Social Features of Integration in Health Systems and Their Relationship to Provider Experience, Care Quality and Clinical Integration

More is known about the structural features of health system integration than the social features—elements of normative integration (alignment of norms) and interpersonal integration (collaboration among professionals and with patients). We surveyed practice managers and 1,360 staff and physicians at 59 practice sites within 17 health systems (828 responses; 61%). Building on prior theory, we developed and established the psychometric properties of survey measures describing normative and interpersonal integration. Normative and interpersonal integration were both consistently related to better provider experience, perceived care quality, and clinical integration (e.g., a 1-point increase in a practice’s normative integration was associated with 0.53-point higher job satisfaction and 0.77-point higher perceived care quality in the practice, measured on 1 to 5 scales, p < .01). Variation in social features of integration may help explain why some health systems better integrate care, pointing to normative and interpersonal integration as potential resources for improvement.

The COVID-19, Migration and Livelihood in India: Challenges and Policy Issues

The worldwide spread of COVID-19 first reported from Wuhan in China is attributed to migration and mobility of people. In this article, we present how our understanding of migration and livelihood could be helpful in designing a mitigating strategy of the economic and social impact of COVID-19 in India. We conclude that there are many challenges migrants face during the spread of COVID-19 resulting from nation-wide lockdown. Many internal migrants faced problems such as lack of food, basic amenities, lack of health care, economic stress, lack of transportation facilities to return to their native places and lack of psychological support. On the other hand, COVID-19 has also brought into sharp focus the emigrants from India and the major migration corridors India shares with the world as well. There is huge uncertainty about how long this crisis will last. This article further provides some immediate measures and long term strategies to be adopted by the government such as improving public distribution system, strengthening the public health system, integration of migrants with development, decentralisation as a strategy to provide health services, and providing support to return migrants to reintegrate them, and also strengthen the database on migration and migrant households.

Colombian Health System: integration for quality

The central objective of this document is to analyze the elements of integration and quality on the Colombian Health System and to verify their articulation in accordance with the postulates set forth by the national government in terms of quality. Based on a qualitative approach, supported by the bibliographic review as a tool for research and deepening, a matrix of documents associated with the research topic of the last five years is made. The results indicate that Colombia’s health model has been forged in recent decades and has incorporated elements such as universality, coverage and quality. The analysis of these aspects can facilitate or support research in the health sector at the national or international level.

Meeting the Challenge of Diabetes in China

China’s estimated 114 million people with diabetes pose a massive challenge for China’s health policy-makers who have significantly extended health insurance coverage over the past decade. What China is doing now, what it has achieved, and what remains to be done should be of interest to health policy-makers, worldwide. We identify the challenges posed by China’s two principal strategies to tackle diabetes: (1) A short-term pilot strategy of health promotion, detection and control of chronic diseases in 265 national demonstration areas (NDAs); and (2) A long-term strategy to extend health promotion and strengthen primary care capacity and health system integration throughout China. Finally, we consider how Chinese innovations in artificial intelligence (AI) and Big Data may contribute to improving diagnosis, controlling complications and increasing access to care. Health system integration in China will require overcoming the fragmentation of a system that still places excessive reliance on local government financing. Moreover, what remains to be done resembles deeper challenges faced by healthcare systems worldwide: the need to upgrade primary care and reduce inequalities in access to health services.

A conceptual model for physician-system integration: A scoping review

Despite the widespread pursuit of physician-health system integration, the evidence for factors affecting successful integration is uncertain and inconclusive. We sought to identify and categorize the organizational factors in the current landscape of physician-health system integration. We conducted a scoping review of the empirical literature on this topic, first surveying the theoretical perspectives that have been used in past studies in order to determine how theory has been used to explain and predict changing integration strategies over time. Second, we extracted factors that have been used to define the environment, physician group, hospital, care coordination, and health system success. From the 29 eligible articles, bargaining-market power theory and transaction cost theory were the predominant theories applied. We identified 48 organizational factors that comprise the landscape of physician-system integration. Our findings cumulated in a conceptual model that may help health care executives, policymakers, and researchers more effectively address the complexities of integration.

Quality assurance as a foundational element for an integrated system of dementia care

Purpose Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of an integrated system of dementia care. The purpose of this paper is to understand physicians’ and specialists’ perspectives on such a system and identify barriers to its implementation. Design/methodology/approach The authors used interviews and a constructivist framework to understand the perspectives on a quality assurance framework for dementia care and barriers to its implementation from ten primary care and ten specialist physicians affiliated with PCCMCs. Findings Interviewees found that the framework reflects quality dementia care, though most could not relate quality assurance to clinical practice. Quality assurance was viewed as an imposition on practitioners rather than as a measure of system integration. Disparities in resources among providers were seen as barriers to quality care. Greater integration with specialists was seen as a potential quality improvement mechanism. Standardized electronic medical records were seen as important to support both quality assurance and clinical care. Practical implications This work identified several challenges to the implementation of a quality assurance framework to support an integrated system of dementia care. Clinicians require education to better understand quality assurance. Additional challenges include inadequate resources, a need for closer collaboration between specialists and PCCMCs, and a need for a standardized electronic medical record. Originality/value Greater health system integration is necessary to provide quality dementia care, and quality assurance could be considered a foundational element driving system integration.