BMC Med Res Methodol. For example an increase in service usage may be positive for patients or the service, but may also be negative in terms of costs or detrimental effect on other services. Health and social care integration. On May 17, 1954, the Supreme Court declared in its landmark unanimous decision, Brown v. Board of Education, that . Elements of new models of integrated care in the included literature. We included studies of both comparator and non-comparator design from the UK (as these data were considered to privilege relevance), whereas we prioritised international systematic reviews and international primary studies with comparative design (thereby privileging rigour). The integrated curriculum is a perfect way to develop generic abilities such as cooperation, creativity, communication, character education, literacy and critical thinking. Last week, we wrote a blog post on the benefits of integrating genomics into clinical trials, such as improved methods for patient stratification, contributing to genetic research and accounting for sources of variability.. PLoS One. 2008;17:4653. Jha S, Moran P, Blackwell A, Greenham H. Integrated care pathways: the way forward for continence services? Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Service user involvement and integrated care pathways. Paulus A, van Raak A. Guerrero EG, Aarons GA, Palinkas LA. Coupe M. Integrated care in Herefordshire: a case study. Butler M, Kane RL, McAlpine D, Kathol RG, Fu SS, Hagedorn H, et al. Farmer J, Clark M, Drewel E, Swenson T, Ge B. Consultative care coordination through the medical home for CSHCN: a randomized controlled trial. J Obstet Gynaecol. This paper focuses on data relating to the effects of models of integrated care on actual and perceived service delivery, including the efficiency, effectiveness and quality of care. Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. We identified diverse and frequently contradictory outcomes for models of integrated care reported in the included literature. 2007;298:262333. Psychiatr Quart. It can result in decreased flexibility. Only just over half used statistical measures (such as p values) to evaluate change over time. 2010;65:10718. London: Imperial College; 2013. We also acknowledge a potential issue of publication bias, with studies reporting less positive outcomes potentially under-represented in the review. A cost-effectiveness study of a patient-centred integrated care pathway. Health Inf Libr J. Health Care Manag Rev. Worldviews Evidence-based Nurs. Despite the small percentage that found disadvantages with interdisciplinary teaming, overall, students felt that working in teams beyond their own grade level gave them a sense of community and that by keeping a journal and making portfolios, they gained a sense of personal growth. A critical synthesis of research on patient-centred medical homes and patient-related outcomes. In May 2017 we conducted a citation search to identify any literature published subsequent to the formal bibliographic searches. Integration of mental health/substance abuse and primary care. As with the UK comparative design studies, none met all the criteria for reduction of potential bias. Deep learning engages the whole student (and teacher) -- heart, mind, body, and soul. BMC Health Serv Res. 2013;158:16978. Integrating social studies within an English Language Arts instructional block creates learning opportunities that more closely align with recommendations from the National Council for the Social Studies (2009) for increased breadth and depth of study through . Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, et al. Imison C, Curry N, Holder H, Castle-Clarke S, Nimmons D, Appleby J, et al. BMC Health Serv Res. 2013;13:262. Cohen E, Lacombe-Duncan A, Spalding K, MacInnis J, Nicholas D, Narayanan U, et al. J Healthcare Qual. Reporting strength by volume of studies (vote counting) may be imperfect, primarily indicating where there has been research activity. London: National Audit . 3. Pediatrics. 2012;31:237987. Homer CJ, Klatka K, Romm D, Kuhlthau K, Bloom S, Newacheck P, et al. Bland F, Bergman H, Lebel P, Dallaire L, Fletcher J, Contandriopoulos A, et al. Tieman J, Mitchell G, Shelby-James T, Currow D, Fazekas B, ODoherty L, et al. 2011;11(1):207. PubMed Central 2013;37:115763. J Pediatr Infect Dis. Lancet Neurol. 2014;14:58. 1 for a diagram illustrating the study selection process. There seems a need for further attention to how reconfiguration impacts on patients and carers, including whether service users perceive any change, or have greater knowledge of or involvement in services. 