Integrated Care Research Papers - Academia.edu (original) (raw)

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- Integrated Care

We dedicate the English version of our book to the memory of Bruce S. McEwen, Ph.D. Alfred E. Mirsky Professor Head, Harold and Margaret
Milliken Hatch, Laboratory of Neuroendocrinology The Rockefeller University. McEwen was a great scientist, with 700 published papers which received 130,000 citations. He was the world leader in research in the field of PsychoneuroendocrineImmunology and, at the same time, was a deep and courageous intellectual engaged in researching both the molecular aspects and the social conditions that determine health
and disease.
Our Manual is indebt to the scientific work of this giant of the 20th century, to whom goes our passionate admiration and gratitude.
Finally, please note that the English edition has been updated and, where needed, expanded.
Francesco and Anna Giulia Bottaccioli
Rome, .01.19. 2020

- by Francesco Bottaccioli
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- Psychology, Stress, Biopsychosocial model, Integrated Care

Developing and Implementing Change Change is not a new concept. However, it is an important part of an organization and it happens all the time. Without change, improvement will not happen. If First Nations schools continue to hold onto the belief that the Federal Government will ever deal fairly and justly then we are only deluding ourselves into a great travesty, eventually leading to a dismantling of an education system. Change can be either planned or unplanned. Unplanned change occurs suddenly due to specific circumstances whereas planned change is a longer process that involves planning to achieve a specific goal. Change can be personal or organizational. However, in order for an organization to have positive change, then it begins with you.

Recent laws in the United States incent healthcare practices to adopt electronic health records (EHRs). While there is extensive research related to EHRs generally, there is a dearth of EHR research specific to collaborative care settings. This study reports responses from 101 collaborative care offices who completed a 13-question online survey. The mixed-methods analysis provides insights as to the satisfaction, obstacles, and solutions to interdisciplinary collaboration in the presence of an EHR. Respondents reported highest satisfaction with medical billing, interdisciplinary communication, and scheduling. Satisfaction was lower as it relates to time consumption, difficult learning curve, creation of appointment notes, and health registries. This research reveals varied and conflicting approaches to addressing confidentiality and HIPAA within the EHR. Recommendations for improving EHR to better support collaborative care include the addition of modules common in mental health-specific EHR, enhanced tracking of mental health outcomes, templates for joint appointments, and improvements in population-based registry functions.

- by Peter Fifield
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- Mental Health, Job Satisfaction, Electronic Health Records, Medicine

Background: Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness.

- by Bert Vrijhoef and +2
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- Non-communicable diseases, Collaboration, Health Services Research, Chronic illness and long-term care

Integration of conventional and complementary care in the United States is driven by the growing use of complementary therapies by patients, limitations in the effectiveness of conventional care for a variety of chronic conditions, a growing emphasis on patient satisfaction as a legitimate outcome of care, and an awareness on the part of insurers and practitioners that complementary approaches can offer a broad array of options that may significantly enhance healing and promote more active patient participation in health maintenance. Many models of integrative care are possible, ranging from the informed practitioner, to fully integrated group practices, to hospital-based and academic center systems of integration. A variety of barriers and challenges can slow the process of integration, including limited personal financial and temporal resources, negative peer opinion, legislative hindrances, and reimbursement shortfalls. This review describes seven models of integrative health car...

- by Susan Gaylord
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- Complementary and Alternative Medicine, Health Care, Holistic Health, Legislation

asistencia en domicilio. En un contexto de predominancia de las ECNT, Chile ha logrado una notable mejora en el acceso a los servicios de atención y una mejor integración funcional de éstos. Los pendientes más relevantes, entre otros, son lograr pasar de una participación social sólo como mecanismo de control social a ser una instancia que permita una real inclusión, autonomía y diálogo, y cambiar el paradigma de los prestadores[xvii] que siguen organizados en base a "problemas y patologías", hacia uno efectivamente centrado en necesidades integrales de personas y comunidades.

