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Journal of Integrated Care
Journal Prestige (SJR): 0.275
Citation Impact (citeScore): 1
Number of Followers: 18  
 
Hybrid Journal Hybrid journal   * Containing 9 Open Access Open Access article(s) in this issue *
ISSN (Print) 1476-9018 - ISSN (Online) 2042-8685
Published by Emerald Homepage  [360 journals]
  • Integrated care with digital health innovation: pressing challenges

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      Authors: Kanchan Pant , Meena Bhatia , Ranjan Pant
      Abstract: Digital health care has emerged as one of the most important means to deliver integrated care by care providers in recent years. As the use of digital health increases, there are some pressing issues such as interoperability of data across different healthcare information systems, regulatory environment and security and privacy of patient’s information which need to be discussed and addressed in order to reduce information silos and to ensure efficient and seamless use of digital health technologies. The purpose of this paper is to address these issues. In this paper the authors outline the key concepts of interoperability, key challenges pertaining in achieving interoperability and concepts of security and privacy in context of digital health models of integrated care. The study suggests that standardization of digital health information systems and connecting existing systems to health network, addressing privacy and security related issues through a comprehensive but supportive regulatory environment and educating citizens and healthcare providers are some of the ways to achieve effective use of digital health in models of integrated care. Although the concepts of privacy and interoperability are not new, however, as per best of the authors’ knowledge, this is the first attempt to discuss the challenges and possible actions to meet the objective of achieving integrated care through digital innovation.
      Citation: Journal of Integrated Care
      PubDate: 2022-09-20
      DOI: 10.1108/JICA-01-2022-0008
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • The ‘Service Transformation Outline’ toolkit to assist in the design,
           comparison and replication of integrated care programmes

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      Authors: Angelo Rossi Mori
      Abstract: The author is introducing a toolkit that can assist stakeholders to design, compare and replicate integrated care programmes, by making explicit their view on the transformations of care and cure services, according to a structured template. The purpose of this paper is to address this issue. The toolkit is made of two elements: a classification and a template. The author adopted a step-wise approach of semantic modelling to work out three layers of a classification in the domain of integration needs related to care and cure services. The third layer consists of 23 non-overlapping classes that fully cover that semantic domain. The classes are used to build a template to elicit the stakeholder's standpoint about the transformations involved in the deployment of a programme. The result is the «Outline» of the programme. So far, in eight years the author applied the toolkit to 100+ programmes either to design, simulate or evaluate them, either to compare them to similar ones in the same or in different jurisdictions, and we refined the description of the classes according to that experience. The objective of the toolkit is not to provide solutions, but to stimulate reflections on the transformations involved in a programme and their practical consequences in a precise context. In fact, the Outlines cannot be generalized: they are conceived to reflect the perspective of the stakeholders and thus are intrinsically subjective; in addition, they must be contingent, as they must depend on the local context in the particular timeframe. In case of similar initiatives in other localities, the Outlines must be filled in again by the local stakeholders; however, a subsequent comparison could help to explore similarities and motivated differences. Ideally the stakeholders should use the Outline of the actual transformations in a programme as a reference to mediate between the principles and the methodologies provided by the «Models» and «Conceptual Frameworks» in the literature (e.g. Chronic Care Model, Rainbow Model, Development Model of Integrated Care Patient-Centered Medical Home and Maturity Models) and the deeper studies using the specific tools developed in their disciplines (e.g. on information modelling, process modelling, cost–benefit analysis and health technology assessment). The toolkit could have its role also in a multi-annual roadmap made of a sequence of programmes to cope with the urgent challenges on ageing, social changes and technological evolution, in synergy with regulations, budget, context maturity, critical success factors and local priorities. The author argues that the approach of the structured Outline is unique, as the scoring mechanism to assess the relevance of the transformation within each class on the overall change brought by the whole programme into the health systems.
      Citation: Journal of Integrated Care
      PubDate: 2022-09-20
      DOI: 10.1108/JICA-01-2022-0009
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • An analysis of a novel Canadian pilot health information exchange to
           improve transitions between hospital and long-term care/skilled nursing
           facility

