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To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of…
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.
This article introduces the on‐line International Journal of Integrated Care to British subscribers to the Journal of Integrated Care. It is hoped that a working…
This article introduces the on‐line International Journal of Integrated Care to British subscribers to the Journal of Integrated Care. It is hoped that a working partnership can be established between the two publications.
Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This…
Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This paper is based on an explorative case study of recent reforms in the healthcare sector and their outcomes in Denmark, Norway and Sweden. We discuss the possibilities of and problems for integrating the healthcare sector through the coordination mechanisms of hierarchy, market and network. The paper also discusses whether the institutional logic of the healthcare field is moving from a dual logic of ‘cure’ and ‘care’ towards a unifying logic of ‘integrated care’. We find that although the organisational principles that regulate the relationship between actors in the healthcare field in the three countries have changed, the challenge of achieving a mix of coordinative mechanisms that promote, rather than weaken, integration remains. However, the new organisational and regulative arrangements are an arena for increased interaction and collaboration between the actors, and thus a foundation for change towards the institutional logic of integrated health care.
The purpose of this paper is to outline the development of the institutional repository of Utrecht University, the Igitur Archive. The Utrecht repository is unique for…
The purpose of this paper is to outline the development of the institutional repository of Utrecht University, the Igitur Archive. The Utrecht repository is unique for several reasons: it was started several years before the international repository movement began; the repository is combined with an e‐publishing service, Igitur, Utrecht Publishing and Archiving Services; and because the repository is firmly embedded in the structural tasks of the university library. This case‐study highlights the advantages and disadvantages of this particular situation.
In order to give an outline of the evolution of the Igitur Archive, the paper uses information from policy papers and annual reports of the Utrecht University Library and Utrecht University, from the business plan of Igitur and from the Proceedings of the Dutch DARE project. The findings are sorted in four sections: the start of e‐publishing in Utrecht; a section about Igitur; a section detailing the lessons learned; and finally a glance at the future is given.
The conclusion is that the position of Utrecht as an “early adapter” in the Dutch repository movement has caused some delays, but that the combination of the repository with the additional e‐publishing services has proved to be very fruitful. Igitur has developed a strong position and both the e‐publishing services and the repository have a sound base for further growth.
This paper gives useful information to other university libraries who want to start a repository and an e‐publishing service or who are already developing such services.
The purpose of this article is to share emerging evidence about the qualitative and economic benefits of integrating care, based on an innovative population‐based approach…
The purpose of this article is to share emerging evidence about the qualitative and economic benefits of integrating care, based on an innovative population‐based approach across a small region of Germany. The article aims to discuss the features that have similarities to the international discussion around managed care and accountable care, e.g. the use of a “gain share” model to incentivise all the main partners, and the quite unique approaches derived from a public health background. The operation of Gesundes Kinzigtal could be considered as a benchmark for the “Clinical commissioning groups” that are in development as a result of the Health and Social Care Act 2012 in the UK.
A regional health management company in cooperation with the physicians' network in the region and two health insurance providers has reorganized the delivery of care across all sectors towards improving the health of the population. The key features of the approach are summarised in the paper. Administrative and medical data obtained from the health insurance providers and from routine management monitoring are used to evaluate the benefits of the approach compared to control groups.
The project is beginning to demonstrate that this model of integrated care can be effective, with cost benefits and savings for the partners, and improved health outcomes for the population.
The project started in 2006, and only early results of the first three to four years are reported here because of the use of claims data of health insurers.
The approach is an innovative model of integration in its combination of logistical re‐engineering of care processes, IT integration, public health and prevention measures. Its evaluation through an ambitious series of studies may have long‐term relevance for the organisation and management of care services internationally.
Purpose: Researchers and advocates alike have noted that persons with disabilities and older persons are the two groups most marginalized by neoliberal economic policies…
Purpose: Researchers and advocates alike have noted that persons with disabilities and older persons are the two groups most marginalized by neoliberal economic policies and therefore could come together as a broad-based movement against the roll back of their rights. Yet, these two groups fail to collaborate, and instead compete against one another for an ever-shrinking pool of benefits. This chapter explores the barriers to their collaboration within the context of structural adjustment in Jamaica.
