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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 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.

Community policing has been around for at least two decades now and it is safe to say that it has become, in large part, more about managing disruptive subjects and virtuous citizens than preventing crime or disorder (Crank, 1994; DeLeon-Granados, 1999; Yngvesson, 1993). While the rhetoric of community may be succeeding where the policing policy is failing, the experience has certainly contributed to the growth of homologous efforts that include community prosecution and community correction. We see a criminal justice system pro-actively seeking to blur the boundaries between its institutions and the communities they work within and, all too often, without. In recent years, there has been a rapid growth in justice approaches that turn their attention toward the community. There are literally hundreds of examples of this trend, from offender-victim reconciliation projects in Vermont and Minneapolis to ‘beat probation’ in Madison, Wisconsin; from neighborhood-based prosecution centers in Portland, Oregon, and New York City, to community probation in Massachusetts. Of course, the most well-known version of community justice is community policing, but localized projects involving all components of the justice system have been widely promoted (Clear & Karp, 1998, p. 3).Like community policing and community prosecution, community correction programs generally focus on partnering with service providers and community groups in order to more finely calibrate their service delivery. For community corrections the recent focus has been on delivering re-entry programs and expanding the availability of intermediate sanctioning options. The sheriff (above) focuses on re-entry, to link jails and communities in two ways: extending the correctional continuum into power-poor communities and increasing political support for expanding the criminal justice system in more affluent communities. Even as fiscal stress translates into budget cuts in education, housing, drug treatment, and other services, the reach of the criminal justice system expands outside the fences as new community-based partnerships and inside the fences as an increasingly program-rich environment. These partnerships are, not surprisingly as we shall see, dominated by criminal justice professionals and dependent on coercive control techniques. Further, their budgets are growing with funds in previous eras earmarked for providing many of the same services in a social welfare, rather, than social control, service delivery context. While these budgetary trends map a macro political trend from an old democratic New Deal toward a new republican new deal network of patronage relationships (see Lyons, forthcoming 2004), this paper examines the micro politics of community corrections developing within an increasingly punitive American political-culture.

Women with HIV have increased longevity and the potential for decreasing mother to child transmission with the use of antiretroviral therapy. Since the beginning of the AIDS epidemic in 1980, the disease has evolved from an acute condition to a chronic one. How have women long-term survivors transitioned from a “death sentence” to living with HIV/AIDS as a chronic illness? In this study, we investigate the reproductive, mothering, and living experiences of HIV positive women 10 years after their participation in a study of their reproductive decisions. The sample was taken from two groups of women living with HIV (n = 60), one in Oakland, California (n = 30) and one in Rochester, New York (n = 30). Both groups participated in the initial study (1995–2001). The inclusion criteria for this study are women with HIV who are living and well enough to participate in a face-to-face interview. Of the original 60 women, 52 women are living. Two and one half years into this 4-year study, the author has completed interviews with 25 women from Oakland (n = 10) and Rochester (n = 15). An unexpected life with HIV challenges participants to live a viable life different from their pre-diagnosed life. It involves a life of defining normalcy in everyday experiences and building a legacy of a life worth living. Participants’ issues and concerns of living with HIV/AIDS identify what kinds of cultural notions, and medical and social interventions support or undermine women's reproductive, mothering, and long-term living with HIV/AIDS.

Literature suggests that the poor often face a myriad of health care constraints and health problems. This study uses bivariate and multivariate analyses to examine the effects of systemic factors such as the availability of health care providers and neighborhood poverty on individual health decisions for a sample of African Americans, Whites, Mexicans, and Puerto Ricans in poor Chicago neighborhoods. Results show that Medicaid usage and having a regular physician increase the number of days home ill and days hospitalized, while frequenting clinics decreases such activity. Additionally, residents in more impoverished urban areas are less likely to stay home ill. Differences in health profiles and providers are also evident based on race/ethnicity. These findings illustrate the important relationship between macro-level factors and specific health choices many residents in poor urban areas make at the micro-level.

The transition to adulthood involves risk. In the 90s, sociologists have focused on the question of understanding and managing this risk. Much of this research has tried to go beyond family characteristics and examine the possible role of community or neighborhood. Furstenberg (2000) concludes, however, that the research “on adolescent behaviors has not shown a strong impact of the quality of neighborhoods, independent of the demographic characteristics of the resident families” (p. 902). The exploratory research reported in this paper on suburban neighborhoods, however, suggests that the neighborhood may have effects that have not yet been fully examined. Two problems with the previous research are highlighted. First is the problem of the definition of neighborhood in contrast to community, a continuing problem in neighborhood research. The second is that this research has largely focused on urban neighborhoods; the success of adolescents in suburban neighborhood contexts has not been highlighted. The result is that the focus of these studies has been more on poverty; this paper, however, will focus on inequality in contrasting the situation of adolescents in white suburban neighborhoods to that found in the inner city.