         This is an Open Access Article Open Access Article

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      Authors: Tyler Aird , Ceara Holditch , Sarah Culgin , Margareta Vanderheyden , Greg Rutledge , Carlo Encinareal , Dan Perri , Fraser Edward , Hugh Boyd
      Abstract: The purpose of the article is to assess the effectiveness, compliance, adoption and lessons learnt from the pilot implementation of a data integration solution between an acute care hospital information system (HIS) and a long-term care (LTC) home electronic medical record through a case report. Utilization statistics of the data integration solution were captured at one-month post implementation and again one year later for both the emergency department (ED) and LTC home. Clinician feedback from surveys and structured interviews was obtained from ED physicians and a multidisciplinary LTC group. The authors successfully exchanged health information between a HIS and the electronic medical record (EMR) of an LTC facility in Canada. Perceived time savings were acknowledged by ED physicians, and actual time savings as high as 45 min were reported by LTC staff when completing medication reconciliation. Barriers to adoption included awareness, training efficacy and delivery models, workflow integration within existing practice and the limited number of facilities participating in the pilot. Future direction includes broader staff involvement, expanding the number of sites and re-evaluating impacts. A data integration solution to exchange clinical information can make patient transfers more efficient, reduce data transcription errors, and improve the visibility of essential patient information across the continuum of care. Although there has been a large effort to integrate health data across care levels in the United States and internationally, the groundwork for such integrations between interoperable systems has only just begun in Canada. The implementation of the integration between an enterprise LTC electronic medical record system and an HIS described herein is the first of its kind in Canada. Benefits and lessons learnt from this pilot will be useful for further hospital-to-LTC home interoperability work.
      Citation: Journal of Integrated Care
      PubDate: 2022-09-19
      DOI: 10.1108/JICA-03-2022-0022
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Data and care integration for post-acute intensive care program of stroke
           patients: effectiveness assessment using a disease-matched comparator
           cohort

         This is an Open Access Article Open Access Article

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      Authors: Emili Vela , Aina Plaza , Gerard Carot-Sans , Joan Carles Contel , Mercè Salvat-Plana , Marta Fabà , Andrea Giralt , Aida Ribera , Sebastià Santaeugènia , Jordi Piera-Jiménez
      Abstract: To assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration. The RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data. The study included 92 stroke patients attended within the RHP program and the patients' matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group. The authors' analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals (thus avoiding redundant assessments) but also to monitor health and resource use outcomes of care delivery.
      Citation: Journal of Integrated Care
      PubDate: 2022-09-12
      DOI: 10.1108/JICA-12-2021-0062
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Human-centered integrated care pathways for co-creating a digital,
           user-centric health information solution

         This is an Open Access Article Open Access Article

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      Authors: Eva Turk , Viola Wontor , Cecilia Vera-Muñoz , Lucia Comnes , Natercia Rodrigues , Giovanna Ferrari , Anne Moen
      Abstract: A broader challenge of co-creating digital solutions with patients addresses the question how to apply an open-access digital platform with trusted digital health information as a measure to transform the way patients access and understand health information. It further addresses use this for adherence to treatment, risk minimization and quality of life throughout the integrated patient journey. The aim of this paper is to demonstrate the early steps in towards progress to co-creating the digital solution. To coordinate the co-creation process, the authors established a multiphased plan to deep-dive into user needs and behaviors across patient journeys, to identify nuances and highlight important patterns in stakeholder and end-user segment at various stages in the patient's journey. A set of tools was designed to serve as a human-centered compass throughout the lifecycle of the project. Those tools include shared objects; personas, user journeys, a set of performance indicators with related requirements – all those tools being consistently refined in ongoing co-creation workshops with members of the cross-functional stakeholder groups. In this study, a multidisciplinary, public-private partnership looked at integrated digital tool to improve access, understanding and adherence to treatment for diverse groups of patients across all stages of their health journeys in a number of countries including European Union (EU) and United States of America (USA). As a result of this work, the authors attempt to increase the possibility that the improved availability and understanding of health information from trusted sources translates to higher levels of adherence to treatment, safer use of medication (pharmacovigilance), better health outcomes and quality of life integrated in the patient's journey.
      Citation: Journal of Integrated Care
      PubDate: 2022-09-06
      DOI: 10.1108/JICA-01-2022-0007
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • “Unchaining the doctor from the desk”: deliberate
           team-based care in action