- by osvaldo artaza
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- Nursing, Public health systems and services research, Integrated Care

Background: Currently telemedicine is introduced with the expectation that it can solve basic challenges faced by the health system regarding an increasing number of patients with chronic service needs (1). The effects of teleconsultations, however, on the embodied, experiential and perceptual dimension of the relationship between nurses and patients are little known. This study focused on real-time video consultations (teleconsultations) as experienced by Danish hospitalbased, respiratory nurses (telenurses) and patients with chronic obstructive pulmonary disease, COPD, discharged after hospitalisation with acute exacerbation (telepatients). Purpose: 1) to explore how telepatients and telenurses use and develop sensual perceptions during teleconsultations; and how teleconsultations affect communication and interaction between patient and nurse, 2) to inform the implementation process in clinical practice.

- by Ditte Høgsgaard
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- Sociology, Integrated Care

The abstract presents results of the "InterQuality Project-International Research Project on Financing Quality in Healthcare" funded by the 7th Framework Programme (FP7) for Research and Technological Development of the European Union. Grant Agreement No: HEALTH-F3-2010-261369 Objectives: To identify, classify and assess indicators reflecting outcomes, efficiency, quality and equity of pharmaceutical care services from the perspective of three stakeholders: healthcare professionals, patients and payers as well as to describe them in accordance with Donabedian's [1] and ECHO [2] models. Theory: Providing guidance for authorities seeking scientifically validated knowledge in the area of pharmaceutical care as a part of managed care is needed. Methods: A systematic review restricted to the last 10 years was conducted in Medline, Embase and the Cochrane Library. A non-systematic review was added. Results: 87 articles were identified during the systematic review and 10 publications were manually added. Indicators were assigned according to topic (efficiency, outcomes, quality and

The majority of new HIV diagnoses in the UK occur in people with heterosexually acquired HIV infection, the majority of whom are migrant Africans. In the UK HIV positive Africans access HIV services at a later stage of disease than non-Africans . Employing purposive sampling techniques, semi-structured interviews were conducted with key informants to identify the key issues affecting utilization of HIV services for Africans in Britain. Considerable agreement about the major issues influencing uptake of HIV services existed amongst the key informants. Respondents felt there was high HIV awareness but this did not translate into perception of individual risk. Home country experience and community mobilization was highly influential on HIV awareness, appreciation of risk, and attitudes to health services. Institutional barriers to care exist; these include lack of cultural understanding, lack of open access or community clinics, failure to integrate care with support organizations, and the inability of many General Practitioners to address HIV effectively. Community involvement should include input to ensure there is: better cultural understanding within the health care system; normalization of the HIV testing process; and a clear message on the effectiveness of therapy.

- by James Nazroo
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- Psychology, Open Access, Community-Based Mental Health Services, Health Care

Home care services HIV AIDS Internet Patient care team a b s t r a c t

- by Cesar Caceres
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- Information Systems, Engineering, Medical Informatics, Telemedicine

Introduction: Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multidisciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. Methods: We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures-the Valence, the Focus, and the Level. Standardized weighted integrative intensity scores are calculated across ten time deciles in the Case Discussion providing a graphical representation of its integrative intensity.

- by sue patterson
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- Nursing, Communication, Medicine, Public health systems and services research

Purpose“Integrated care” (IC) is an approach to health and social care delivery that aims to prevent problems arising from fragmented care systems. The collective content of the IC literature, whilst valuable, has become extensive and wide-ranging to such a degree that knowing what is most important in IC is a challenge. This study aims to address this issue.Design/methodology/approachA scoping review was conducted using Arksey and O'Malley's framework to determine IC priority areas.FindingsTwenty-one papers relevant to the research question were identified. These included studies from many geographical regions, encompassing several study designs and a range of populations and sample sizes. The findings identified four priority areas that should be considered when designing and implementing IC models: (1) communication, (2) coordination, collaboration and cooperation (CCC), (3) responsibility and accountability and (4) a population approach. Multiple elements were identified...