Methods/Approach: The author engages in a critical analysis of neoliberalism's effect on the advocacy strategies of the disability and older persons' movements in Jamaica based on 32 semi-directed depth interviews, participant observation of numerous events, and a survey of media written by local advocates.
Findings: The disability movement makes claims on behalf of their members by focusing on the potential returns that society will gain by providing the opportunities that will make young persons with disabilities productive employees over their lifetime. The older persons' movement advocates by portraying themselves as “vibrant” and worthy of social investment because of the contributions they make. Both of these arguments for inclusion are also exclusionary. The disability movement excludes older persons as potential contributors and the older persons' movement similarly excludes persons with disabilities.
Implications: The only way neoliberalism will successfully be rolled back and universal rights returned is if the disability movement and older persons' movements build an alliance that is more inclusive, including of one another, by rejecting the language of investment and productivity, and instead focus on rights and inherent dignity.
Purpose: The aim is to explore how family relations are affected by societal changes in relation to informal and formal caregiving and self-determination of older adults.…
Purpose: The aim is to explore how family relations are affected by societal changes in relation to informal and formal caregiving and self-determination of older adults.
Design/methodology/approach: Care managers (CMs)/social workers (SWs) (N = 124) participated in a comparative vignette study including Japan, South Korea, and Sweden. Systems theory was used.
Findings: Japanese CMs/SWs clearly describe their efforts to create networks in a relational way between formal and informal actors in the community. South Korean CMs/SWs balance between suggesting interventions to support daily life at home or a move to a nursing home, often acknowledging the family as the main caregiver. In Sweden, CMs/SWs highlight the juridical element in meeting the older adult and the interventions offered, and families primarily give social support. Regarding self-determination, the Japanese priority is for CMs/SWs to harmonize within the family and the community. South Korean CMs/SWs express ambivalent attitudes to older adults’ capability for self-determination in the intersection between formal and family care. Swedish CMs/SWs adhere to the older adult’s self-determination, while acknowledging the role of the family in persuading the older adult to accept interventions. The results suggest emerging defamilialization in South Korea, while tendencies to refamilialization are noticed in Japan and Sweden, albeit in different ways.
Research limitations/implications: In translation, nuances may be lost. A focus on changing families shows that country-specific details in care services have been reduced. For future research, perspectives of “care” need to be studied on different levels.
Originality/value: Using one vignette in three countries with different welfare regimes, discussing changing views on families’, communities’ and societal caregiving is unique. This captures changes in policy, influencing re- and defamilialization.
This chapter aims to provide an overview of the ethical framework and decision-making in clinical dementia research, and to analyze and discuss the ethical challenges and…
This chapter aims to provide an overview of the ethical framework and decision-making in clinical dementia research, and to analyze and discuss the ethical challenges and issues that can arise when conducting clinical dementia research.
Informed consent is the most scrutinized and controversial aspect of clinical research ethics. In clinical dementia research, assessing decision-making capacity may be challenging as the nature and progress of each disease influences decision-making capacity in diverse ways. Persons with dementia represent a vulnerable population deserving special attention when developing, implementing, and evaluating the informed consent process. In this chapter, particular attention will be given to vulnerability categories and how these influence decision-making capacity. Ethical frameworks with a pragmatic contour and implication are needed to protect vulnerable patients from potential harms and ensure their optimal participation in clinical dementia research.
In addition, this chapter analyses important ethical challenges and issues in clinical dementia research. If handled thoughtfully, they would not pose insuperable barriers to research. But if they are ignored, they could slow the research process, alienate potential study subjects and cause harm to research participants. Ethical considerations in research involving persons with dementia primarily concern the representation of the interests of the participants with dementia and protection of their vulnerabilities and rights.
A core set of ethical questions and recommendations are drawn to aid researchers, institutional review boards and potential research participants in the process of participating in clinical dementia research.