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      Authors: Caroline Robertson , Tabitha Jones , Philippa Southwell
      Abstract: As a model of integrated care (IC), deliberate team-based care (DTBC) can help address workforce shortages facing rural communities by improving the health and wellbeing of healthcare providers. This study focuses on a GP practice implementing DTBC in rural Australia. The aim of this research was to understand the perspectives of the healthcare workers involved and to ascertain factors impacting on the day to day running of the model, patient care and clinician work-life. The authors conducted a qualitative study on the experiences of the DTBC workers. Team members were invited to participate in semi-structured interviews (n = 9). Interviews were analysed using an iterative thematic analysis, summarised, collated and explored for emergent themes. Key themes included: creating change from old ways of doing things, development and implementation processes outlining how the model evolved and how it ran from day to day, model outcomes for patients and clinicians, as well as practical considerations like funding, technology and time. Building DTBC from the ground up has produced a high functioning team who demonstrate trust and equality, share information freely and all have a voice which is heard and respected. By acting as a champion and a leader, the GP has created a psychologically safe environment allowing the team to share knowledge, collaborate in problem solving and provide effective patient care which is holistic and community grounded. This work environment holds promise for creating improved work-life for rural clinicians and potential for workforce retention.
      Citation: Journal of Integrated Care
      PubDate: 2022-08-23
      DOI: 10.1108/JICA-03-2022-0020
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Personalized care with mass production efficiency: integrating care with a
           virtual care operator

         This is an Open Access Article Open Access Article

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      Authors: Paul Lillrank , Fares Georges Khalil , Annika Bengts , Perttu Kontunen , An Chen , Satu Kaleva , Paulus Torkki
      Abstract: This article aims to describe the thinking behind MASSE, a project in Finland that helps address the fragmentation of care and patient journey disruptions for long-term care. It outlines the conceptualization of an information technology (IT)-assisted solution and presents preliminary findings and research problems in this ongoing project. The project employs a service engineering and design science approach with the objective of addressing chronic and multimorbid patients in specialized multiprovider environments. It does this by applying information and communication technologies and organizational design. The project has been a cocreative effort with ongoing interviews and workshops with various stakeholders to inform the conceptualization of a solution, an intermediary step before the implementation phase. Patient journey disruptions occur when caregivers do not know what to do in specific situations. A potential solution is a virtual care operator (VCO) with a personalized patient card that would enable service ecosystem actors to integrate and coordinate their tasks. This article presents the basic design principles of such a solution. Conceptual ideas and preliminary results only indicative. Systemic integration efforts like those ongoing in Finland can benefit from the VCO concept encouraging a more collaborative way of thinking about integrative solutions and opening up new avenues of research on business implications and ecosystem strategies. The VCO concept answers to the continuity of care, the rising costs of health care and the growing numbers of patients with chronic disease and multimorbidity whose care remains fragmented and uncoordinated. Taking an ecosystem approach to care integration and addressing interoperability issues are on the cutting edge of healthcare system transformation.
      Citation: Journal of Integrated Care
      PubDate: 2022-08-18
      DOI: 10.1108/JICA-01-2022-0006
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • A qualitative exploratory study of training requirements for general
           practitioners attending older people resident in care homes

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      Authors: Sarah Ruaux , Neil Chadborn
      Abstract: Older people who reside in care homes have varying access and quality of medical care; in the UK, this is provided by general practitioners (GPs). The authors aimed to explore the experiences of trainee GPs in delivering integrated care and discuss, with senior GPs, opportunities to improve training. Two trainees and thirteen senior GPs were recruited through professional networks and participated in semi-structured interviews. Transcriptions were analysed using thematic analysis, and the theory of negotiated order was used to interpret findings. Trainees received no specific training on working with care homes. Exposure to the care home setting was variable, and could be negligible, depending on the GP practice placement. Senior GPs expressed concerns about patient safety, due to practical challenges of the consultation and a sense of lack of control. Considering the theory of negotiated order, where GPs had trusting relationships with care home staff, the input of the staff could mitigate the sense of risk. Care plans could communicate needs and preferences within the team and may be a way of extending the negotiated order, for example giving care homes authority to implement end-of-life care when the GP is not present. The authors identified a need for trainees to engage with the organisational aspect of the care home to deliver integrated care. Trusted relationships with staff led to improved consultations, care plans, and better management of risk. This is the first study of learning needs for GP trainees to provide integrated care for older care home residents.
      Citation: Journal of Integrated Care
      PubDate: 2022-08-12
      DOI: 10.1108/JICA-11-2021-0060
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • A maturity model framework for integrated virtual care

