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Integrated Care (Types of care (Acute Hospital, Community Hospital,…

- - - - Local agreement between orgs
  - - - With Chronic Illness (Case Management)
      - High Risk Patients (Illness Management)
      - Chronic (self- Management Support)
      - General Population (Promotion and prevention)
  - - - Prevention Index
      - Chronic disease index
      - Palliative care. Pain screening and management
- - - - Access
      - Care Management
      - Care Corrdination
      - Care team
      - Fiscal responsibility
        
        Cost benefit
      - IT
      - Quality & Safety
- - - - Partnership with other organisations
      - Encourage Patients participation in programmes
      - Advocate Patient Care policies
    - - Create Culture, Organisation, Quality Care
    - - Support Patient for their Self-care with community resources
      - Assessment/ Goal Setting, problem solving, followup
    - - Delivery of clinical care
    - - Promote Clinical Care, Evidence based
    - - Proactive
      - Reminders
      - monitor
      - Facilitate patients