Google Scholar. The effects of an integrated care intervention for the frail elderly on informal caregivers: a quasi-experimental study. UK studies found a reduction in out-patient appointments [31, 44, 53, 60, 67], however, the two international studies reporting this outcome found no significant effect. Impact of Quebecs healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up. Int J Integr Care. Paize F, White E, Heaf LJ, Baillie C, Kenny S, Couriel JM, et al. Addicott R, Dewar S. Improving choice at the end of life: a descriptive analysis of the impact and costs of the Marie curie delivering choice programme in Lincolnshire. Best A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large-system transformation in health care: a realist review. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. 2012;2 https://doi.org/10.1136/bmjopen-2012-000930. Part of Fagan P, Schuster A, Boyd C, Marstellar J, Griswold M, Murphy S. Chronic care improvement in primary care: evaluation of an integrated pay-for-performance and practice-based care coordination program among elderly patients with diabetes. Qual Saf Health Care. Simmons D, Yu D, Wenzel H. Changes in hospital admissions and inpatient tariff associated with a diabetes integrated care initiative: preliminary findings. A controlled trial of the multi-disciplinary doctor-nurse practitioner (MDNP) model. J Am Med Assoc. Susan Baxter. Study protocol. Our protocol allowed for meta-analysis if heterogeneity permitted. The merging companies expect certain benefits from the horizontal integration, but the hardware and software of either of the companies don't match up. However, some authors have emphasised that it is imperative to consider contextual differences before implementing the same models in different services and location [4]. Fuller RL, Clinton S, Goldfield NI, Kelly WP. Loader BD, Hardey M, Keeble L. Health informatics for older people: a review of ICT facilitated integrated care for older people. Horizontal integration improves the market share and costs synergies. List of Disadvantages of Vertical Integration. Breton M, Pineault R, Levesque JF, Roberge D, Da Silva RB. Of the included 54 UK articles, 16 reported findings from studies using higher quality comparator designs [25, 28, 30, 31, 34, 38, 40, 44, 49, 60, 63, 64, 67, 68, 71, 72]. Med Decision Making. The authors declare that they have no competing interests. 2014;22:6270. van der Marck MA, Munneke M, Mulleners W, Hoogerwaard EM, Borm GF, Overeem S, et al. This is what exactly called Ethnography. 2006;9:11126. Int J Qual Health Care. Bird SR, Noronha M, Kurowski W, Orkin C, Sinnott H. Integrated care facilitation model reduces use of hospital resources by patients with pediatric asthma. The system-wide impact on community and hospital-based services was unclear, with reports of both increased and decreased use of community services, although we identified no evidence to suggest that models of integrated care increase use of secondary care. J Am Geriatr Soc. Bird SR, Kurowski W, Dickman GK, Kronborg I. Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trials. What are the disadvantages of using an integrated approach? 2013;10 https://doi.org/10.1002/14651858.CD010414.pub2. 2018;18:5. J Health Serv Res Policy. Wilberforce M, Tucker S, Brand C, Abendstern M, Jasper R, Challis D. Is integrated care associated with service costs and admission rates to institutional settings? Emerg Med J. 2006;14:50820. In view of this challenge, we used strength of evidence ratings to summarise where greater or lesser certainty existed in the literature, considering quality, volume and consistency of the evidence identified. J Ambulat Care Manag. 2010;16:32633. Quality of care and health outcomes. Integrating physician Services in the Home: evaluation of an innovative program. de Bruin SR, Versnel N, Lemmens LC, Molema CC, Schellevis FG, Nijpels G, et al. New England J Med. J Obstet Gynaecol. Ettner SL, Kotlerman J, Afifi A, Vazirani S, Hays RD, Shapiro M, et al. Does an enhanced recovery integrated care pathway (ICP) encourage adherence to prescribing guidelines, accelerate postoperative recovery and reduce the length of stay for gynaecological oncology patients? A decade on: has the use of integrated care pathways made a difference in Lanarkshire? Service redesign: the experience of Newcastle diabetes service 2001-2007. Health Serv Manag Res. We therefore used comparator labels (stronger versus weaker), to provide a relative evaluation of strength. Arch Gerontol Geriatr. 2012;31:115666. Article A literature review. Hammar T, Rissanen P, Perl M. The cost-effectiveness of integrated home care and discharge practice for home care patients. London: Department of Health; 2012. Health Policy. Two systematic reviews reported that access to services had improved [76, 104]. Boult C, Reider L, Frey K, et al. Typically models contained four to six elements. BMC Health Serv Res. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. Beacon A. Practice-integrated care teams -- learning for a better future. 2010;33:7180. Med J Aust. J Gerontol A Biol Sci Med Sci. 2009;35:68190. Article 2010;24(8):82838. J Healthcare Qual. Chronic Respir Dis. 