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      Authors: ChiLing Joanna Sinn , Zain Pasat , Lindsay Klea , Sophie Hogeveen , Ceara Holditch , Carrie Beltzner , Andrew Costa
      Abstract: Remote patient monitoring (RPM) and virtual visits have the potential to transform care delivery and outcomes but require intentional planning around how these technologies contribute to integrated care. Since maturity models are useful frameworks for understanding current performance and motivating progress, the authors developed a model describing the features of RPM that can advance integrated care. This work was led by St. Joseph's Health System Centre for Integrated Care in collaboration with clinical and programme leads and frontline staff offering RPM services as part of Connected Health Hamilton in Ontario, Canada. Development of the maturity model was informed by a review of existing telehealth maturity models, online stakeholder meetings, and online interviews with clinical leads, programme leads, and staff. The maturity model comprises 4 maturity levels and 17 sub-domains organised into 5 domains: Technology, Team Organisation, Programme Support, Integrated Information Systems, and Performance and Quality. An implementation pillars checklist identifies additional considerations for sustaining programmes at any maturity level. Finally, the authors apply one of Connected Health Hamilton's RPM programmes to the Team Organisation domain as an example of the maturity model in action. This work extends previous telehealth maturity models by focussing on the arrangement of resources, teams, and processes needed to support the delivery of integrated care. Although the model is inspired by local programmes, the model is highly transferable to other RPM programmes.
      Citation: Journal of Integrated Care
      PubDate: 2022-08-05
      DOI: 10.1108/JICA-02-2022-0015
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Interdependencies or integration' A qualitative evaluation of a
           national emergency department improvement programme

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      Authors: Katie Jones , Jaynie Y. Rance
      Abstract: In Wales (United Kingdom (UK)), a programme known as the emergency department quality and delivery framework (EDQDF) was launched in 2018 with the purpose of designing a framework of what good looks like for emergency care and then implementing this framework in a measurable and sustainable way. A gatekeeper emailed attendees of the EDQDF launch event (n = 70), providing recipients with an information sheet and inviting them to contact the researcher (KJ) if they agreed to be interviewed. The authors conducted semi-structured interviews with all respondents (n = 8) after three invitation rounds sent between August and October 2021. The authors used a thematic analysis approach (Braun and Clarke, 2006). Participants agreed with the aims and design of the framework, and the authors identified four themes relating to barriers and to facilitators of implementation. Participants perceive a softening of geographical boundaries through the project, but findings correspond with evidence generated elsewhere regarding emergency departments’ (EDs') system-wide interdependencies and a need for cross-organisational collaboration. A quality improvement method for health services known as CAREMORE® is found to be a useful approach for the collaborative design of service improvements. Participants perceive a softening of geographical boundaries through the project, but the interviews correspond with evidence generated elsewhere regarding EDs' system-wide interdependencies and a need for cross-organisational collaboration. This evaluation relies on a relatively small number of participants, but as a qualitative evaluation it does not aim towards broadly generalisable findings but rather contributes to broad field concerned with the production of knowledge on the implementation of health service improvements. The project under evaluation is also on-going, and the findings reflect the period from inception to December 2021, but not beyond that date. This evaluation builds upon previous work in relation to the application of CAREMORE to design a quality improvement framework in a complex area (see Nelson et al., 2018), but this evaluation considers the implementation process. The findings echo research elsewhere and add to a growing body of research that underlines system interconnectivities that impact upon the emergency department.
      Citation: Journal of Integrated Care
      PubDate: 2022-08-04
      DOI: 10.1108/JICA-04-2022-0026
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • What role can education play in integrated care' Lessons from the ECHO
           (Extensions for Community Health Outcomes) Concussion program

