scholarly journals Applying Large Scale Intervention methodologies for (re)designing Integrated Care Systems

2016 ◽  
Vol 16 (6) ◽  
pp. 376
Author(s):  
Ezra Dessers ◽  
Geert Van Hootegem
Keyword(s):  
Integrated Care ◽  
Large Scale ◽  
Care Systems

scholarly journals A scaling-up strategy supporting the expansion of integrated care: a study protocol

2019 ◽  
Vol 27 (3) ◽  
pp. 215-231 ◽  
Author(s):  
Liset Grooten ◽  
Cristina-Adriana Alexandru ◽  
Tamara Alhambra-Borrás ◽  
Stuart Anderson ◽  
Francesca Avolio ◽  
...  
Keyword(s):  
Integrated Care ◽  
Large Scale ◽  
Scale Up ◽  
Implementation Fidelity ◽  
Scaling Up ◽  
Realist Evaluation ◽  
Content Type ◽  
Project Outcomes ◽  
Care Systems ◽  
Funded Project

Purpose To ensure that more people will benefit from integrated care initiatives, scaling-up of successful initiatives is the way forward. However, new challenges present themselves as knowledge on how to achieve successful large-scale implementation is scarce. The EU-funded project SCIROCCO uses a step-based scaling-up strategy to explore what to scale-up, and how to scale-up integrated care initiatives by matching the complementary strengths and weaknesses of five European regions involved in integrated care. The purpose of this paper is to describe a multi-method evaluation protocol designed to understand what factors influence the implementation of the SCIROCCO strategy to support the scaling-up of integrated care. Design/methodology/approach The first part of the protocol focuses on the assessment of the implementation fidelity of the SCIROCCO step-based strategy. The objective is to gain insight in whether the step-based strategy is implemented as it was designed to explore what works and does not work when implementing the scaling-up strategy. The second part concerns a realist evaluation to examine what it is about the SCIROCCO’s strategy that works for whom, why, how and in which circumstances when scaling-up integrated care. Findings The intended study will provide valuable information on the implementation of the scaling-up strategy which will help to explain for what specific reasons the implementation succeeds and will facilitate further improvement of project outcomes. Originality/value The expected insights could be useful to guide the development, implementation and evaluation of future scaling-up strategies to advance the change towards more sustainable health and care systems.

scholarly journals Can health and social care integration make long-term progress? Findings from key informant surveys of the integration Pioneers in England

2019 ◽  
Vol 28 (1) ◽  
pp. 14-26
Author(s):  
Bob Erens ◽  
Gerald Wistow ◽  
Nicholas Mays ◽  
Tommaso Manacorda ◽  
Nick Douglas ◽  
...  
Keyword(s):  
Integrated Care ◽  
Large Scale ◽  
Social Care ◽  
Community Health Services ◽  
Content Type ◽  
Barriers To Change ◽  
Health And Social Care ◽  
Wide Range ◽  
Key Informant ◽  
Care Systems

Purpose All areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary and community health services, and involve local authorities and the voluntary sector. ICSs build on previous pilots, including the Integrated Care Pioneers in 25 areas from November 2013 to March 2018. This analysis tracks the Pioneers’ self-reported progress, and the facilitators and barriers to improve service coordination over three years, longer than previous evaluations in England. The paper aims to discuss these issues. Design/methodology/approach Annual online key informant (KI) surveys, 2016–2018, are used for this study. Findings By the fourth year of the programme (2017), KIs had shifted from reporting plans to implementation of a wide range of initiatives. In 2018, informants reported fewer “significant” barriers to change than previously. While some progress in achieving local integration objectives was evident, it was also clear that progress can take considerable time. In parallel, there appears to have been a move away from aspects of personalised care associated with user control, perhaps in part because the emphasis of national objectives has shifted towards establishing large-scale ICSs with a particular focus on organisational fragmentation within the NHS. Research limitations/implications Because these are self-reports of changes, they cannot be objectively verified. Later stages of the evaluation will look at changes in outcomes and user experiences. Originality/value The current study shows clearly that the benefits of integrating health and social care are unlikely to be apparent for several years, and expectations of policy makers to see rapid improvements in care and outcomes are likely to be unrealistic.

North central London elective orthopaedic network and health service innovation to improve the quality of NHS patient care

2021 ◽  
pp. 1-4
Author(s):  
Joshua W. Thompson ◽  
Alice O'Brien ◽  
Anna Stewart ◽  
Rob Hurd ◽  
Fares S Haddad
Keyword(s):  
Health Service ◽  
Patient Care ◽  
Integrated Care ◽  
Service Innovation ◽  
Modern Medicine ◽  
North Central ◽  
The North ◽  
Care Systems

Health service innovation is required to meet the ever-growing demands of modern medicine. This editorial discusses the transformation of the north central London elective orthopaedic network and the essential principles which future integrated care systems could incorporate.

scholarly journals Data work: A condition for integrations in health care

2019 ◽  
Vol 25 (3) ◽  
pp. 526-535 ◽  
Author(s):  
Camilla Bjørnstad ◽  
Gunnar Ellingsen
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Health Care Systems ◽  
Medication Management ◽  
Articulation Work ◽  
Efficient Treatment ◽  
Daily Work ◽  
Local Actors ◽  
Care Systems ◽  
Information And Communication

Integration and interoperability between different information and communication technology (ICT) systems are crucial for efficient treatment and care in hospitals. In this article, we are particularly interested in the daily local work conducted by health-care personnel to maintain integrations. A principal aim of our article is, therefore, to contribute to a sociotechnical understanding of the “data work” that is embedded in the integration of health-care systems. Theoretically, we draw on the concepts of “information infrastructures” and “articulation work,” and we discuss how social status may influence the invisible articulation work. Furthermore, we show how historical decisions and existing systems both nationally and regionally have impacts on the daily work of local actors. Empirically, we have studied the formative stages of a large-scale electronic medication management system project in the Northern Norway Regional Health Authority.