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London: National Audit . Palliat Med. Arch Gen Psychiatry. It is a simple, efficient way to integrate two apps. Rittenhouse DR, Shortell SM, Fisher ES. Discussions Economic Integration in Africa. Munn Z, Stern C, Aromataris E, Lockwood C, Jordan Z. J Am Geriatr Soc. The evidence was inconsistent regarding the impact on cost of provision (17 studies reported a reduction, two an increase and 20 no difference); community care activity (four studies reported a reduction, five an increase, and one no difference); secondary care activity (no studies reported an increase, four found a reduction, and two no difference); and overall healthcare utilisation (two systematic reviews found the evidence was unclear). If it doesn't, the following disadvantages would happen; No Benefits. Abdul AA, Muhammad NA, Sulong S, Aljunid S. The integrated care pathway for managing post stroke (iCaPPS) patients in the community: a cost-effectiveness analysis. PubMed Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. Some of the arguments for integrative curriculum include: There is not enough time in the day to teach everything in isolation. Three outcomes appeared to offer stronger evidence of effect: firstly, that integrated care leads to increased patient satisfaction; secondly, that integration increases perceived quality of care; and thirdly, that integrated care increases patient access to services. 2016;176:116775. BMC Health Serv Res. 2013;30:26675. A retrospective analysis. 2012;29:20812. By using this website, you agree to our Terms and Conditions, 2013;18:110. Health Policy. PubMed 2010;56:e209. Other iterative searching techniques were also employed, including hand searching of reference lists of primary studies and other reviews. One particular limitation relates to the lack of statistical summary of effectiveness (meta-analysis) although we would argue that not only did the heterogeneity of interventions and outcomes preclude this type of analysis, but also, in exploring the complexity of the area a strength of evidence approach was beneficial. Pearson V, Chant S. Different models of health and social care in Devon -- observations and implications for commissioners and providers. Offredy M, Cleary M, Bland A, Donovan A, Kelshiker A. 2009;361:23013. Soljak M, Cecil E, Gunn L, Broddle A, Hamilton S, Tahir A, et al. There have been calls for greater clarity regarding precisely how integration may impact on outcomes [5]. We also looked for any patterns in regard to the type of initiatives that appeared to lead to more positive outcomes, with little clarity in signal beyond suggesting that integrated pathways as stand alone interventions may have a limited effect. J Diabetes. Royal College of Nursing: Edinburgh; 2011. PREFER: a randomized controlled study. Kinley J, Froggatt K, Bennett MI. Schizophr Bull. J Integr Care. 2009;301:60318. Martinez-Gonzalez NA, Berchtold P, Ullman K, Busato A, Egger M. Integrated care programmes for adults with chronic conditions: a meta-review. After independent screening and discussion of the first 5% of the database to establish agreement, further screening was carried out by a single reviewer, with checking of a 10% sample by other team members. Boult C, Green AF, Boult LB, Pacala JT, Snyder C, Leff B. Randomized controlled trial of anticipatory and preventive multidisciplinary team care: for complex patients in a community-based primary care setting. The effect of the Liverpool care pathway for the dying: a multi-Centre study. SA HealthPlus: a controlled trial of a statewide application of a generic model of chronic illness care. Brown RS, Peikes D, Peterson G, SchoreJ RCM. Double counting was avoided by noting where included primary studies were also contained in included systematic reviews. Other findings from this study including factors influencing implementation and outcomes are reported elsewhere (Baxter et al. 2014;44:57785. PubMedGoogle Scholar. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. Wedel R, Kalischuk RG, Patterson E, Brown S. Turning vision into reality: successful integration of primary healthcare in Taber, Canada. Multidisciplinary group performance-measuring integration intensity in the context of the north West London integrated care pilot. A case study of eight Partnership for Older People Projects (POPP). 2008;8:193. The effects of integrated care: a systematic review of UK and international evidence. It is argued that increased service integration will enable the achievement of a financially sustainable health and social care system in the NHS by 2020. BMC Health Serv Res. J Integrat Care. Cost analysis of the geriatric resources for assessment and Care of Elders care management intervention. 2009;57:14206. Huntley AL, Thomas R, Mann M, Huws D, Elwyn G, Paranjothy S, et al. We examined the data regarding outcomes and impacts for studies in the two largest sub-groups of patients - older adults, and populations described as having complex needs. 1) Enhance the Competitive Advantage. Disadvantages Of Integrated Care. 2011;34:15262. 