scholarly journals Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people

2013 ◽  
Vol 13 (2) ◽  
Author(s):  
Nicole Dubuc ◽  
Lucie Bonin ◽  
André Tourigny ◽  
Luc Mathieu ◽  
Yves Couturier ◽  
...  
Keyword(s):  
Older People ◽  
Integrated Care ◽  
Management System ◽  
Care Management ◽  
Community Dwelling ◽  
Care Pathways ◽  
Integrated Care Pathways ◽  
Community Dwelling Older People

scholarly journals Early detection of malnutrition in community dwelling older people An evidence based integrated care approach

2019 ◽  
Vol 19 (4) ◽  
pp. 348
Author(s):  
Roelof Ettema ◽  
Marian De vander Schueren ◽  
Ben Witteman ◽  
Elke Nauman ◽  
Getty Huisman-De Waal
Keyword(s):  
Early Detection ◽  
Older People ◽  
Integrated Care ◽  
Community Dwelling ◽  
Evidence Based ◽  
Care Approach ◽  
Community Dwelling Older People

The Care Process Organization Triangle: A Framework to Better Understand how Clinical Pathways Work

2007 ◽  
Vol 11 (2) ◽  
pp. 54-61 ◽  
Author(s):  
Kris Vanhaecht ◽  
Karel de Witte ◽  
Walter Sermeus
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Care Management ◽  
Clinical Pathways ◽  
Health Care Management ◽  
Care Process ◽  
Care Pathways ◽  
Patient Needs ◽  
Care Processes ◽  
Integrated Care Pathways

Clinical pathways, also known as care pathways or integrated care pathways, are used worldwide to make care processes transparent and organize care around patient needs. Although this is in international use, it is still unclear why pathways sometimes work and sometimes do not. To better understand how pathways work, there is a growing need for paradigms or organizing concepts. Different quality and health-care management gurus have developed frameworks to better understand how certain processes or methods work. This paper will provide an overview of several frameworks and integrate them into Donabedian's Structure–Process–Outcome configuration. In view of this configuration, the care process organization triangle was developed. In this paper, we will describe the three cornerstones of this triangle by integrating the literature on clinical pathways. The care process organization triangle is only one model, but as Deming described it: ‘Some models can be quite useful’.

scholarly journals Early Detection of Malnutrition in Community Dwelling Older People, an Evidence Based Integrated Care Approach

2018 ◽  
Vol 18 (s2) ◽  
pp. 295
Author(s):  
Roelof Ettema ◽  
Marian De van der Schueren ◽  
Ben Witteman ◽  
Elke Naumann ◽  
Getty Huisman
Keyword(s):  
Early Detection ◽  
Older People ◽  
Integrated Care ◽  
Community Dwelling ◽  
Evidence Based ◽  
Care Approach ◽  
Community Dwelling Older People

scholarly journals Effect of an integrated care model for pre-frail and frail older people living in community

2020 ◽  
Vol 49 (6) ◽  
pp. 1048-1055
Author(s):  
Ruby Yu ◽  
Cecilia Tong ◽  
Jean Woo
Keyword(s):  
Health Services ◽  
Older People ◽  
Integrated Care ◽  
Intervention Group ◽  
Community Dwelling ◽  
Control Group ◽  
Care Model ◽  
Health And Social Care ◽  
Community Dwelling Older People

Abstract Objectives to evaluate the effect of an integrated care model for pre-frail and frail community-dwelling older people. Design a quasi-experimental design. Setting and participants we enrolled people aged ≥60 years from a community care project. An inclusion criterion was pre-frailty/frailty, as measured by a simple frailty questionnaire (FRAIL) with a score of ≥1. Methods we assigned participants to an intervention group (n = 183) in which they received an integrated intervention (in-depth assessment, personalised care plans and coordinated care) or a control group (n = 270) in which they received a group education session on frailty prevention. The outcomes were changes in frailty, individual domains of frailty (‘fatigue’, ‘resistance’, ‘ambulation’, ‘illnesses’ and ‘loss of weight’) and health services utilisation over 12 months. Assessments were conducted at baseline and at the 12-month follow-up. Results the mean age of the participants (n = 453) at baseline was 76.1 ± 7.5 years, and 363 (80.1%) were women. At follow-up, the intervention group showed significantly greater reductions in FRAIL scores than the control group (P < 0.033). In addition, 22.4% of the intervention and 13.7% of the control participants had reverted from pre-frail/frail to robust status, with the difference reaching significance when the intervention was compared with the control group (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.0–2.4) after adjustments for age, sex, living arrangement/marital status and hypercholesterolemia. For individual domains of frailty, the adjusted OR for improved ‘resistance’ was 1.7 (95% CI 1.0–2.8). However, no effects were found on reducing use of health services. Conclusion the integrated health and social care model reduced FRAIL scores in a combined population of pre-frail/frail community-dwelling older people attending older people’s centres.

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