- by Corey Burke and +3
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- Integrated Care

Education needs for integrated care: a literature review Aim. This paper reports a systematic review to identify the education needs of the workforce within primary care to promote the effective delivery of integrated health and social care services. Background. The need for different professionals to work more closely dominates global health policy. The drive to develop a workforce prepared for the future is crucial to the success of integrated services. However, some have argued that nurses are ill-equipped to meet the challenges of integrated service provision. The ability to work interprofessionally is an important skill which needs to be developed to support integrated working. Methods. Structured searches were undertaken on organizational websites and the Caredata, CINAHL, Cochrane Library, MEDLINE, Sociofile databases between December 2002 and April 2004 to identify policy documents and primary research studies. The robustness of identified research studies were appraised using recognized appraisal tools. Findings. Six themes were identified which indicate essential elements needed for integrated care. The need for effective communication between professional groups within teams and an emphasis on role awareness are central to the success of integrated services. In addition, education about the importance of partnership working and the need for professionals to develop skills in relation to practice development and leadership through professional and personal development is needed to support integrated working. Conclusion. Education which embeds essential attributes to integrated working is needed to advance nursing practice for interprofessional working. Further research exploring this and its impact on integrated provision is essential to ensure that evidence-based services are provided. The reinforcement of partnerships between higher education institutions and health and social care organizations should ensure that the workforce is educated to manage continuous change in service delivery. Innovative ways of teaching and learning which promote inter-professional working need to be explored.

- by Michelle Howarth
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- Nursing, Communication, Social Work, Leadership

Well-functioning collaboration between professionals in the welfare sector has a strong influence on the contacts with parents of children and adolescents suffering from mental illness, and it is a precondition for the availability of support for these parents. This paper describes how such parents perceive collaboration between professionals in mental health care, social services, and schools. This was a small-scale qualitative study. Data were collected by in-depth interviews with seven parents of children and adolescents diagnosed with anxiety and depression. The families were selected from the Child and Adolescent Mental Health patient records kept by the Stockholm County Council (Sweden), and they all lived in a catchment area for Child and Adolescent Mental Health outpatient services in Stockholm. Our results suggest that when the encounter between parents and professionals is characterised by structure and trust, it is supportive and serves as a holding environment. Parents t...

- by David Bergman and +2
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- Nursing, Public health systems and services research, Integrated Care

Implementation of large scale, comprehensive, and interoperable ICT is a preferred tool to transform health care delivery systems across Europe. Embedded in this transformation is the goal of integrated services and integrated care. The... more

- by David Finnegan
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- Nursing, ICT, Public health systems and services research, Integrated Care
- by Barbara Rubel
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- Sociology, British Sociology, Primary Health Care Nursing, Integrated Care

A rapid-feedback evaluation (RFE) model is presented as an alternative or complement to comprehensive models of evaluation. RFEs are a four-step process, involving (1) collecting existing data on program performance, (2) collecting new data on program performance, (3) performing a preliminary evaluation, and (4) assisting in policy and management decisions. The argument is made that RFEs are preferable to comprehensive models of evaluation when program managers need a rapid and focused assessment of a particular program process. The utility of RFEs is demonstrated by showing how an RFE contributed to improvements in the retention rates of a longitudinal HIV/AIDS care study that targeted a hard-to-retain population. The implementation of changes to retention procedures recommended by the RFE was associated with significant increases in study retention rates. The strengths and limitations of RFEs as an alternative to other evaluation models are discussed.

- by Miles McNall
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- Management, Program Evaluation, Evaluation, Population Dynamics

Aim Integrated care pathways (ICP) are management technologies which formalise multidisciplinary team-working and enable professionals to examine their roles and responsibilities. ICPs are now being implemented across international healthcare arena, but evidence to support their use is equivocal. The aim of this study was to identify the circumstances in which ICPs are effective, for whom and in what contexts.

- by Laura Rixson and +1
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- Nursing, Systematic review, Clinical Sciences, Public health systems and services research

Purpose – This paper aims to: analyze the challenge of health services fragmentation; present the attributes of integrated health service delivery networks (IHSDNs); review lessons learned on integration; examine recent developments in selected countries; and discuss policy implications of implementing IHSDNs.Design/methodology/approach – A literature review, expert meetings, and country consultations (national, subregional, and regional) in the Americas resulted in a set of consensus‐based essential attributes for implementing IHSDNs. The analysis of 11 country case studies on integration allowed for the identification of lessons learned.Findings – Studies suggest that IHSDNs could improve health systems performance. Principal findings include: integration processes are difficult, complex, and long term; integration requires extensive systemic changes and a commitment by health workers, health service managers and policymakers; and, multiple modalities and degrees of integration ca...

