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Article

Michael Leibert

Healthcare services in the USA have been described as being fragmented and uncoordinated. Integrated delivery systems are frequently promoted as being instrumental in…

Abstract

Purpose

Healthcare services in the USA have been described as being fragmented and uncoordinated. Integrated delivery systems are frequently promoted as being instrumental in efforts to improve the coordination of care and, thus, enhancing the quality of clinical care and patient services while ensuring optimum cost‐efficiencies. This study seeks to analyze and compare the performance of hospitals participating in highly integrated systems with non‐integrated hospitals based on outcome measures involving hospital performance.

Design/methodology/approach

The study compares the performance of 50 flagship hospitals participating in the most highly integrated delivery systems in the USA with a representative sample of non‐system hospitals utilizing one‐way analysis of variance. The comparative analysis was based on three key performance measures; clinical quality of medical care, patient satisfaction, and cost‐efficiency considerations.

Findings

The results of the review demonstrate that there is a statistically significant positive difference between the clinical quality performance of the highly integrated hospitals compared with the quality performance of non‐highly integrated facilities. No difference was identified between the two sample groups of hospitals for the performance measures related to patient satisfaction or cost‐efficiencies.

Originality/value

The study is an attempt to evaluate the implications and effectiveness of integration within the health care delivery system. It suggests that integrated delivery systems may provide the organization structure appropriate to help support and enhance the quality of clinical care for patients.

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Book part

Katharina Janus and Volker Amelung

Integrated health care delivery (IHCD), as a major issue of managed care, was considered the panacea to rising health care costs. In theory it would simultaneously provide…

Abstract

Integrated health care delivery (IHCD), as a major issue of managed care, was considered the panacea to rising health care costs. In theory it would simultaneously provide high-quality and continuous care. However, owing to the backlash of managed care at the turn of the century many health care providers today refrain from using further integrative activities. Based on transaction cost economics, this chapter investigates why IHCD is deemed appropriate in certain circumstances and why it failed in the past. It explores the new understanding of IHCD, which focuses on actual integration through virtual integration instead of aggregation of health care entities. Current success factors of virtually integrated hybrid structures, which have been evaluated in a long-term case study conducted in the San Francisco Bay Area from July 2001 to September 2002, will elucidate the further development of IHCD and the implications for other industrialized countries, such as Germany.

Details

International Health Care Management
Type: Book
ISBN: 978-0-76231-228-3

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Book part

Jenna M. Evans, Ross G. Baker, Whitney Berta and Barnsley Jan

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of

Abstract

Purpose

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature.

Methods

A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration.

Findings

Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS).

Originality/value

This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.

Details

Annual Review of Health Care Management: Revisiting The Evolution of Health Systems Organization
Type: Book
ISBN: 978-1-78350-715-3

Keywords

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Book part

Peter Lazes, Liana Katz, Maria Figueroa and Arun Karpur

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically…

Abstract

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and patient-centered.

Design/methodology – This case study of Montefiore Medical Center is based on a year of research that included focus-group interviews; individual interviews with executives, frontline staff, and union leaders; site visits; analysis of internal data; and a literature review.

Findings – Montefiore Medical Center is using both adaptive and disruptive strategies to develop an integrated delivery system driven by capitated payments from health insurance companies, a focus on primary care and chronic disease management programs, and community outreach. The growth of these delivery system components in conjunction with Montefiore's Care Management Corporation (to help manage the health plan contracts) has contributed to an affordable cost of care, improved clinical outcomes, and proactive patient and community engagement.

Originality and value – There is a paucity of case studies describing how safety-net hospitals – and health systems in general – can integrate the services they provide to create a positive, seamless, and economical patient experience. The story of Montefiore Medical Center offers an overview of how health care infrastructure and payment methods can be transformed to align financial and clinical incentives and to better serve a patient population that largely depends on government health insurance.

