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Emerald Group Publishing Limited
Article Type: Editorial From: Journal of Integrated Care, Volume 24, Issue 1.
The name Donabedian is synonymous with the evaluation and improvement of quality within health and care services. Perhaps most famously connected with the "structure, process and outcomes" model, Dr Avedis Donabedian was an advocate for taking a systemic approach that not only considers the interventions to be deployed but is also responsive to the context in which such interventions are being introduced and is clear on the expected impacts and beneficiaries. The model’s continued use five decades later highlights that what may at first seem a simple conceptual framework has considerable depth and practice relevance. Reflecting this significant contribution, the Avedis Donabedian Foundation at Barcelona University each year presents an international award to leaders in the field of quality in healthcare. In 2016 the award has been presented to Dr Nick Goodwin, the Chief Executive of the International Federation of Integrated Care. We hope that readers of the Journal of Integrated Care will join us in congratulating Dr Goodwin in this prestigious recognition of his tireless work to promote the principles and practice of integrated care. Over recent years he and his committed team have been travelling the globe to share good practice and research insights, and in doing so will undoubtedly have improved the health and wellbeing of many individuals and communities.
The work of both these improvement pioneers recognises the important connection between research and practice, and this is also a key principle underpinning the work of the Journal of Integrated Care. This edition is an excellent exemplar of this commitment, with four fascinating papers that bring empirical and/or conceptual insights to the development of more person-centred and co-ordinated care. The edition begins with an evaluation by Francesca Albanese et al. of the Homeless Discharge Fund, which was launched in England in 2013 to improve the transition from hospital experienced by those with no permanent residence. Previous studies have shown that over 70 per cent of such patients will be discharged back to onto the street which both endangers their health and recovery, and increases the likelihood of frequent hospital use. The evaluation provides a helpful typology of the various arrangements that were developed through the programme and suggests the differing impacts of these types on individual outcomes and enabling processes of integration.
Hospital discharge is also the focus of our second paper by Maria Goddard et al. which explores the connection between length of stay and the annual review of patients with dementia by general practitioners in England. Incentivised through the payments in the Quality and Outcomes Framework, this review seeks to gain a holistic view of the needs of the individual and their carer, and ensure that there is the necessary communication between relevant agencies to respond to these needs. The research finds that whilst the effect of the review on length of stay appear is modest for each individual the collective impact through achieving such an improvement for a growing population could be substantial. The authors recommend that focusing the incentive payment on the content of the review (rather than just that it has taken place) could encourage a better quality of review which in turn may improve its beneficial effects.
Our third paper by Ayla Humphrey et al. also considers the commissioning process but this time this is in relation to children and young people. It reflects on the experience of the 1,419 project in Cambridge which sought to improve the care of young people with mild to moderate mental health difficulties through providing accessible, responsive and evidence-based services. It finds that key to the success of the project was its commitment to a multi-professional and collaborative approach that incorporated primary and secondary care, children and adult services and the community and voluntary sector. Collaboration was also evident in the relationship between the providers and purchasers with the authors suggesting that a relational model of commissioning may prove more productive in certain contexts.
The edition is concluded by Mirella Minkman who provides an overview of the Development Model for Integrated Care (DMIC). This seeks to provide a generic quality management model for integrated care to support self-evaluation and improvement. The product of a thorough process which included a Delphi study, concept mapping and extensive validation, the DMIC identifies 89 elements of integrated care which are then grouped into nine clusters. It has been translated into a practice-friendly on-line tool that has been used in the Netherlands and French-speaking Canada to enable integrated care initiatives to reflect on their phase of development, and identify further options for improvement. It is also hoped that in the near future an English language version of the tool will be available which could be of great benefit to all those working in integrated care within English-speaking countries.
An edition then that firmly builds on Donabedian’s interest in the complicated interplay between context, process and outcome but translates these to the challenges and opportunities of the current financial, policy and practice environment. Finally for further information of the work of the International Federation of Integrated Care please see http://integratedcarefoundation.org/about-ific. Its conferences are recommended as an opportunity to participate in a growing community of practice regarding integrated care.
Robin Miller, Sue White and Jon Glasby