- by renato tasca
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- Nursing, Health Care, Literature Review, Health Services

The primary care health setting is in crisis. Increasing demand for services, with dwindling numbers of providers, has resulted in decreased access and decreased satisfaction for both patients and providers. Moreover, the overwhelming majority of primary care visits are for behavioral and mental health concerns rather than issues of a purely medical etiology. Integrated-collaborative models of health care delivery offer possible solutions to this crisis. The purpose of this article is to review the existing data available after 2 years of the St. Louis Initiative for Integrated Care Excellence; an example of integratedcollaborative care on a large scale model within a regional Veterans Affairs Health Care System. There is clear evidence that the SLI 2 CE initiative rather dramatically increased access to health care, and modified primary care practitioners' willingness to address mental health issues within the primary care setting. In addi-tion, data suggests strong fidelity to a model of integrated-collaborative care which has been successful in the past. Integrated-collaborative care offers unique advantages to the traditional view and practice of medical care. Through careful implementation and practice, success is possible on a large scale model.

- by Jamie Manwaring
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- Primary Care, Mental Health, Primary Health Care, United States

Background: More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials. Methods: To study how practices integrate care, we are conducting a cross-case comparative, mixedmethods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator. Results: Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient-and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges. Conclusion: Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving widespread implementation. (

- by Melinda Davis
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- Health Sciences, Nursing, Mental Health, Organizational Culture

The European Welfare State crisis since 2008 has shown the weakness of these European welfare systems to cope with a health crisis such as COVID-19, which in turn has not guaranteed the rights and wellbeing of older people. This article aims at shed light on the scarcity of resources in Spin for its care homes and nursing homes system, while analyzing its integrated care failure and the urgent legislative measures implemented to overcome COVID-19 health crisis. At the same time, this paper advocates for a reflexion on ageist practices, so as to foster a debate on the ‘deinstitutionalization’ process of older adults in Spain. In this COVID-19 context, it has become utmost in implementing an older adults’ policy to guarantee older adults rights as vulnerable population; likewise, which has already been done in respect to laws protecting children rights.

- by Blanca Deusdad
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- Long Term Care, Ageism, Ageing and Health, Nursing Homes

Background: Triply diagnosed patients, who live with HIV and diagnosed mental health and substance abuse disorders, account for at least 13% of all HIV patients. This vulnerable population has substantial gaps in their care, attributable in part to the need for treatment for three illnesses from three types of providers. Aims of the study: The HIV/AIDS Treatment Adherence, Health Outcomes and Cost study (HIV Cost Study) sought to evaluate the cost-effectiveness of integrated HIV primary care, mental health, and substance abuse services among triply diagnosed patients. The analysis was conducted from a health sector budget perspective. Methods: Patients from four sites were randomly assigned to intervention group or (n=232) or control group (n=199) that received care-as-usual. Health service costs were measured at baseline and three, six, nine and 12 months and included hospital stays, emergency room visits, outpatient visits, residential treatment, formal long-term care, case management, and both prescribed and over-the-counter medications. Costs for each service were the product of self-reported data on utilization and unit costs based on national data (2002 dollars). Quality of life was measured at baseline and six and 12 months using the SF-6D, as well as the SF-36 physical composite score (PCS) and mental composite score (MCS). Results: During the 12 months of the trial, total average monthly cost of health services for the intervention group decreased from 3235to3235 to 3235to3052 and for the control group decreased from 3556to3556 to 3556to3271, but the decreases were not significant. For both groups, the percentage attributable to hospital care decreased significantly. There were no significant differences in annual cost of health services, SF-6D, PCS or MCS between the intervention and control group. Implications for Health Care Provision and Use: The results of this randomized controlled trial did not demonstrate that the integrated interventions significantly affected the health service costs or quality of life of triply diagnosed patients. Professionals could pursue coordination or integration of care guided by the evidence that it does not increase the cost of care. The results do not however, provide an imperative to introduce multi-disciplinary care teams, adherence counseling, or personalized nursing services as implemented in this study. Implications for Health Policies: There is not enough evidence to either limit continued exploration of integration of care for triply diagnosed patients or adopt policies to encourage it, such as financial reimbursement, grants regulation or licensing. Implications for Further Research: Future trials with interventions with lower baseline levels of integration, longer duration and larger sample sizes may show improvement or slow the decline in quality of life. Future researchers should collect comprehensive cost data, because significant decreases in the cost of hospital care did not necessarily lead to significant decreases in the total cost of health services.

