Search results

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.

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.

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.

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.

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.

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.

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.

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).

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

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.

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.

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.

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.

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.

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.

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.

Many countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to reduce health inequalities. Integration is supported by population health management (PHM) which links data across health and care organisations to inform service delivery. It is not well-understood how PHM can help ICSs reduce health inequalities. This paper describes development of a programme theory to advance this understanding.

This study was conducted as a mixed-methods process evaluation in a local ICS using PHM. The study used Framework to analyse interviews with health and care professionals about a PHM tool, the COVID-19 vaccination uptake Dashboard. Quantitative data on staff Dashboard usage were analysed descriptively. To develop a wider programme theory, local findings were discussed with national PHM stakeholders.

ICS staff used PHM in heterogeneous ways to influence programme delivery and reduce inequalities in vaccine uptake. PHM data was most influential where it highlighted action was needed for “targetable” populations. PHM is more likely to influence decisions on reducing inequalities where data are trusted and valued, data platforms are underpinned by positive inter-organisational relationships and where the health inequality is a shared priority.

The COVID-19 pandemic accelerated a shift toward use of digital health platforms and integrated working across ICSs. This paper used an evaluation of integrated data to reduce inequalities in COVID-19 vaccine delivery to propose a novel programme theory for how integrated data can support ICS staff to tackle health inequalities.

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.

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.

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.

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.

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.

Design, implementation, and evaluation are all important for integrated care. However, they miss one critical factor: education. The authors define “integrated care education” as meaningful learning that purposefully supports collaboration and the development of adaptive expertise in integrated care. The ECHO (Extensions for Community Health Outcomes) model is a novel digital health solution that uses technology-enabled learning (TEL) to facilitate, support, and model integrated care education. Using ECHO Concussion as a case study, the authors describe the effects of technology-enabled integrated care education on the micro-, meso-, and macro-dimensions of integrated care.

This case study was constructed using data extracted from ECHO Concussion from video-archived sessions, participant observation, and internal program evaluation memos. The research team met regularly to discuss the development of relevant themes to the dimensions of integrated care.

On the micro-level, clinical integration occurs through case-based learning and the development of adaptive expertise. On the meso-level, professional integration is achieved through the development of the “specialist generalist,” professional networks and empathy. Finally, on the macro-level, ECHO Concussion and the ECHO model achieve vertical and horizontal system integration in the delivery of integrated care. Vertical integration is achieved through ECHO by educating and connecting providers across sectors from primary to quaternary levels of care. Horizontal integration is achieved through the establishment of lateral peer-based networks across sectors as a result of participation in ECHO sessions with a focus on population-level health.

This case study examines the role of education in the delivery of integrated care through one program, ECHO Concussion. Using the three dimensions of integrated care on the micro-, meso-, and macro-levels, this case study is the first explicit operationalization of ECHO as a means of delivering integrated care education and supporting integrated care delivery.

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.

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.

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.

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

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.

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

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.

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.

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.

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.

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.

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.