2013;28:61221. Grant MJ, Booth A. Stokes JPM, Alam R, Checkland K, Suderaghi-Sohi S, Bower P. Effectiveness of case management for at risk patients in primary care: a systematic review and meta-analysis. Cost analysis of the geriatric resources for assessment and Care of Elders care management intervention. Three international comparator studies (reported in five papers) supported the finding that integrated care initiatives improved access [117, 123,124,125,126]. Munn Z, Stern C, Aromataris E, Lockwood C, Jordan Z. PubMed Google Scholar. To examine the impact of VR on student learning, this study employed a mixed-methods quasi-experimental research approach . 2009;361:23013. Evidence regarding the following outcomes was rated as inconsistent: number of clinician contacts (five indicated a reduction, and three an increase); number of GP appointments (two UK studies reported a reduction and another UK study no difference); length of stay (24 studies reported a reduction, two studies found an increase, and 11 no effect); unscheduled admissions (10 studies found a reduction, two an increase; and nine no effect); number of admissions (24 studies found a reduction, five reported an increase, and nine no effect) although considered alone the systematic reviews provided stronger evidence of a reduction; re-admissions (nine studies, with eight from the same authors reported no effect, two studies found an increase and two a reduction); attendance at accident and emergency (nine studies found a reduction, two an increase and eight no effect); quality of care standards (two studies reported an increase and one no difference); and staff work experience (two reviews of UK studies indicated improved experience, and one international study indicated no difference). Arch Intern Med. Hbert R, Veil A, Rache M, Dubois MF, Dubuc N, Tousignant M. Evaluation of the implementation of PRISMA, a coordination-type integrated service delivery system for frail older people in Qubec. Qual Saf Health Care. Google Scholar. 2006;25:542. Huntley AL, Thomas R, Mann M, Huws D, Elwyn G, Paranjothy S, et al. Nineteen studies specifically described both health and social care services being included in the integration, although reporting of specific details of partner organisations/services was often limited. 2011;12:95111. London: Nuffield Trust; 2011. writing, grammar, social studies, and science" (p.11). BMJ Open. The effectiveness of inter-professional working for older people living in the community: a systematic review. Can Fam Physician. Although our search terms enabled relevant citations to be retrieved, we recognise that indexing may be imperfect, and we may have not identified all studies of relevance. Additional file 2: Table S1 details the number of studies reporting each outcome, with each study (or papers from the same study) represented by either a plus + meaning that the study reported an increase for this outcome, or a plus/minus sign meaning that the study reported no significant change for this outcome, or a minus sign - meaning that the study reported a reduction for this outcome. Schizophr Bull. A retrospective analysis. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study. British J Nurs. While there appeared to be no clear pattern of differential outcomes between settings or initiatives, there appeared to be potential for more positive outcomes amongst those categorised by authors as having complex needs, although currently most research evidence comes from studies in older adults. Privacy This blog post by Sano Genetics identifies reasons why people may not integrate genomics . Callahan C, Boustani M, Unverzagt F, Austrom M, Damush T, Perkins A, et al. 2007;110:178290. 2014;14:428. https://doi.org/10.1186/1472-6963-14-428. National Audit Office. Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. Should care managers for older adults be located in primary care? van der Marck MA, Munneke M, Mulleners W, Hoogerwaard EM, Borm GF, Overeem S, et al. JAMA. 2009;26:91108. CAS Mobile technology continues to change and evolve the way people and society function in their everyday lives. National Evaluation of the Department of Healths integrated care pilots. The implementation of highly complex whole-system change interventions such as new forms of integration is known to be challenging [188], and differing degrees of success in implementation may contribute to the varying outcomes reported. London: OPM Group; 2014. A literature review. 3.2. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. Despite the small percentage that found disadvantages with interdisciplinary teaming, overall, students felt that working in teams beyond their own grade level gave them a sense of community and that by keeping a journal and making portfolios, they gained a sense of personal growth. Trivedi D, Goodman C, Gage H, Baron N, Scheibl F, Iliffe S, et al. 2013;69:14452. Palliat Med. In Press). The effect of the Liverpool care pathway for the dying: a multi-Centre study. https://doi.org/10.1016/j.jval.2014.08.259. UK studies indicated evidence of a reduction in waiting times and out-patient appointments, although the international literature as a whole was more inconclusive. Factors enabling implementation of integrated health and social care: a systematic review. 