         This is an Open Access Article Open Access Article

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      Authors: Q. Jane Zhao , Nathan Cupido , Cynthia R. Whitehead , Maria Mylopoulos
      Abstract: Design, implementation, and evaluation are all important for integrated care. However, they miss one critical factor: education. The authors define “integrated care education” as meaningful learning that purposefully supports collaboration and the development of adaptive expertise in integrated care. The ECHO (Extensions for Community Health Outcomes) model is a novel digital health solution that uses technology-enabled learning (TEL) to facilitate, support, and model integrated care education. Using ECHO Concussion as a case study, the authors describe the effects of technology-enabled integrated care education on the micro-, meso-, and macro-dimensions of integrated care. This case study was constructed using data extracted from ECHO Concussion from video-archived sessions, participant observation, and internal program evaluation memos. The research team met regularly to discuss the development of relevant themes to the dimensions of integrated care. On the micro-level, clinical integration occurs through case-based learning and the development of adaptive expertise. On the meso-level, professional integration is achieved through the development of the “specialist generalist,” professional networks and empathy. Finally, on the macro-level, ECHO Concussion and the ECHO model achieve vertical and horizontal system integration in the delivery of integrated care. Vertical integration is achieved through ECHO by educating and connecting providers across sectors from primary to quaternary levels of care. Horizontal integration is achieved through the establishment of lateral peer-based networks across sectors as a result of participation in ECHO sessions with a focus on population-level health. This case study examines the role of education in the delivery of integrated care through one program, ECHO Concussion. Using the three dimensions of integrated care on the micro-, meso-, and macro-levels, this case study is the first explicit operationalization of ECHO as a means of delivering integrated care education and supporting integrated care delivery.
      Citation: Journal of Integrated Care
      PubDate: 2022-07-25
      DOI: 10.1108/JICA-01-2022-0012
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • The development of a platform to ensure an integrated care plan for older
           adults with complex care needs living at home

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      Authors: Lorena Villa-García , Ariadna Puig , Pau Puigpelat , Montse Solé-Casals , Oriol Fuertes
      Abstract: The purpose of this paper is to describe the design and development of the digital platform for the development and monitoring of care plans for older adults with complex care needs who are users of a home care service. Case study. The authors conducted an iterative process of design adapted to the environment and user-centred, agile development and research methodologies and a framework of complex interventions. They followed a four-step process: (1) conceptualization: analysis and design; (2) usability and high-fidelity prototyping; (3) software development; and (4) field testing in usual care. Older adults, informal caregivers, professional caregivers, and healthcare and social workers identified specific requirements and participated continuously through interviews, focus groups and consensus. In the conceptualization phase, the theory, context and requirements were identified, and the content and prototypes were developed. In the usability phase, the design was validated. The approach employed resulted in a digital technology that supports a person-centred care model in a home care company. In the conceptualization phase, the theory, context and requirements were identified, and the content and prototypes were developed. In the usability phase, the design was validated. The approach employed resulted in a digital technology that supports a person-centred care model in a home care company. The methodology employed has allowed the development of a platform based on theory, user needs and context. This could increase the possibilities of use and implementation of the technology and inspire other developers.
      Citation: Journal of Integrated Care
      PubDate: 2022-07-11
      DOI: 10.1108/JICA-01-2022-0010
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Hospital-based ambulatory clinic adoption of video and telephone visits
           