scholarly journals Újraélesztést követő koszorúér-angiográfia és katéteres intervenció

2019 ◽  
Vol 160 (46) ◽  
pp. 1826-1831
Author(s):  
László Rudas ◽  
Endre Zima
Keyword(s):  
Coronary Angiography ◽  
Large Scale ◽  
Health Care Systems ◽  
Coronary Intervention ◽  
Developed Countries ◽  
Public Access ◽  
Temperature Management ◽  
Prehospital Management ◽  
Care Systems ◽  
St Elevation

Abstract: Out-of-hospital cardiac arrest (OHCA) presents a great challenge for the health care systems even in the highly developed countries. For several decades, our greatest efforts have been directed toward the improvement of the prehospital management, including promotion of lay resuscitation and deployment of public access automated defibrillators. Recently, the importance of the hospital phase of the OHCA-management has been also emphasized. Attention has been paid to targeted temperature management and also to early coronary intervention. For those patients who present with ST-elevation on their post-resuscitation ECG, our approach is straightforward: urgent coronary angiography is indicated. The optimal management of those survivors of OHCA who present without ST-elevation is, however, still debated. Although up to 30% of these subjects also suffer from acute occlusive epicardial coronary disease, the clear benefit of urgent coronary angiography for the whole group is yet to be documented. Several large-scale randomized studies are under way to resolve this question. In our present review we detail the above controversies and outline the future directions. Orv Hetil. 2019; 160(46): 1826–1831.

scholarly journals Integrated Care Systems as an Arena for the Emergence of New Forms of Epistemic Injustice

2020 ◽  
Vol 23 (5) ◽  
pp. 723-737
Author(s):  
Andrew Fletcher ◽  
Jeremy Clarke
Keyword(s):  
Integrated Care ◽  
Epistemic Injustice ◽  
Clinical Knowledge ◽  
Health Issues ◽  
Careful Evaluation ◽  
Policy Context ◽  
Mental Health Issues ◽  
Raising Awareness ◽  
Care Systems ◽  
Forms Of Knowledge

AbstractEpistemic injustice has rapidly become a powerful tool for analysis of otherwise hidden social harms. Yet empirical research into how resistance to knowing and understanding can be generated and replicated in social programmes is limited. We have identified a range of subtle and not-so-subtle inflections of epistemic injustice as they play out in an intervention for people with chronic depression in receipt of disability benefits. This article describes the different ‘species’ of epistemic injustice observed and reveals how these are unintentionally produced at frontline, management, commissioning and policy levels. Most notably, there remains a privileging of clinical knowledge over other forms of knowledge, producing a ‘pathocentric epistemic complex’. This, combined with the failure of different agencies with competing ideologies to adequately understand each other, and a vicious policy context, added to the injustices already faced by people with mental health issues, generating multiple harms. This has important implications for a range of integrated care and welfare interventions – not least by drawing attention to their unintended potential for replicating epistemic injustice as an institutionalised complex. Careful evaluation and design of such programmes, applying the philosophical and epistemic resources illustrated here, can help mitigate this outcome. Further, by raising awareness of epistemic injustice among programme participants, we can generate epistemic structures that secure programme integrity locally, and promote better policy.

Healthcare staff perceptions of integrated care in a programme for complex chronic patients admitted to hospital because of heart failure (ProMIC)

2019 ◽  
Vol 22 (2) ◽  
pp. 81-89 ◽  
Author(s):  
Cristina Domingo ◽  
Iratxe Regidor ◽  
Edurne Alonso ◽  
Ariadna Besga ◽  
Domingo Orozco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Integrated Care ◽  
Large Scale ◽  
Care Needs ◽  
Chronic Patients ◽  
Care Programme ◽  
Patients With Heart Failure ◽  
Care Approach ◽  
Study Participants ◽  
Complex Care Needs

Introduction Patients with heart failure are usually a frail population characterised by complex care needs. To ensure an integrated care approach, it is necessary to work collaboratively across organisational boundaries. The purpose of this study is to measure and understand the perception of collaboration between clinicians participating in a comprehensive care programme for patients with heart failure, known as PROMIC. Methods A sequential mixed-method study design was used. A sample of PROMIC clinicians completed a survey in which they evaluated 10 dimensions of collaboration in 2010 and in 2014. The perspectives of clinicians were studied more in depth in a focus group in 2012, which was analysed using content analysis. Outcomes: Professionals’ perception of collaboration showed an improvement by 1.18 points (53%) over the period 2010–14. The comprehensive programme proved to be of major support to the professionals. Sometimes, the study participants did not feel prepared to manage cases due to the complexity of the situations with regard to patients’ care. Both, the quantitative and the qualitative methods, showed up a congruent information about the positive perception of participants of the programme itself and the collaboration. Discussion The complexity of care processes and the need for continuity of care mean that large-scale collaboration is necessary between care levels as well as major interdisciplinary teamwork, to achieve the best possible outcomes in terms of health. ProMIC intervention has helped to improve professionals’ perception in terms of collaboration between levels.

The maturity of integrated care systems: lessons learned in using the SCIROCCO tool across Europe

2018 ◽  
Vol 28 (suppl_4) ◽  
Author(s):  
A Pavlickova ◽  
D Henderson ◽  
CA Alexandru ◽  
T Alhambra
Keyword(s):  
Integrated Care ◽  
Lessons Learned ◽  
Care Systems
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