2012;2 https://doi.org/10.1136/bmjopen-2012-000930. The effects of integrated care: a systematic review of UK and international evidence. Int J Qual Health Care. It is a simple, efficient way to integrate two apps. Articles which met the inclusion criteria were read in full and data extracted by the team of three reviewers. Palliat Med. https://doi.org/10.1186/s12913-018-3161-3, DOI: https://doi.org/10.1186/s12913-018-3161-3. 2006;26:917. 2009;57:14206. 2012;12 https://doi.org/10.5334/ijic.850. National Health Institute. Article UK-only evidence indicated that patient waiting time and outpatient appointments may be reduced, and patient wishes at end of life are met more often (although inconsistency or lack of evidence for these effects was found in the international literature). In view of this challenge, we used strength of evidence ratings to summarise where greater or lesser certainty existed in the literature, considering quality, volume and consistency of the evidence identified. 2016;2:120816. The studies all utilised non-comparator designs however, so this indication needs to be treated with caution. Prim Care Respir J. Emerg Med J. Royal College of Nursing: Edinburgh; 2011. 2013;21:198207. J Am Geriatr Soc. Battersby M, Harvey P, Mills PD, Kalucy E, Pols RG, Frith PA, et al. Much like the phenomenon that was the Internet 20 years . Milbank Q. 2012;107:10845. Taylor A, Lizzi M, Marx A, Chilkatowsky M, Trachtenberg SW, Ogle S. Implementing a care coordination program for children with special healthcare needs: partnering with families and providers. Austr Health Rev. 2011;15:719. Cameron A, Bostock L, Lart R. Service user and carers perspectives of joint and integrated working between health and social care. Int J Evidence-Based Healthcare. After independent screening and discussion of the first 5% of the database to establish agreement, further screening was carried out by a single reviewer, with checking of a 10% sample by other team members. 2014;55:31525. 2014;44:479505. PubMed England NHS. What kind of systematic review should I conduct? https://doi.org/10.5334/ijic.996. Hammar T, Rissanen P, Perl M. The cost-effectiveness of integrated home care and discharge practice for home care patients. Does an enhanced recovery integrated care pathway (ICP) encourage adherence to prescribing guidelines, accelerate postoperative recovery and reduce the length of stay for gynaecological oncology patients? 2006;61:36773. Rowlandson PH, Smith C. An interagency service delivery model for autistic spectrum disorders and attention deficit hyperactivity disorder. Int J Evidence-Based Healthcare. We also looked for any patterns in regard to the type of initiatives that appeared to lead to more positive outcomes, with little clarity in signal beyond suggesting that integrated pathways as stand alone interventions may have a limited effect. Integration could be used in a variety of ways, including to describe interventions which related to enhanced care or quality assurance but did not include staff working in new ways. How effective are mental health nurses in A&E departments? 2014;14:229. Qual Prim Care. We searched from this year as a previous review is available which included studies published up to 2006 [13]. Point-to-point (P2P) integration. 2014;58:3505. It can have capacity-balancing problems. Johansson G, Eklund K, Gosman-Hedstrom G. Multidisciplinary team, working with elderly persons living in the community: a systematic literature review. BMC Health Serv Res. Richings C, Cook R, Roy A. Open Document. Randomized controlled trial of anticipatory and preventive multidisciplinary team care: for complex patients in a community-based primary care setting. 2007;24:35963. North West London integrated care pilot evaluation: report on work Programme 3. 2010;45:176382. BMC Med Res Methodol. https://doi.org/10.1136/bmjopen-2015-010468. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. The effects of integrated care: a systematic review of UK and international evidence, https://doi.org/10.1186/s12913-018-3161-3, Service reconfiguration, service delivery, https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf, https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/implementing-the-nhs-five-year-forward-view-kingsfund-feb15.pdf, https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration.pdf, https://www.nuffieldtrust.org.uk/files/2017-02/shifting-the-balance-of-care-report-web-final.pdf, https://doi.org/10.1186/s12913-014-0590-5, https://doi.org/10.1002/14651858.CD010414.pub2, https://doi.org/10.1136/bmjopen-2012-000930, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215103/dh_133127.pdf, https://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/Policy-paper-6.pdf, https://doi.org/10.1136/bmjopen-2015-010468, https://doi.org/10.1016/j.jval.2014.08.259, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, bmchealthservicesresearch@biomedcentral.com. Scand J Occup Ther. Baxter SK, Blank L, Woods HB, Payne N, Rimmer M, Goyder E. Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions. An integrated care pathway improves the management of paracetamol poisoning. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. 2009;339:b2700. 2008;8 https://doi.org/10.1186/1472-6963-8-115. 2007;32:28494. The effect of integrated care initiatives in older adult populations echoed the strength rating for all studies, with reports of increased access and patient satisfaction, and inconsistency in regard to admissions, emergency admissions, length of stay, patient contacts/service usage, and costs. Katon W, Russo J, Lin E, Schmittdiel J, Ciechanowski P, Ludman E, et al. 2015;23:7487. Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries. Int J Integrat Care. Martinez-Gonzalez NA, Berchtold P, Ullman K, Busato A, Egger M. Integrated care programmes for adults with chronic conditions: a meta-review. Boult C, Reider L, Leff B, Boyd CM, Wolff JL. London: Nuffield Trust; 2017. Hildebrandt H, Schulte T, Stunder B. Some authors highlighted the continuance of varied pre-existing governance arrangements following integration of organisations, with progress on new models often reported to be particularly limited in the areas of budgets, financial, and contracting mechanisms [187]. Some studies reported that increasing quality of care for patients may come at increased cost for services already facing financial pressure. 2010;363:124555. We then compared this to the strength of evidence ratings assigned to the included studies as a whole. Steventon ABM, Billings J, Georghiou T, Lewis G. An evaluation of the impact of community-based interventions on hospital use. Lamb BW, Jalil RT, Sevdalis N, Vincent C, Green JS. Following screening of 13,323 unique citations, 167 documents representing 153 unique studies were eligible for inclusion. CAS Genet N, Boerma WG, Kringos DS, Bouman A, Francke AL, Fagerstrom C, et al. Suter E, Oelke ND, Adair CE, Armitage GD. The potentially positive outcome of increasing ease of access for patients, also offers contradictory effects. 2009;23:34154. Int J Health Care Qual Assur. 2014;14:19. 2010;17(2):10116. Health Serv Res. System integration, or integration at the system level, refers to the integration of components, elements or subsystems, or human interactions in order to realise a system that accomplishes the system objectives. Four of six international comparator studies similarly reported increased satisfaction amongst older, acute and paediatric patient populations following service integration, case management and patient-centred medical home interventions [119, 136, 150, 159]. Appendix S4. jparshall@americanprogress.org. Due to the nature of the intervention no studies were able to achieve the gold standard of double blinding and full randomisation and thus provide evidence considered to be strong. The literature included in this review rarely focused on organisational change within integrated care models. Article Pearson V, Chant S. Different models of health and social care in Devon -- observations and implications for commissioners and providers. 2014;16:114251. Palliat Med. 2018;18:5. Breton M, Pineault R, Levesque JF, Roberge D, Da Silva RB. 2012;20:20522. Figure4 summaries the types of patients and conditions in the studies included in the review. The extraction form collected data on: first author/year; study design; sample size; population characteristics (type of group, condition/department, sex, age, other details reported); context; data collection method; outcome measures; type and details of the intervention; summary of results; main author conclusions; reported associations; and potential factors relating to applicability. UK studies found a reduction in out-patient appointments [31, 44, 53, 60, 67], however, the two international studies reporting this outcome found no significant effect. Ng SM, Mariguddi S, Coward S, Middleton H. Paediatric community home nursing: a model of acute care. In other words, it is . A matched-pair cluster-randomized trial of guided care for high-risk older patients. J Integr Care. 2006;295:214857. Integrated team working: a literature review. Am J Pub Health. 