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      Authors: Vess Stamenova , Suman Budhwani , Charlene Soobiah , Jamie Fujioka , Rumaisa Khan , Rebecca Liu , Ilana Halperin , R. Sacha Bhatia , Laura Desveaux
      Abstract: The purpose of this study is to understand virtual care use (e.g. telephone and video visits) during the COVID-19 pandemic across three hospital-based ambulatory clinics (i.e. mental health, renal and respiratory care) and to describe associated patient and provider experiences. A mixed-methods convergent study was conducted including quantitative electronic medical records data on virtual care use, electronic surveys assessing domains of experience (e.g. satisfaction, acceptance and technology use) among patient and providers and semi-structured interviews exploring the associated barriers and facilitators of virtual care adoption. Virtual care adoption rates and relative modality use (telephone vs video) varied across specialty clinics. Mental health clinics) showed the greatest use of virtual care and greater use of video over telephone, as compared to renal and respiratory care, where telephone was used almost exclusively. Patients and providers reported an overall good satisfaction and acceptance of virtual care (60–72%) across clinics, but commonly observed barriers (technical problems, behavioral adaptations needed and inequity) persisted. Good value propositions, tech support and the presence of early adopters who can support others in workflow re-design and highlight value propositions of virtual care were listed as adoption facilitators. The study provides a unique opportunity to compare the rate of virtual care adoption before and during the COVID-19 pandemic across distinct specialties that operate within the same organizational and political setting. This study showed that the nature of the condition (e.g. mental health conditions) and the characteristics of the users (e.g. younger patients) may drive models of care with higher rate of video use. Focusing on removing common barriers, like providing tech support and ensuring equitable access to patients, continues to be important even in the context of high virtual care adoption rates during the pandemic.
      Citation: Journal of Integrated Care
      PubDate: 2022-07-05
      DOI: 10.1108/JICA-01-2022-0011
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Crisis and mental health of working women: risk factors and integrated
           care interventions based on organizational, individual, and institutional
           partnership

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      Authors: Salima Hamouche
      Abstract: Crises can weigh heavily on individuals' mental health. COVID-19 is a crisis that has shaken humanity, plunging it into a great wave of fear, ambiguity and uncertainty, due to its novelty and rapid spread, as well as lethality. Mental health disparities between women and men have widened as a result of this pandemic. Stress factors have multiplied, especially among working women, making them more psychologically vulnerable than they were before this pandemic and easy prey to psychological distress. This emphasized the importance of having integrated care interventions that take into consideration the organizational context, with gendered lenses. This paper discusses the relationship between COVID-19 and psychological distress among women in the workforce. It presents the main sources of stress and addresses integrated care interventions that can help to prevent psychological distress among women. This paper is a viewpoint and critique of the recent literature. Interventions based on a partnership between employers, employees, and government, including health and social services are needed to prevent mental health problems among women in the workplace that can result from crises. In this case, a gendered approach as well as an optimization of the use of new technologies should be favored. There is little focus on the development of integrated care approaches to address psychological distress among working women in times of crisis and beyond. This paper helps to expand the scope of integrated care to work-related mental health research by exploring the impact of an unprecedented health crisis on a vulnerable group that suffers from disparities in mental health. It also provides insights into preventive interventions, built upon an integrated care approach, based on a tripartite partnership between working women, employing organizations, and governmental institutions, facilitated by the integration of new technologies. By doing this, the author aims to contribute to the prevention of mental health issues that can result from this crisis.
      Citation: Journal of Integrated Care
      PubDate: 2022-06-10
      DOI: 10.1108/JICA-02-2022-0014
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Healthcare provider selection for elderly patients suffering from NCD's:
           an analysis with the combined approach of DEMATEL and AHP

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      Authors: Ankit Singh , Ajeya Jha , Shankar Purbey , Priya Ravi
      Abstract: Elderly patients suffering from non-communicable disease face a dilemma in the selection of healthcare providers. This study attempts to identify the key variables playing a crucial role and identify the appropriate healthcare destination with the help of a combination of Decision-making Trial and Evaluation Laboratory (DEMATEL) and analytic hierarchy process (AHP) techniques. The primary objective is to introduce the DEMATEL and AHP as efficient decision-making methods to choose the right healthcare provider for elderly patients suffering from non-communicable diseases. An integrative approach utilizing DEMATEL and AHP is used to reach the ideal solution for healthcare provider selection decisions. The DEMATEL approach is used to segregate the cause and effect variables. Similarly, the AHP is used to identify the weights of the top five cause-inducing variables, and the paired comparison method is used to select the healthcare provider. The variables such as dependency on family members, easily accessible services, and patient autonomy play a vital role in the selection decision of healthcare providers in elderly patients suffering from non-communicable diseases. In terms of priority, home healthcare should be considered the preferred provider for elderly patients suffering from non-communicable diseases followed by neighbourhood registered medical practitioners and hospitals. This is the first of its kind study which has attempted to solve the healthcare provider selection decision with the combined approach of DEMATEL and AHP.
      Citation: Journal of Integrated Care
      PubDate: 2022-06-06
      DOI: 10.1108/JICA-11-2021-0056
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Does a discharge to assess programme introduced in England meet the
           quadruple aim of service improvement'