- by Peter S Arno
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- Psychology, Primary Care, Mental Health, Long Term Care

In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model. Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3646 patients and 17,311 matched controls, and changes in overall secondary care utilisation. Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about the...

- by Martin Roland
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- Nursing, Preventive medicine, Chronic illness, Medicine

Partners rather than just providers…" : a qualitative study on health care professionals' views on implementation of multidisciplinary group meetings in the North West London integrated care pilot. International Journal of Integrated... more

- by Yannis Pappas
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- Nursing, Qualitative methodology, Qualitative Methods, Health Services Research

This paper reports on some of the findings of a literature review commissioned to explore integrated care for older people. The process of revising included finding and selecting literature from multidisciplinary sources, and encompassed both published papers and 'grey' literature, i.e. material which had not been reviewed for publication. The study found that thinking has moved on from a focus on the problems of accessing services to exploring ways in which they may function in an integrated way. The study shows how thinking on integrated care for older people has developed, and knowledge of micro, mezzo and macro strategies is now more available.

- by Glenda Cook
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- Nursing, Public health systems and services research, Integrated Care

Partiendo de una lectura de la actual situación de los servicios sociales (en el contexto del conjunto del sistema de bienestar) en España y de los retos que tienen ante sí, se plantea una propuesta de diferenciación sectorial de los servicios sociales y de integración intersectorial de éstos con otros ámbitos, sectores o pilares de la acción pro bienestar, como el sanitario, intentando fundamentar y argumentar en qué medida y en qué sentido un nuevo modelo de servicios sociales (dedicados a promover y proteger la interacción de todas las personas) y una atención integrada efectiva y sostenible (entre servicios sociales y sanidad y también entre estos y otros sectores) se alimentan mutuamente y, a la vez, resultan necesarias en el contexto actual que la nueva complejidad social convierte en crecientemente obsoletos los servicios sociales residuales e inespecíficos y el modelo de bienestar correspondiente.

- by Fernando Fantova
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- Social Policy, SERVICIOS SOCIALES, Integrated Care

demonstrated that person-centred planning (PCP) leads to positive changes for people. This research shows how PCP is associated with benefits in the areas of community involvement, contact with friends, contact with family and choice. This paper briefly describes this research and its recommendations. In addition it explores the implications for managers and professionals supporting people with learning disabilities.

- by Helen Sanderson
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- Nursing, Evidence Based Practice, Community Involvement, Learning Disability

Questo articolo è la traduzione dall’originale inglese di Francesco Bottaccioli, Anna G. Bottaccioli, Enrica Marzola, Paola Longo, Andrea Minelli, and Giovanni Abbate-Daga. 2021. "Nutrition, Exercise, and Stress Management for Treatment and Prevention of Psychiatric Disorders. A Narrative Review Psychoneuroendocrineimmunology-Based" Endocrines 2, no. 3: 226-240. https://doi.org/10.3390/endocrines2030022. La traduzione è di Patrizia Stirgwolt, la revisione scientifica della traduzione è di Paola Longo, Università di Torino.

- by Francesco Bottaccioli and +1
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- Exercise Physiology, Meditation, Psychoneuroendocrinoimmunology (PNEI), Psychiatrie
- by Fiona Keogan
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- Psychology, Integrated Care

Emergency clinicians undertake boundary-work as they facilitate patient trajectories through the Emergency Department (ED). Emergency clinicians must manage the constantly-changing dynamics at the boundaries of the ED and other hospital departments and organizations whose services emergency clinicians seek to integrate. Integrating the care that differing clinical groups provide, the services EDs offer, and patients' needs across this journey is challenging. The journey is usually accounted for in a linear way e as a "continuity of care" problem. In this paper, we instead conceptualize integrated care in the ED using a complex adaptive systems (CAS) perspective. A CAS perspective accounts for the degree to which other departments and units outside of the ED are integrated, and appropriately described, using CAS concepts and language. One year of ethnographic research was conducted, combining observation and semi-structured interviews, in the EDs of two tertiary referral hospitals in Sydney, Australia. We found the CAS approach to be salient to analyzing integrated care in the ED because the processes of categorization, diagnosis and discharge are primarily about the linkages between services, and the communication and negotiation required to enact those linkages, however imperfectly they occur in practice. Emergency clinicians rapidly process large numbers of high-need patients, in a relatively efficient system of care inadequately explained by linear models. A CAS perspective exposes integrated care as management of the patient trajectory within porous, shifting and negotiable boundaries.