2. Case management for elderly patients at risk of hospital admission: a team approach. Provided by the Springer Nature SharedIt content-sharing initiative. Ham C, Murray R. Implementing the NHS five year forward view: aligning policies with the plan. 2014;104:e407. 2014;33(1):95102. Evaluating outcomes and impacts from models of integrated care presents challenges in determining what a good outcome may be. Eur J Obs Gynecol Reprod Biol. Article J Health Serv Res Policy. We highlight the paucity of literature reporting objective quality of care outcomes, with our findings regarding the effect on quality based on staff or patient perceptions. Integrating physician Services in the Home: evaluation of an innovative program. Hawthorne G, Grzebalski DK. Studies excluded at full paper screening. Bird S, Noronha M, Sinnott H. An integrated care facilitation model improves quality of life and reduces use of hospital resources by patients with chronic obstructive pulmonary disease and chronic heart failure. CAS Health Quart. J Interprof Care. 2011;11:93. https://doi.org/10.1186/1472-6963-11-93. 2007;2:7782. Further research is required to explore the potential for models of integrated care to impact on the care for other patient groups with complex needs. Boult C, Reider L, Frey K, et al. 2013;13:e001. 2016;176:116775. Graffy J, Grande M, Campbell J. PubMed Central PubMed In terms of financial outcomes, the effects of integrated care may be perceived differently by different stakeholders, offering contradictory incentives for achieving change. We observed little overlap between primary studies and reviews, with time lags in publication of the systematic reviews meaning that the majority of their primary studies preceded our inclusion date of 2006. J Nurs Manage. The importance of relational coordination for integrated care delivery to older patients in the hospital. HSMC policy paper 6: Health Services Management Centre, University of Birmingham, 2010. Ahmad F, Roy A, Brady S, Belgeonne S, Dunn L, Pitts J. Four UK intervention studies reported staff perceptions of increased quality of care following service redesign, case management or integrated pathway interventions in hospital or primary care for older adults, general caseloads or patients with C-difficile infection [31, 50, 58, 69]. 2007;31(3):4510. Science is often the subject that suffers particularly if it is simply a matter of trying to incorporate it within a broad topic. 2008;122:e922e37. Impact on hospital admissions of an integrated primary care model for very frail elderly patients. The elements contained within them could be divided into four main categories: first, those with a focus on improving patient care directly; secondly, those that focused on making changes to organisations and systems; thirdly, those that focused on changing staff employment or working practices; and finally, those that addressed financial or governance aspects of integration. Roberts JA, Maslin TK, Bakerly ND. It is important that any assessment of strength of evidence considers not only quality and volume of studies, but also considers consistency [17]. Gardner K, Banfield M, McRae I, Gillespie J, Yen L. Improving coordination through information continuity: a framework for translational research. J Integrat Care. 2015;86:15368. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Overall therefore the UK studies were all considered to be at risk of potential bias, with none achieving all six criteria for reducing potential sources of bias. 2014;14:397. https://doi.org/10.1186/1472-6963-14-397. The rating of very limited evidence (insufficient studies) was assigned to the following outcomes: prescribing rates; access to resources; time spent in accident and emergency department; the number of incidents/complaints; and identification of unmet need. Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina A, et al. Ouwens M, Hermens R, Termeer R, Vonk-Okhuijsen SY, Tjan-HeijnenVG VAF, et al. It requires a huge amount of money. Just over half the included studies reported sample sizes that were sufficiently large to have confidence in the findings. Paize F, White E, Heaf LJ, Baillie C, Kenny S, Couriel JM, et al. BMJ Support Palliat Care. Brit J Comm Nurs. 2012;25:519. Joint Commission J Qual Saf. 2008;6:78110. 2009;57(12):232837. 2014;14:140. Edited by Steven F. Messner, Marvin D. Krohn, and . 2009;35:8292. Health Policy. Hartgerink JM, Cramm JM, Bakker TJ, van Eijsden R, Mackenbach JP, Niebor AP. Accountable care for the poor and underserved: Minnesota's Hennepin health model. Figure3 summarises elements of new models of integrated care in the included studies. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. 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