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      Authors: Stuart Jeffery , Julie MacInnes , Lavinia Bertini , Susie Walker
      Abstract: This paper intends to examine and evaluate the implementation and delivery of a discharge to assess pathway based on the UK Department of Health and Social Care Hospital Discharge Policy in relation to the quadruple aim of healthcare improvement: improving patient experience, reducing costs, benefiting the wider population and improving the work life of staff. Using a place based partnership in the south of England, 18 staff involved the delivery of discharge to assess and four patients who had recently been through the pathway were interviewed and the narratives analysed using a framework method. All four dimensions of the quadruple aim were felt to be positively impacted by the discharge to assess pathway in varying degrees. Staff described improvements to working lives; patients described a positive experience. There was no evidence of reduced costs and wider benefit through reduced length of stay was suggested rather than demonstrated. The study showed a need to ensure both information flows and discharge process are smooth, that there is sufficient community capacity and capability, a need for strong relationships and shared goals, for clarity of pathway and empowered staff, and for an avoidance of the over prescription of care. The revised discharge to assess pathway in England has been in place since 2020 and no other assessments of the pathway were found that related the changes to the quadruple aim framework.
      Citation: Journal of Integrated Care
      PubDate: 2022-06-03
      DOI: 10.1108/JICA-02-2022-0018
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • The patient experience of telehealth access and clinical encounters in
           Australian health care during COVID-19: implications for enhancing
           integrated care

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      Authors: Jennifer White , Julie Byles , Tom Walley
      Abstract: Telehealth consultations are likely to continue while living with COVID-19 and the risk of other pandemics. Greater understanding of patient perceptions is important in order to inform future integrated care models involving telehealth. An interpretative qualitative study. Fifteen, in-depth qualitative interviews were conducted with diverse range of community dwelling patients who attended outpatient clinics at The John Hunter Hospital, Newcastle. Data were analysed using an inductive thematic approach. Key themes were identified: (1) telehealth is valuable in a pandemic; (2) telehealth accessibility can be challenging; (3) there are variations in care experiences, especially when visual feedback is lacking; (4) telehealth for acute and complex care needs may lead to gaps and (5) considerations towards the future of telehealth, beyond a pandemic. There is a shortfall in evidence of the patient experience of integrated care within a telehealth framework. The results provided practical insights into how telehealth services can play a greater role in integrated care. Apart from the need for affordable access to high-speed data for basic Internet access, the author posit the need for patient and clinician training towards promoting communication that is underpinned by choice, trust and shared decision-making. Telehealth is important towards keeping patients safe during COVID-19. Key findings extend knowledge of the practical implications need to promote integrated telehealth systems. While there is a benefit in extending telehealth to more preventative activities, there is also a need for greater service coordination and sharing of information between treating clinicians. Overall the results highlight telehealth consultations to be an effective means of treating well-known conditions and for follow-up rather than for acute conditions.
      Citation: Journal of Integrated Care
      PubDate: 2022-02-04
      DOI: 10.1108/JICA-05-2021-0024
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • The European Health Data Space: a step towards digital
           and integrated care systems

         This is an Open Access Article Open Access Article

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      Authors: Stefano Genovese , Rafael Bengoa , John Bowis , Mary Harney , Bastian Hauck , Michel Pinget , Mike Leers , Tarja Stenvall , Nick Guldemond
      Abstract: The COVID-19 pandemic has demonstrated the urgency of better chronic disease management and the importance of making it an integral part of the recovery agenda in Europe. This paper aims to explore the shift towards digital and integrated care systems in Europe. In this viewpoint paper the Expert Group for Integrated Care and Digital Health Europe (EGIDE) group argues that an orchestrated shift towards integrated care holds the solution to the chronic disease pandemic. The development of integrated care cannot happen without shifting towards a digitalised healthcare system via large-scale initiatives like the European Health Data Space (EHDS) and the involvement of all stakeholders. The EGIDE group has identified some foundational principles, which can guide the way to realise the full potential of the EHDS for integrated care and can support the involved stakeholders’ thinking.
      Citation: Journal of Integrated Care
      PubDate: 2022-01-10
      DOI: 10.1108/JICA-11-2021-0059
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • A delicate balance: how physicians manage change towards collaborative
           care within their institutions