2014;17:A761. Belanger E, Rodriguez C. More than the sum of its parts? Integrated care can mean different things to different people. Paulus A, van Raak A. 2013;13:528. Khanna N, Shaya F, Chirikov V, Steffen B, DisVonk-Okhuijsen SY SD, Tjan-Heijnen VG, Verhagen AF, et al. Salmon RB, Sanderson MI, Walters BA, Kennedy K, Flores RC, Muney AM. Another disadvantage is that social studies can be perceived as dry and boring by some students. Our evaluation therefore draws on work by Hoogendoom [17], together with principles from the GRADE and CERQUAL rating schemes [16, 18], and our work from a previous systematic review with diverse evidence [19] to indicate a rating of strength (certainty) for each reported outcome across the included studies. Int J Evidence-Based Healthcare. Janse B, Huijsman R, Fabbricotti I. Laver K, Lannin NA, Bragge P, Hunter P, Holland AE, Tavender E, et al. Roberts S, Unadkat N, Chandok R, Sawtell T. Learning from the integrated care pilot in West London. Int J Evidence-Based Healthcare. 2013;69:14452. Int J Integrat Care. London: OPM Group; 2014. Windle K, Wagland R, Forder J, DAmico F, Janssen D, Wistow G. National Evaluation of partnerships for older people projects, final report. The extraction form for systematic review included number of studies in the review, together with details of the inclusion criteria. 2008;9:713. Child: Care, Health Devel. National Evaluation of the Department of Healths integrated care pilots. Open Document. We included studies reporting any outcome relating to the delivery of services (effectiveness or efficiency or quality) and/or the effect on patients and staff delivering services. 2014;14:140. Integrated hospital emergency care improves efficiency. Article Case management for elderly patients at risk of hospital admission: a team approach. Boyle A, Fuld J, Ahmed V, Bennett T, Robinson S. Does integrated emergency care reduce mortality and non-elective admissions? Milbank Q. CAS Answer: Greetings, Integrating Social Studies elements offers the opportunity to provide relevance. Battersby M, Harvey P, Mills PD, Kalucy E, Pols RG, Frith PA, et al. Integrated multidisciplinary care in Parkinson's disease: a non-randomised, controlled trial (IMPACT). Economic evaluation of an integrated care programme for patients with hand dermatitis. Levelt E, Thwaites B, Yadegarfar G. Integrated care pathway for acute coronary syndromes: does it help? 2007;16(2):1105. A cost-effectiveness study of a patient-centred integrated care pathway. Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review. 2013;13:e003. Four of six international comparator studies similarly reported increased satisfaction amongst older, acute and paediatric patient populations following service integration, case management and patient-centred medical home interventions [119, 136, 150, 159]. BMJ Support Palliat Care. Completed quality appraisals. In contrast to the wider evidence base however, the evidence on patients described as having complex needs, suggested a stronger indication of positive outcomes in terms of reduced admissions and emergency department use, and weaker strength of evidence regarding reduced length of stay. All authors read and commented on drafts of the manuscript. Shifting the balance of care: great expectations. BMJ Open. Grant MJ, Booth A. This paper focuses on data relating to the effects of models of integrated care on actual and perceived service delivery, including the efficiency, effectiveness and quality of care. Lancet Neurol. Johansson G, Eklund K, Gosman-Hedstrom G. Multidisciplinary team, working with elderly persons living in the community: a systematic literature review. 2007;334:31. UK studies indicated evidence of a reduction in waiting times and out-patient appointments, although the international literature as a whole was more inconclusive. In regard to similarities and differences between studies carried out in the UK and in other countries, we found three areas of variance in rating between UK evidence and the evidence overall. Alexander JA, Bae D. Does the patient-centred medical home work? J Integr Care. BMC Geriatr. Theodoridou A, Hengartner M, Gairing S, Jager M, Ketteler D, Kawohl W, et al. Stewart MJ, Georgiou A, Westbrook JI. 2013;13:262. Petticrew M, Rehfuess E, Noyes J, Higgins J, Mayhew A, Pantoja T, et al. 2011;171:4606. 2014;33(1):95102. Boyle AA, Ahmed V, Palmer CR, Bennett TJ, Robinson SM. 2014;44:479505. 1035 Words. This can make it harder for some students to engage with the material and find it meaningful. Beland F, Hollander MJ. (DOCX 197 kb), Table S1. Allen D, Rixson L. How has the impact of care pathway technologies on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? Curriculum development describes how a training or teaching organization plans and guides learning. 2011;15:11108. While there appeared to be no clear pattern of differential outcomes between settings or initiatives, there appeared to be potential for more positive outcomes amongst those categorised by authors as having complex needs, although currently most research evidence comes from studies in older adults. Google Scholar. Mobile technology continues to change and evolve the way people and society function in their everyday lives. Health Aff. 2014;26:56170. See Fig. BMC Health Serv Res. The potential for integrated services to increase patient contacts, is a particular concern in already over-stretched services.
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