Details

Organizing for Sustainable Health Care
Type: Book
ISBN: 978-1-78190-033-8

Keywords

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Article

Siu Mee Cheng and Cristina Catallo

The purpose of this paper is to develop a case definition of integrated health and social services initiatives that serve older adults, and will provide characteristics to…

Abstract

Purpose

The purpose of this paper is to develop a case definition of integrated health and social services initiatives that serve older adults, and will provide characteristics to aid in the identification of such initiatives. The case definition is intended to ease the identification of integrated health and social care initiatives.

Design/methodology/approach

A limited search was undertaken of both scientific and gray literature that documented and/or examined integrated health and social services initiatives. In addition, literature on well-documented and generally accepted integrated healthcare and social services models that reflect collaborations from healthcare and social services organizations that support older adults was also used to develop the case definition.

Findings

The case definition is as follows: healthcare organizations from across the continuum of care working together with social services organizations, so that services are complementary and coordinated in a seamless and unified system, with care continuity for the patient/client in order to achieve desired health outcomes within a holistic perspective; the initiatives comprise at least one healthcare organization and one social care organization; and these initiatives possess 18 characteristics, grouped under 9 themes: patient care approach; program goals; measurement; service and care quality; accountability and responsibility; information sharing; culture; leadership; and staff and professional interaction.

Research limitations/implications

A limitation of this study is that the characteristics are based on a limited literature search. The quality of some of the literature both gray and published was not definitive: information on how they undertook the literature search was not provided; exclusion and inclusion criteria were not included; and there was insufficient detail on the design of the studies included. Furthermore, the literature reviews are based on integrated initiatives that target both seniors and non-senior’s based services. The cross-section of initiatives studied is also different in scale and type, and these differences were not explored.

Practical implications

The case definition is a useful tool in aiding to further the understanding of integrated health and social care initiatives. The number of definitions that exist for integrated health and social care initiatives can make it confusing to clearly understand this field and topic. The characteristics identified can assist in providing greater clarity and understanding on health and social care integration.

Originality/value

This study provides greater coherence in the literature on health and social care integration. It aids in better framing the phenomenon of healthcare and social services integration, thereby enhancing understanding. Finally, the study provides a very useful and concrete list of identifying characteristics, to aid in identifying integrated health and social care initiatives that serve older adults.

Details

Journal of Integrated Care, vol. 27 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

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Article

Derek Birrell and Deirdre Heenan

This paper assesses the recommendations and proposals contained in Transforming Your Care, the recent review of health and social care in Northern Ireland, in the context…

Abstract

Purpose

This paper assesses the recommendations and proposals contained in Transforming Your Care, the recent review of health and social care in Northern Ireland, in the context of the existing integrated structures. It is designed to promote a better understanding of the implications of the proposed reconfiguration of health and social care.

Design/methodology/approach

This paper reviews a number of published documents encompassing an independent review and subsequent plans and strategies. It also draws upon a case study of a Rapid Access Clinic undertaken by the authors as part of a wider research project.

Findings

The paper concludes that the planned changes question the ability of an integrated structure operating across primary, secondary and social care. It notes that there are real concerns about the capacity of the social care workforce to deliver services. It is suggested that the proposal for Integrated Care Partnerships can be seen as a reflection of the need for a more localised approach to delivery.

Research limitations/implications

The findings are derived from a small‐scale study and as such may make generalisation difficult. There is a clear need for a more robust evidence‐based approach to the evaluation of structural integration in health and social care and a process for monitoring of this change process.

Originality/value

The article is a reminder of the unique example of structural integration within the UK. As such it could have important lessons for England, Scotland and Wales which are moving in a similar direction.

Details

Journal of Integrated Care, vol. 20 no. 6
Type: Research Article
ISSN: 1476-9018

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Article

Isaac S. Obeng and Ikedinachi K. Ogamba

This study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising…

Abstract

Purpose

This study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising diabetic patient health outcomes and improving healthcare systems in low and middle-income countries.