- by Katherine Carroll and +1
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- Sociology, Anthropology, Australia, Complexity

Developed health systems want to avoid unnecessary hospital admissions by addressing the needs of chronically ill older adults throughout acute episodes of illness. Transitional care (TC) is a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location, of which the main outcome of interest is avoiding hospital readmission. Implementation of TC is complex because it entails different actions to put multiple care components into practice, with various degrees of flexibility of adapting the intervention. Furthermore, the outcome involves behaviour change required by those delivering or receiving the intervention. Although there are examples of promising interventions, the possible variations in conceptualization and implementation present a real challenge for the adaptation of efficacious TC interventions from trial to 'real-world' settings. There is a lack of a theoretical basis or explicit logic model for why adapted interventions should work. This study provides conceptual approaches for the implementation and evaluation of TC programmes. It describes a framework of (1) conceptualization – with respect to the components in an intervention and the population of interest; (2) manner and context of implementation; and (3) evaluation – how these processes of implementation impact health outcomes.

- by Bert Vrijhoef and +1
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- Health Services Research, Chronic illness and long-term care, Logic Models, Integrated Care

Purpose: In all Western countries, ageing populations cause the demand for elderly care services to increase dramatically. In addition, elderly clients are getting more demanding about the services they require to fulfil their widely varying and multiple needs. Besides, cost reductions have been the focus of governmental policies and organisational practices for many years. Health care providers increasingly see operations management as a promising approach to align both client-orientation and cost-efficiency in their day-today practices. Theory: The paper starts from operations management literature on front office-back office design and modular production. Organisations have several options for deciding which activities need to be performed by FO, BO, or the client himself, and in deciding which employees need to perform these activities. By applying modular production, organisations can differentiate care and related services to a high degree without major cost increases. Method: A literature review will be presented leading to a theoretical framework. This formed the basis for explorative case studies in the elderly care sector. Results and conclusions: It will be argued how insights provided with the framework may enhance a client-orientation in integrated care delivery without major cost increases. Although case studies need to be interpreted with caution, interesting implications for organisational structures and inter-organisational cooperation can be seen. We will discuss how combined supply of care services can be made transparent to enhance choice options in service products, and what is required at the level of professionals for providing care and service packages based on client demand.

- by Katrien Luijkx
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- Business, Nursing, Operations Management, Cost Efficiency

Purpose-The purpose of this paper is to support the ongoing dialogue and shed light on the different views on integrated care. An overarching definition of integrated care is proposed combining the ways of thinking of the four quality paradigms the authors identify. The idea of epistemic fluency offers a way-out of ongoing discussions about "what integration is". Design/methodology/approach-Four paradigms of quality are presented and applied to healthcare. Epistemic fluency is proposed as the capacity to understand, switch between and combine different kinds of knowledge. The authors compare previously developed definitions of integrated care to the various combinations of paradigms. Findings-All four paradigms of care quality are present in healthcare and in the most used definitions of integrated care. The Reflective Paradigm and the Emergence Paradigm receive least attention. Some definitions combine more than one paradigm. An overarching definition of integrated care is proposed. Research limitations/implications-In this paper, only the most prominent definitions of integration have been considered. Practical implications-Integration research and practice requires a widely accepted definition of integrated care, embracing all four paradigms of care quality. Our suggestion provides a common foundation that may prevent misunderstanding. Originality/value-The use of quality management paradigms to frame the debate on defining integrated care is new and leads to new insights for teaching, research and practice.

