Please enable JavaScript.

Coggle requires JavaScript to display documents.

W8: From Continuum of Care to Integrated Care, Normative Integration,…

- - - - rs between single practitioner & patient extending beyond specific episodes of illness/disease
      - sense of affiliation between patients & practitioners
        
        expressed as implicit contract of loyalty by patient & clinical responsibility by provider
      - in family medicine
        
        continuity ≠ coordination of care but continuity leads to :arrow_up: coordination
        
        trade-off required bet. continuity & accessibility of healthcare providers
    - - emphasis on
        
        stability of patient-provider rs over time
        
        Rs is built with a team unlike single provider in primary care
        
        coordination of services
        
        extends to social services (eg. housing & employment)
        
        case managers facilitate health & social services
      - Features
        
        Care plans
        
        should remain flexible to accommodate changes in patients’ needs & circumstances
        
        important tools for bridging current and past care & arranging for future needs
        
        Continuity of contact
        
        care team maintains contact with patients
        
        monitors their progress
        
        facilitates access to needed services
        
        included as a dimension of continuity w issues of continuity & accessibility closely entwined
    - - emphasis on
        
        Information transfer
        
        Care coordination over time
      - Communication between nurses
        
        maintain consistent approach to care across nurses
        
        personalise care to patient's needs during illness
      - Discharge planning
        
        after acute care
        
        usually from hospital to community or self care
    - - delivery of services by diff providers in coherent, logical, timely fashion
      - referred to as continuum of care in LTC literature
      - coordination of care when patients moved from 1 setting of care or 1 level of intensity to another
      - context of long-term diseases like HIV, AIDS, diabetes, CVDs, rheumatological conditions, cancer
- - - - used by many govts to understand different components of IC
      - Features
        
        imbues IC with qualities of care coordination
        
        primarily bounded within scope of healthcare
        
        continuous support process over time
        
        differentiates integration & integrated care
        
        IC => outcome experienced by service users
        
        rather mechanistic
        
        seen as set of processes instead of entity with meaning or value for end user
      - Definition
        
        integration => process of professionals & organisations coming together
    - - supports *defining narrative* & *purpose* for IC strategies at all levels of system
      - Features
        
        highlights importance of population & individual needs in
        
        design, implementation, evaluation of IC models
        
        used by Govt of England to frame IC strategies
    - - as used by WHO Regional Office for Europe
      - Features
        
        acknowledges IC is achieved through alignment of all health system functions & effective change mgmt
      - Integrated health services delivery
        
        strengthening people-centred health systems through
        
        promotion of comprehensive delivery of quality health services across life-course
        
        designed based on multidimensional needs of population & individual
        
        delivered by coordinated multidisciplinary team of providers working across settings & levels of care
        
        effectively managed to ensure optimal outcomes & appropriate use of resources
        
        feedback loops to
        
        continuously :arrow_up: performance
        
        tackle upstream causes of ill health
  - - - evidence that focus on needs of beneficiary stakeholders needed to
        
        bring about consensus & collaboration between potentially competing factions
- - - - Meso level
        (organisational)
        
        Macro level
        (system)
        
        System Integration
        
        Vertical Integration
        
        result of specialisation of health services
        
        diseases treated at different vertical levels of specialisation (disease-focused view)
        
        integration of care across sectors
        
        1 more item...
        
        brings together organisations atdifferent levels of hierarchical structure under 1 management umbrella (WHO)
        
        eg. integrating general care and community care
        
        primary, secondary, tertiary care
        
        Horizontal Integration
        
        improving overall population health
        (holistic-focused view)
        
        characterises primary care & public health
        
        through peer-based & cross-sectorial collaboration
        
        strategies that link similar levels of care
        
        activities across operating units and/or organisations at same stage in process of delivering services coming together (WHO)
        
        Eg. mergers of acute hospitals or social and healthcare organisations
        
        combination of structures, processes and techniques to fit needs of people and population
        
        current specialisations of health systems (disease-focused medical interventions)
        
        requires vertical and horizontal integration to counter fragmentation of services
        
        Professional Integration
        
        pertains to professional partnerships both within and between organisations
        
        collective responsibility to deliver comprehensive continuum of care
        
        promotes shared accountability, problem solving, decision-making
        
        achieve optimal health & wellbeing in population
        
        Arrangements
        
        Virtually integrated professional networks
        
        Fully integrated organisations
        
        Network-like
        
        traditional form of professional integration in primary care
        
        :arrow_down: conditions for shared accountability
        
        characterised as vertical or horizontal integration
        
        Organisational Integration
        
        extent to which different organisations coordinate to produce and deliver services
        
        require collective action of organisations across entire care continuum (vertical & horizontal) to meet population needs
        
        deliver comprehensive services to population through
        
        interorganisational relationships
        
        contracting, strategic alliances, knowledge networks, mergers
        
        common governance mechanisms
        
        Governance structures
        
        Market-based
        
        Segegrated
        
        every organisation is autonomous and functions independently
        
        :arrow_up: flexibility & :arrow_down: commitment made by organisations
        
        Hierarchy-based
        
        Full Integration
        
        contains hierarchical mechanisms (mergers & acquisitions)
        
        long-term commitment duration & :arrow_up: shared decision making
        
        1 more item...
        
        Network-like
        
        Inter-organisational
        
        Linkage
        
        Coordination
        
        golden mean which unite flexibility & commitment
        
        1 more item...
        
        organisations need to continuously negotiate & assess outcomes of collaboration
        
        voluntary collaboration between organisations depending on
        
        relationships
        
        mutual interests
        
        reputation
        
        less guided by formal authority structures
        
        address opposing demands of state regulation & market competition in Western healthcare systems
        
        bringing together several organisations through (WHO)
        
        coordinated provider networks & mergers
      - Clinical integration
        
        coordination of person-focused care in single process across time, place, discipline (Valentin)
        
        coherence in primary process of care delivery to individual patients
        
        tends to be disease-focused
        
        requires person-focused to improve overall well-being
        
        shared guidelines & protocols
        
        integration of care into single & coherent process within & across professions (WHO)
      - Service Integration
        
        eg. establishing multidisciplinary teams
        
        integration of different clinical services at an organisational level (WHO)
    - - Normative or systemic
      - Horizontal or vertical
      - real or virtual
  - - - contrasts with disease-focused view
        
        leads to fragmentation and specialisation of health services
      - reflects biopsychosocial perspective on health
        
        acknowledges
        
        health problems not synonymous with biological terms, diagnoses or diseases
        
        diseases simultaneously medical, psyhchological & social problem
      - based on personal preferences, needs and values
        
        personal meaning of illness to patient
    - - based on population needs & health characteristics
        
        political, economic, social, environmental characteristics
        
        improve equitable distribution of health & well-being in population
      - entails defining & categorising populations by burden of mortality
        
        disease-focused view dominates Western health systems
        
        problem as :arrow_up: number of patients suffer from chronic & overlapping health problems (multi-morbidity)
- - - - sharing of physical assets & infrastructure