Case 5: Integrated care Flashcards
What is integrated care (IC)?
concept of bringing together inputs, delivery, management & organisation of services related to diagnosis, treatment, care, rehabilitation & health promotion
What does it mean when IC is referred to as an ‘umbrella term’ or ‘conceptual soup’?
- IC is used as an ‘umbrella term’ for a wide variety of concepts and organisational structures
- Conceptual soup: mix of different concepts, contexts
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What does IC require?
- collaboration between many stakeholders
- These stakeholders may have different, even competing, interests which makes collaboration difficult
What is a major problem of health systems in highly developed countries?
increasing demand of HC expenditures caused by ageing chronic patients with both physical & cognitive problems
*What can IC improve?
- cost
- efficiency
- quality of care
What patient groups can benefit from IC?
- Multimorbid patients with 2 (+) chronic diseases
- Patients with mental health conditions
- Elderly patients
They consume highest amount of HC resources & require most coordinated care (i.e. have a high economic burden)
What 3 levels are part of the Goddard model?
3 “levels” defined by the group to whom care is delivered:
- Macro
- Meso
- Micro
Explain the macro level of the Goddard model
providers deliver IC across full spectrum of services to entire population
Explain the meso level of the Goddard model
care delivered to particular sub-populations (eg, older people, mental health)
Explain the micro level of the Goddard model
care delivered to individual service users & their carers (eg, through care coordination & planning)
What is horizontal integration (Grattani model)
IC applied at various services delivered at the same clinical stage
What is vertical integration (Grattani model)
- IC brings together services at different stages of care
- Takes patients from first contact → specialist → ongoing care.
What is functional integration (FI)?
Mechanisms by which financing, information & management (FIM) modalities are linked to add the greatest overall value to the system.
What is normative integration (NI)?
development & maintenance of a common frame of reference (i.e. shared mission, vision, values & culture) between organisations
What is the rainbow model of integrated care (RMIC)?
- Conceptual framework for IC based on integrative functions of primary care (rainbow model)
What are the benefits of IC?
- Better access & preventive care
- improved satisfaction & experience
- reduced avoidable hospital & emergency admissions
- improved health status
- improved QoL
What problems does IC try to solve?
- Fragmentation
- Duplication
- Poor coordination of care
What is value?
- an economic term.
- used in VBHC
- degree of success shown by provider in meeting needs of clients, relative to costs
What are values?
- organisational term
- Can be defined as meaningful beliefs, principles or standards of behaviour referring to desirable goals that motivate action
What are 5 common characteristics of values?
- values are concepts or beliefs.
- values refer to desirable goals, end states or behaviours.
- values go beyond specific situations & objects - values relevant in multiple contexts: in personal relationships, work, politics
- values used in selection/evaluation of events, policies or behaviour.
- values are ordered by relative importance.
What are enablers of IC?
- Professional & cultural enablers
- Organisational enablers
- Policy enablers
What are professional & cultural enablers for IC?
- common purpose & vision
- shared professional values
- shared culture
- strong leadership
What are organisaitonal enablers for IC?
- involvement of staff at all levels
- ability to share data across organisations
- incentives for collaboration
- trained and engaged workforce.
What are policy enablers for IC?
- payment mechanisms supporting cross-organisational care
- consistent regulatory policies
- political will to support appropriate structural changes
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What are barriers of IC?
- Disease-centred ?
- IC initiatives could reveal ‘unmet needs’ of multimorbid patients within & beyond HC = extra costs rather than savings.
- Division, decentralisation & specialisation can impact effectiveness & efficiency of IC
- Lots of costs and complexity - regulatory challengers and cultural inertia
- Insufficient IT infrastructure
How to achieve IC?
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- identification & targeting of a specific patient population
- Achieving IC is challenging & highly context dependent. NO one-size-fits-all solution
How can integration of service be achieved according to the rainbow model?
- system integration
- institutional (organisational) integration
- professiona integration
- service (clinical) integration
What pillars does the framework contain?
- Key elements of primary care
- Dimension of integrated care
- combination of key elements & dimensions
What are 2 features in the key elements of primary care?
rainbow model
- Person-focused care
- Population-based care
What is person-focused care?
reflects a biopsychosocial perspective of health which acknowledges that health problems are not synonymous to biology alone bridging the gap between medical and social problems
What is population based care?
based on personal preferences, needs and values which recognises a need to understand the personal meanings behind an illness
What are the dimensions of IC?
pillar rainbow model
- Macro level / system integration
- Meso level / organisational integration
- Meso level / proffessional integration
- Micro level / clinical integration
Explain the macro level / system integration
rainbow model
- refers to alignment of rules & policies in health system.
- includes horizontal & vertical integration
Explain the meso level / organisational integration
extent to which organisations coordinate services across different organisational boundaries
Explain meso level / professional integration
partnerships within & between different organisations
Explain the micro level / clinical integration
- extent to which care services are coordinated across various professional, institutional and sectoral boundaries
- Integration based on person-focused care
How to combine key elements & dimensions
pillar 3 of rainbow model
FI & NI supports & links clinical (micro-level), professional & organisational integration (meso-level) dimensions within a system (macro-level).