- by Everard van Kemenade and +1
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- Emergence, Integrated Care, Quality Paradigms

In the fast-growing geriatric population, we are confronted with both osteoporosis, which makes fixation of fractures more and more challenging, and several comorbidities, which are most likely to cause postoperative complications. Several models of shared care for these patients are described, and the goal of our systematic literature research was to point out the differences of the individual models. A systematic electronic database search was performed, identifying articles that evaluate in a multidisciplinary approach the elderly hip fracture patients, including at least a geriatrician and an orthopedic surgeon focused on in-hospital treatment. The different investigations were categorized into four groups defined by the type of intervention. The main outcome parameters were pooled across the studies and weighted by sample size. Out of 656 potentially relevant citations, 21 could be extracted and categorized into four groups. Regarding the main outcome parameters, the group with integrated care could show the lowest in-hospital mortality rate (1.14%), the lowest length of stay (7.39 days), and the lowest mean time to surgery (1.43 days). No clear statement could be found for the medical complication rates and the activities of daily living due to their inhomogeneity when comparing the models. The review of these investigations cannot tell us the best model, but there is a trend toward more recent models using an integrated approach. Integrated care summarizes all the positive features reported in the various investigations like integration of a Geriatrician in the trauma unit, having a multidisciplinary team, prioritizing the geriatric fracture patients, and developing guidelines for the patients’ treatment. Each hospital implementing a special model for geriatric hip fracture patients should collect detailed data about the patients, process of care, and outcomes to be able to participate in audit processes and avoid peerlessness.

- by Thomas J. Luger
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- Literature Review, Osteoporosis, Hip Fractures, Sample Size
- by Quentin Spender
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- Sociology, British Sociology, Primary Health Care Nursing, Integrated Care
- by Patrick Bindels
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- Nursing, Quality of life, Health Services Research, Family Practice

Purpose -The purpose of this paper is to present a definition of integration and coordination in health service production, and to derive basic design rules. Design/methodology/approach -The paper is based on an operations management perspective and applies a design science methodology to identify purposes, contexts, and design rules. Findings -Integration and coordination need to be conceptually separated, as the former means the merger of various service contributions into a common understanding, while the latter means the arrangement of service elements into processes.

- by Paul Lillrank
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- Integrated Care

Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

- by Charles Normand
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- Primary Health Care, Evidence Based Medicine, Epilepsy, Self Care

La cirugía de mama puede resultar muy estresante para la mujer por la elevada carga simbólica que representa a nivel biopsicosocial. Antes de la puesta en marcha de la consulta, la enfermera tenía la sensación de que la mujer era dada de alta, después del proceso quirúrgico, con excesivas preocupaciones y dudas. El objetivo de este trabajo es presentar la organización, estructura, funciones y actividad de la consulta de enfermería de patología mamaria durante los años 2002-2005 en el Hospital de Palamós (Girona), así como promover la existencia de este tipo de consultas. En la consulta se realizan cuidados posquirúrgicos, educación sanitaria y soporte psicológico que benefician la atención integral de la mujer que presenta este importante problema de salud. La consulta es un recurso para el seguimiento de las pacientes con patología mamaria, que facilita la cirugía ambulatoria, el alta precoz y la disminución de la estancia media hospitalaria.

- by Gilbert Ansah Owusu
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- Breast Cancer, Health Education, Enfermería clinica, Nursing Care

Other articles in this issue present relevant arguments why assessment and treatment of psychosocial comorbidities should be integrated in the provision of general medical care. Psychosocial comorbidities, highly prevalent because of an increase in numbers of the elderly and of patients who have chronic diseases , influence the outcome of various somatic diseases and are associated with excessive health care use , diminished quality of life [4], survival , and compliance with treatments, which represents a major obstacle to effective medical care . Moreover, several symptoms co-occur in psychiatric and somatic syndromes; for example, some psychiatric disorders such as depression have somatic symptoms , and physiologic and behavioral mechanisms have been described that cross the borders between somatic and psychiatric disciplines, such as in depression and coronary Med Clin N Am 90 (2006) artery disease and diabetes mellitus (see articles in this issue by Kroenke and Rosmalen and by Egede). Finally, many risk factors for somatic and psychiatric diseases are shared, for example in the concept of frailty or in the metabolic syndrome (see articles in this issue by Slaets and by Gans).

- by Joris Slaets and +2
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- Medical Sociology, Risk assessment, Clinical Sciences, Interdisciplinary Communication

Mothers, newborns, and children are inseparably linked in life and in health care needs. In the past, maternal and child health policy and programmes tended to address the mother and child separately, resulting in gaps in care which especially affect newborn babies. How can these gaps be addressed, especially during birth and the first days of life, when most mothers

- by Joseph Graft-johnson and +1
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- Child health, Health Care, Home Care, Quality of Care