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Article

Bengt Ahgren

It seems impossible to create a comprehensive evaluation model which fully takes into account the multi‐dimensional context of integrated health and social care. Clinical…

Abstract

It seems impossible to create a comprehensive evaluation model which fully takes into account the multi‐dimensional context of integrated health and social care. Clinical integration, as a prerequisite for efficient outcomes of integration, must nonetheless get special attention. For more extensive evaluations, a quality chain matrix, including co‐operating acts by different providers, has proven to be useful. Examples of evaluated services in Sweden are given, and the management benefits of the use of evaluation data are highlighted.

Details

Journal of Integrated Care, vol. 15 no. 6
Type: Research Article
ISSN: 1476-9018

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Article

Angus Ramsay, Naomi Fulop and Nigel Edwards

This paper reviews the evidence base for vertical integration in health care. We describe its impact on organisational structures, on how services are provided, and on…

Abstract

This paper reviews the evidence base for vertical integration in health care. We describe its impact on organisational structures, on how services are provided, and on such outcomes as cost, clinical outcomes and patient experience. We also outline conditions that support successful integration.

Details

Journal of Integrated Care, vol. 17 no. 2
Type: Research Article
ISSN: 1476-9018

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Article

Chris Ham and John Oldham

This paper reports on experience in making use of Health Act flexibilities and care trusts. Three areas were chosen for study because they were known to have attached…

Abstract

This paper reports on experience in making use of Health Act flexibilities and care trusts. Three areas were chosen for study because they were known to have attached priority to health and social care integration and were at the leading edge of development. Drawing on discussions at a series of seminars at which the experience of each area was presented and reviewed, the paper identifies a number of emerging lessons for the future of integration in a context in which the Government has established a Minister‐led review to explore what more needs to be done to encourage integration.

Details

Journal of Integrated Care, vol. 17 no. 6
Type: Research Article
ISSN: 1476-9018

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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

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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

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Article

Axel Kaehne, Derek Birrell, Robin Miller and Alison Petch

The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland…

Abstract

Purpose

The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland and England and offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy.

Design/methodology/approach

The paper is written as a piece of critical reflection by drawing on the authors’ knowledge and expertise and wider evidence where available.

Findings

Since 2010, HSC integration has started to diverge significantly in the four constituent countries of the UK. Although England and Wales have undergone considerable re-organisation of the NHS, Scotland and Northern Ireland have largely been marked by organisational continuity. However, beyond organisational differences, policy approaches, policy emphases and implementation strategies have also started to show considerable dissimilarity across the UK. An important contributory factor may be different ideological perspectives on the role of competition and pilots, partnership, patient choice and organisational incentives to bring about change in the field.

Research limitations/implications

The paper identifies a serious lack of comparative research in integration policy, despite the considerable opportunities for quasi-experimental studies. This lack of empirical research impedes shared learning across the home nations.

Originality/value

The paper presents a descriptive comparison of current integration policy between HSC providers in the four home nations. It reveals considerable opportunities for further research and comparative modelling of integration approaches.

Details

Journal of Integrated Care, vol. 25 no. 2
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

Content available
Article

Antti Peltokorpi, Juri Matinheikki, Jere Lehtinen and Risto Rajala

To investigate the effects of payor–provider integration on the operational performance of health service provision. The research explores whether integration governs…

Abstract

Purpose

To investigate the effects of payor–provider integration on the operational performance of health service provision. The research explores whether integration governs agency problems and tilts the incentives of diverse actors toward more systematic outcomes.

Design/methodology/approach

A two stage multimethod case study of occupational health services. A qualitative stage aimed to understand the reasons, mechanisms, and outcomes of payor–provider integration. A quantitative stage evaluated the performance of the integrated hospital against fee-for-service partner hospitals with a sample of 2,726 patients.

Findings

Payor–provider integration mitigates agency problems on multiple levels of the service system by complementing formal governance mechanisms with informal mechanisms. Compared to partner hospitals, the integrated hospital yielded 9% lower the total costs of occupational injuries achieved primarily by emphasizing conservative care and faster recovery.

Research limitations/implications

Focuses on occupational health services in Finland. Provides initial evidence of the effects of payor–provider integration on the operational performance.

Practical implications

Vertical integration may provide systematic outcomes but requires mindful implementation of multiple mechanisms. Rigorous change management initiative is advised.

Social implications

For patients, the research shows payor–provider integration of health services can be implemented in a manner that it reduces care costs while not compromising care quality and customer satisfaction.

Originality/value

This study provides a rare longitudinal analysis of payor–provider integration in health-care operations management. The study adds to the knowledge of operational performance improvement of health services.

Details

International Journal of Operations & Production Management, vol. 40 no. 4
Type: Research Article
ISSN: 0144-3577

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Article

Vidhya Alakeson

The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or…

Abstract

Purpose

The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care coordination. The paper illustrates the potential for integration through the experience of the personal health budgets pilot programme.

Design/methodology/approach

This paper is based on a review of the experience of personal health budget pilot sites, drawing on the national evaluation of the pilot programme and the author's experience of working with pilot sites between 2010 and 2013. It also draws on the experience of similar programmes in the USA.

Findings

Personal health budgets support integration in two distinct ways. First, they can support the delivery of more holistic, whole‐person care in line with the principles of shared decision making. Second, by bringing personal budgets in social care and personal health budgets together, they can provide a vehicle for integration across health and social care systems. If integration starts from, and responds to, what matters most to individuals rather than with the development of joint structures and processes, the result is more likely to be integrated care.

Originality/value

This is one of only a small number of papers that discusses the scope for personal health budgets to improve the integration of care. Integration between the NHS and social care, in particular, has been identified as a central priority for the NHS.

Details

Journal of Integrated Care, vol. 21 no. 4
Type: Research Article
ISSN: 1476-9018

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Article

Jill Manthorpe and Steve Iliffe

The purpose of this paper is to discuss the different meanings of integration as expressed in dementia care practice and service organisation in England. Dementia is…

Abstract

Purpose

The purpose of this paper is to discuss the different meanings of integration as expressed in dementia care practice and service organisation in England. Dementia is frequently complicated by concurrent illnesses or long-term conditions at the end of life.

Design/methodology/approach

This is a policy discussion.

Findings

The paper describes three forms of integration: linkage, co-ordination of care, and full integration. Each form or level is related to dementia as a progressive neurological disorder with multiple symptoms, which also overlaps with other long-term conditions, making each individual’s dementia unique. Linkage means being able to identify appropriate resources to meet the needs of the individual and their family. Co-ordination usually means multi-disciplinary working at least with general practice and often wider practitioner input. Full integration is best expressed by the work of care homes, which co-ordinate care and often draws on diverse funding streams.

Practical implications

Greater specificity of the meaning of integration may be helpful to policy makers and practitioners. The care and treatment of people with dementia may be optimised if practitioners think about work styles and engagement with other sectors, agencies and professionals rather than pursuing all-encompassing organisational integration. Care homes may have much to teach other practice settings about full integration.

Originality/value

Integration is often seen uncritically as the solution to all problems; this paper explores the varieties of integration and explores their implications for practitioners and policy makers supporting people with dementia and their carers.

Details

Journal of Integrated Care, vol. 25 no. 4
Type: Research Article
ISSN: 1476-9018

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