         This is an Open Access Article Open Access Article

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      Authors: Debbie Vermond , Esther de Groot , Niek de Wit , Dorien Zwart
      Abstract: In response to the COVID-19 pandemic, in 2020–2022, the immutable and fragmented character of our healthcare system changed. Healthcare professionals and their institutional leads proved remarkably agile and managed to change toward collaborative care. The purpose of this paper is to examine experiences with collaborative practice in healthcare during the COVID-19 pandemic in two regions in the Netherlands, to explore and understand the relationship between policy and practice and the potential development of new collaborative care routines. Using a methodology informed by theories that have a focus on professional working practice (so called “activity theory”) or the institutional decision-makers (discursive institutionalism), respectively, the perspective of physicians on the relationship between policy and practice was explored. Transcripts of meetings with physicians from different institutions and medical specialities about their collaborative COVID-19 care were qualitatively analysed. The findings show how change during COVID-19 was primarily initiated from the bottom-up. Cultural-cognitive and normative forces in professional, collaborative working practice triggered the creation of new relationships and sharing of resources and capacity. The importance of top-down regulatory forces from institutional leads was less evident. Yet, both (bottom-up) professional legitimacy and (top-down) institutional support are mentioned as necessary by healthcare professionals to develop and sustain new collaborative routines. The COVID-19 crisis provided opportunity to build better healthcare infrastructure by learning from the responses to this pandemic. Now is the time to find ways to integrate new ways of working initiated from the bottom-up with those longstanding ones initiated from top-down. This paper presents a combination of theories for understanding collaboration in healthcare, which can inform future research into collaborative care initiatives.
      Citation: Journal of Integrated Care
      PubDate: 2022-09-08
      DOI: 10.1108/JICA-04-2022-0027
      Issue No: Vol. 30 , No. 5 (2022)
       
  • Integration, population commissioning and prison health and well-being –
           an exploration of benefits and challenges through the study of
           telemedicine

         This is an Open Access Article Open Access Article

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      Authors: Chantal Edge , Nikki Luffingham , Georgia Black , Julie George
      Abstract: This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS. The study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework. The research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits. This is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.
      Citation: Journal of Integrated Care
      PubDate: 2022-06-03
      DOI: 10.1108/JICA-11-2021-0055
      Issue No: Vol. 30 , No. 5 (2022)
       
  • Link workers, activities and target groups in social prescribing:
           a literature review

         This is an Open Access Article Open Access Article

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      Authors: Denis Rothe , Raffael Heiss
      Abstract: Social prescribing is a model of integrated care, in which primary healthcare staff can link patients to the social care sector. However, social prescribing can occur in different forms. To better understand the concept of social prescribing, this literature review examines the role of the link workers, activities and target groups. A literature review was conducted. Studies before May 2020 were considered. In total, 1,700 studies were identified using the databases Pubmed, PsycInfo, Cinahl, Web of Science and Cochrane Library. After eligibility checks, 16 studies were included in the final analysis. A few studies warned of a deeper engagement of the link worker due to service dependency, but most studies encouraged an active and supportive role of the link worker. Participants engaged in social, physical and counseling activities. The majority of studies emphasized the importance of linking group activities with personal preferences and identity needs. The main target groups were composed of individuals with psychosocial needs, but some studies also included patients with physical or mental illnesses. Social prescribing is widely advocated as an innovative model of integrated care. However, few studies have looked into the complex system of social prescribing. This study analyzes the linking processes, activities and target groups in extant social prescribing programs.
      Citation: Journal of Integrated Care
      PubDate: 2022-02-01
      DOI: 10.1108/JICA-09-2021-0047
      Issue No: Vol. 30 , No. 5 (2022)
       
  • Journal of Integrated Care

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