Design/methodology/approach

Peer-reviewed literature that analysed the integration of health services regarding dental and medical services were reviewed. The articles were identified using the Academic Search Complete, Business Source Complete, CINAHL Complete, Google Scholar and MEDLINE databases and screened using the PRISMA guidelines.

Findings

A total of 40 full-text articles were examined for eligibility out of which 26 were selected for analysis. Diabetes was shown to contribute significantly to the global disease burden and this is also reflected in most low and middle-income countries. It is found that the integration of medical and dental services could help alleviate this burden. Hence, locally adapted Rainbow-Modified Integrated Care model is proposed to fill this integration gap.

Originality

The integration of dental and medical services has been proven to be useful in improving diabetic patient outcomes. Hence, the need to facilitate cross-professional collaboration between dentists and physicians cannot be overemphasised and this can be extended and locally adapted by different health systems across the world.

Practice Implications

The integration of dental and diabetic services using models such as the Rainbow Model of Integrated Care is recommended to optimise health outcomes of diabetic patients and enhancing service delivery, especially in resource-poor healthcare systems.

Details

Journal of Integrated Care, vol. 29 no. 2
Type: Research Article
ISSN: 1476-9018

Keywords

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Article

Heini Sisko Maarit Taiminen, Saila Saraniemi and Joy Parkinson

This paper aims to enhance the current understanding of digital self-services (computerized cognitive behavioral therapy [cCBT]) and how they could be better incorporated…

Abstract

Purpose

This paper aims to enhance the current understanding of digital self-services (computerized cognitive behavioral therapy [cCBT]) and how they could be better incorporated into integrated mental health care from the physician’s perspective. Service marketing and information systems literature are combined in the context of mental health-care delivery.

Design/methodology/approach

An online survey of 412 Finnish physicians was undertaken to understand physicians’ acceptance of cCBT. The study applies thematic analysis and structural equation modeling to answer its research questions.

Findings

Adopting a service marketing perspective helps understand how digital self-services can be incorporated in health-care delivery. The findings suggest that value creation within this context should be seen as an intertwined process where value co-creation and self-creation should occur seamlessly at different stages. Furthermore, the usefulness of having a value self-creation supervisor was identified. These value creation logic changes should be understood and enabled to incorporate digital self-services into integrated mental health-care delivery.

Research limitations/implications

Because health-care systems vary across countries, strengthening understanding through exploring different contexts is crucial.

Practical implications

Assistance should be provided to physicians to enable better understanding of the application and suitability of digital self-service as a treatment option (such as cCBT) within their profession. Additionally, supportive facilitating conditions should be created to incorporate them as part of integrated care chain.

Social implications

Digital self-services have the potential to serve goals beyond routine activities in a health-care setting.

Originality/value

This study demonstrates the relevance of service theories within the health-care context and improves understanding of value creation in digital self-services. It also offers a profound depiction of the barriers to acceptance.

Details

European Journal of Marketing, vol. 52 no. 11
Type: Research Article
ISSN: 0309-0566

Keywords

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Article

Jenna M. Evans and G. Ross Baker

Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration…

Abstract

Purpose

Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter‐organizational and inter‐professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration.

Design/methodology/approach

The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration‐task, system‐role, and integration‐belief.

Findings

The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory‐based framework of psychological factors that may influence inter‐organizational and inter‐professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care.

Practical implications

MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care.

Originality/value

Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.

Details

Journal of Health Organization and Management, vol. 26 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

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Article

Gina Bravo, Michel Raîche, Marie‐France Dubois and Réjean Hébert

Interest has grown in integrated care models as means of responding better to the needs of frail older adults. In order to provide appropriate input for health policy…

Abstract

Interest has grown in integrated care models as means of responding better to the needs of frail older adults. In order to provide appropriate input for health policy reforms, the effects of integrated care must be assessed with sound methodologies. Based on three experiments conducted in the province of Quebec, Canada, this article provides practical advice on key issues involved in evaluating integrated care models.

Details

Journal of Integrated Care, vol. 16 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

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