Recently, the institutional performance model has been used to explain the increased distrust of health care system by arguing that distrust is a function of individuals’ perceptions on the quality of life in neighborhood and social institutions. We examined (1) whether individuals assess two dimensions of distrust consistently, (2) if the multilevel institutional performance model explains the variation of distrust across neighborhoods, and (3) how distrust patterns affect preventive health care behaviors.

Using data from 9,497 respondents in 914 census tracts (neighborhoods) in Philadelphia, we examined the patterns of how individuals evaluate the competence and values distrust using the Multilevel Latent Class Analysis (MLCA), and then investigated how neighborhood environment factors are associated with distrust patterns. Finally, we used regression to examine the relationships between distrust patterns and preventive health care.

The MLCA identified four distrust patterns: Believers, Doubters, Competence Skeptics, and Values Skeptics. We found that 55 percent of the individuals evaluated competence and values distrust coherently, with Believers reporting low levels and Doubters having high levels of distrust. Competence and Values Skeptics assessed distrust inconsistently. Believers were the least likely to reside in socioeconomically disadvantaged and racially segregated neighborhoods among these patterns. In contrast to Doubters, Believers were more likely to use preventive health care, even after controlling for other socioeconomic factors including insurance coverage.

Our findings suggest that distrust patterns are a function of neighborhood conditions and distrust patterns are associated with preventive health care. This study provides important policy implications for health care and future interventions.

This chapter addresses the complex problem of racial, ethnic, and economic segregation in the United States. How can pedagogy address this fundamental problem, by engaging students directly in efforts to dismantle segregationist housing policies? I begin by reviewing the history of public policies that have generated hypersegregation in American cities. I then describe a set of learning activities designed to help graduate students: (1) understand the ways in which we continue to segregate ourselves via public policy, (2) participate in the spheres in which such policy decisions are made, and (3) critically examine the role of our own institution in racialized neighborhood change. The learning activities presented include critical examination of exclusionary zoning policy; participation in public events, including protests, government hearings, and community meetings; and investigation into the complex causes of gentrification in a neighborhood adjacent to our University. Examples from student products are included. This chapter presents a series of novel learning activities designed to help students understand the real connections between public policy, structural racism, and housing opportunity. I present an approach to teaching that empowers students to participate actively in civic life.

This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).

A case study of the transformation at Fairview Medical Group’s primary care clinics was developed from interviews and first-person accounts of the change. Objective data regarding outcomes was used to evaluate the effectiveness of the redesign process.

The Fairview Medical Group developed an innovation and change capability to transform 35 primary care clinics in six months. All of the clinics were certified by the state of Minnesota as complying with their healthcare standards. Clinical outcomes, costs, and employee and physician engagement also increased. All of the improved measures are sustained.

Healthcare reform in the United States struggles because the organization design challenges are great and the change difficulties even greater. Fairview’s experience provides important evidence and lessons that can help advance our understanding of effective healthcare and create more sustainable healthcare systems. This chapter provides healthcare system administrators evidence and alternatives in the pursuit of implementation.

The purpose of this chapter is to advance the medical sociology literature on the relationship between social cohesion and SRHS on an individual level. There is little information about how neighborhood social characteristics affect seniors’ SRHS. Guided by tenets of the collective efficacy theory, this chapter hypothesized that older individuals who perceived that their neighborhood has high levels of social cohesion around elderly issues will have better SRHS. A secondary hypothesis investigates whether the relationship was attenuated once their neighbors’ actual, self-reported attitudes toward seniors were taken into account.

Data come from a telephone survey of Indianapolis, Indiana residents, court data, and census information.

Logistic regression analyses indicated that both social cohesion and low income are statistically significant predictors of poor self-rated health status. Although both are statistically significant, the protective association between cohesion and poor SRHS (−0.69 log odds) is of similar magnitude to the risky association between income and poor health (−0.64 log odds).

Consistent with the classic work of Durkheim who found that individuals who were more socially integrated with society had lower rates of suicide, our study found a significant association between social cohesion and SRHS.

Future research is needed to target other health status outcomes in other geographical locations. Even though the body of research exploring the predictors of SRHS among older individuals is quite robust, this chapter adds to a more recent growing body of research, which has articulated the importance of the social environment in which an individual lives, especially community-dwelling older adults, is associated with their health status.