bridge the gap between the development of interventions and successful implementation of hospital-led integrated care [2]. For researchers, the review will indicate the strength of existing evidence and identify directions for future research.

Towards an international taxonomy of integrated primary care: a Delphi consensus approach.

BackgroundDeveloping integrated service models in a primary care setting is considered an essential strategy for establishing a sustainable and affordable health care system. The Rainbow Model of Integrated Care (RMIC) describes the theoretical foundations of integrated primary care. The aim of this study is to refine the RMIC by developing a consensus-based taxonomy of key features.MethodsFirst, the appropriateness of previously identified key features was retested by conducting an international Delphi study that was built on the results of a previous national Delphi study. Second, categorisation of the features among the RMIC integrated care domains was assessed in a second international Delphi study. Finally, a taxonomy was constructed by the researchers based on the results of the three Delphi studies.ResultsThe final taxonomy consists of 21 key features distributed over eight integration domains which are organised into three main categories: scope (person-focused vs. population-based), type (clinical, professional, organisational and system) and enablers (functional vs. normative) of an integrated primary care service model.ConclusionsThe taxonomy provides a crucial differentiation that clarifies and supports implementation, policy formulation and research regarding the organisation of integrated primary care. Further research is needed to develop instruments based on the taxonomy that can reveal the realm of integrated primary care in practice.