Integrated care

Integrated care – also known as integrated health, coordinated care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems.[1][2][3]

Integrated care covers a complex and comprehensive field and there are many different approaches to and definitions of the concept.[1] WHO gives the following definition: Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency.[2]

Central concepts

The integrated care literature distinguishes between different ways and degrees of working together and three central terms in this respect are autonomy, co-ordination and integration. While autonomy refers to the one end of a continuum with least co-operation, integration (the combination of parts into a working whole by overlapping services) refers to the end with most co-operation and co-ordination (the relation of parts) to a point in between.[2]

Distinction is also made between horizontal integration (linking similar levels of care, e.g. multiprofessional teams) and vertical integration (linking different levels of care, e.g. primary, secondary and tertiary care).[2]

The concept of continuity of care is closely related to integrated care; it emphasizes the patient’s perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided in 3 components: 1. Continuity of information (through shared records), 2. Continuity across the secondary-primary care interface (discharge planning from specialist to generalist care), 3. Provider continuity (seeing the same professional each time with value added if there is a therapeutic, trusting relationship).[2]

The concept of integrated care seems particularly important to service provision to the elderly, as elderly patients often are chronically ill and subjects to co-morbidities and thus in special need of continuous care.[3]

Collaborative Care

Collaborative Care is a related healthcare philosophy and movement that has many names, models, and definitions that often includes the provision of mental health, behavioral health and substance use services in primary care. Common derivatives of the name collaborative care include: "Integrated Care", "Primary Care Behavioral Health", "Integrated Primary Care", and "Shared Care".

The Agency for Healthcare Research and Quality (AHRQ) published an overview of many different models and the research that supports them.[4] The key features of Collaborative Care models are:
-Integration of mental health professionals in primary care medical settings
-Close collaboration between mental health and medical/nursing providers
-Focus on treating the whole person and whole family.

There are various national associations committed to collaborative care such as the Collaborative Family Healthcare Association.

Contradiction to any attempt of merging roles

In contrast to the moves of managers and comptrollers with headcount cutting, the proper integrating of care does not mean the merging of roles. It will steadily remain uneconomical to make a physician serve as a nurse. And the opposite approach is strictly prohibited by accreditation and certification schemes anyhow. Hence the mix of staff for the various roles shall be maintained to enable a profitable integration in caring.

Examples

See also

References

  1. 1 2 Kodner, DL & Spreeuwenberg, C (2002): Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care, Vol. 2, 14. Nov. 2002
  2. 1 2 3 4 5 Gröne, O & Garcia-Barbero, M (2002): Trends in Integrated Care – Reflections on Conceptual Issues. World Health Organization, Copenhagen, 2002, EUR/02/5037864
  3. 1 2 Kai Leichsenring (September 2004). "Developing integrated health and social care services for older persons in Europe". International Journal of Integrated Care 4: e10. PMC 1393267. PMID 16773149.
  4. ↑ Butler M, Kane RL, McAlpine D, Kathol, RG, Fu SS, Hagedorn H, Wilt TJ. Integration of Mental Health/Substance Abuse and Primary Care No. 173 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 09-E003. Rockville, MD. Agency for Healthcare Research and Quality. October 2008.
  5. ↑ Amal N. Trivedi & Regina C. Grebla (June 2011). "Quality and equity of care in the Veterans Affairs health-care system and in Medicare Advantage health plans". Medical Care 49 (6): 560–568. doi:10.1097/MLR.0b013e31820fb0f6. PMID 21422951.
  6. ↑ Lawrence, David (2005). Building a Better Delivery System: A New Engineering/Health Care Partnership — Bridging the Quality Chasm (PDF). Washington, DC: National Academy of Sciences. p. 99. ISBN 0-309-65406-8.
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