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Introduction: The management of chronic diseases and multimorbidity is an important part of primary healthcare. Current disease management programs focus primarily on a single disease, while multimorbidity and social problems often co-occur. Person-centered integrated care delivered by interprofessional collaborative teamwork tailors care to the needs of the individual patient and empowers the patient to become an active participant in his own care. However, it is uncertain how healthcare professionals can be optimally equipped to deliver care and participate as team members in this contemporary approach. Objective: In this review, we explored what competencies primary healthcare professionals need to deliver high-quality person-centered integrated care, and how these competencies can be acquired. Methods: We performed a scoping review guided by the methodological framework proposed by Arksey and O'Malley. Guidelines and chronic disease management programs were searched in the Trip medical database with the following terms including their linguistic variations; a) primary care, b) integrated care, c) chronic illness, d) multimorbidity, e) shared decision making and f) competencies. Next, using the same keywords, we searched for peer-reviewed articles in the following scientific literature databases: Cinahl, Embase, PubMed, Medline, and Web of Science. Grey literature was hand-searched through websites of relevant national and international journals, scanning reference lists and through Google and Google Scholar. All titles and abstracts of both the guidelines and peer-reviewed articles were reviewed against inclusion and exclusion criteria and screened independently by two researchers. Then full text publications were retrieved and synthesized when they met the inclusion criteria. Results: The screening resulted in 17 guidelines and 89 articles to be obtained in full text. After reading full text papers, a total of 4 guidelines and 21 articles met the inclusion criteria and were included in the data synthesis. Next to several subthemes four main themes were identified; interprofessional communication, interprofessional collaborative teamwork, leadership and patient-centred communication. However, all included papers lacked a description of competencies' core concepts, such as knowledge, skills and attitudes necessary for the personcentered integrated care approach or how competencies can be acquired in addition to academic or bachelor professional training. Conclusion: This review provides an integrative view on professionals' competencies necessary for person-centered integrated care within the practice of primary care, though details on competencies' core concepts are lacking. More research is needed, on competencies and educational programs to ensure healthcare professionals in primary care are better equipped to deliver person-centred integrated care for chronic ill patients. [ABSTRACT FROM AUTHOR]

Introduction: Longer lifespans and living with multiple chronic conditions are driving necessary change in healthcare systems. There is an increasing shift towards team-based integrated care, that is accessible, continuous, and of high quality. Health professional roles are changing rapidly; traditional educational approaches no longer suffice. The World Health Organization and the Institute of Medicine acknowledge that preparation of the healthcare workforce has not kept pace with these changes. Interprofessional education (IPE) and professional development training that includes partnering with patients, providers, and communities are identified as key solutions. However, understanding how IPE supports workforce development for integrated care remains unclear. Aims Objectives Theory or Methods: We followed the Arksey and O'Malley method for conducting scoping reviews. The CINAHL, MEDLINE, ProQuest Nursing and Allied Health, and Scholars Portal databases were searched using key search terms (interprofessional education, interdisciplinary education, integrated care, integrated health care delivery). Articles included were peer-reviewed, from all sectors, published in English, from the year 2000 to 2020 and comprised post-licensure health care workers. Study selection and data extraction were conducted by two independent reviewers using a standardized data extraction form. Data were collated, summarized, and key themes were identified. Highlights or Results or Key Findings: A total of 32 papers were included in the review consisting of primary research studies (16), reviews (10), and reports/position papers (6). Integrated care was described as having multiple definitions, various models, key principles, and competencies. Key Themes: The role of IPE in training health care professionals to work in integrated care was elucidated through qualitative thematic analysis. Four key themes were identified: 1) laying the foundation, 2) providing a building block, 3) acting as a catalyst, and 4) generating practice change. Conclusions: IPE has a critical role in training health and social care providers to work in various models of integrated care and increasingly complex healthcare systems. However, IPE is only one part of a larger program of training that is necessary. Extending IPE beyond traditional roles and settings is crucial. Implications for applicability/transferability sustainability and limitations: IPE should begin in academic programs and continue as workplace learning that is context specific. Evidence and theory-based multi-component interventions are required to reinforce learning in the practice setting. A formal evaluation of the quality of the evidence was not conducted and only papers written in English were included. [ABSTRACT FROM AUTHOR]

Background Longer lifespans and living with multiple chronic conditions are driving necessary change in healthcare systems. There is an increasing shift towards team-based integrated care, to provide person-centred care that is accessible, continuous, and of high quality. Health professional roles are changing rapidly; traditional educational approaches no longer suffice. New models of care require new models of learning - from a focus on workforce planning for professionals to workforce planning for patients and populations. The World Health Organization and the Institute of Medicine acknowledge that preparation of the healthcare workforce has not kept pace with these changes. Interprofessional education (IPE) and professional development training that includes partnering with patients, providers, and communities are identified as key solutions. However, understanding how IPE supports workforce development for integrated care remains unclear. This scoping review aimed to answer the question: What is the role of IPE in training healthcare professionals to work in integrated care? The focus of this review was on post-licensure health care professionals (HCPs) in the current workforce versus preparation of students in academic settings. Theory/Methods We followed the Arksey and O'Malley method for conducting scoping reviews. The CINAHL, MEDLINE, ProQuest Nursing and Allied Health, and Scholars Portal databases were searched using key search terms (interprofessional education, interdisciplinary education, integrated care, integrated health care delivery). Articles included were peer-reviewed, from all sectors, published in English, from the year 2000 to 2020 and comprised post-licensure health care workers. Study selection and data extraction were conducted by two independent reviewers using a standardized data extraction form. Data were collated, summarized, and key themes were identified. Results A total of 32 papers were included in the review consisting of primary research studies (16), reviews (10), and reports/position papers (6). Integrated care was described as having multiple definitions, various models, key principles, and competencies. Key Themes The role of IPE in training health care professionals to work in integrated care was elucidated through qualitative thematic analysis. Four key themes were identified: 1) laying the foundation, 2) providing a building block, 3) acting as a catalyst, and 4) generating practice change. Discussion The findings have implications for education and practice. IPE should begin in academic programs and continue as workplace learning that is flexible and context specific. Multi-component interventions based on theory and evidence should be used to reinforce learning in the practice setting. Conclusions IPE has a unique and important role in training health and social care providers to work in various models of integrated care. However, IPE is only one part of a larger program of training that is necessary. Lessons Learned IPE is a critical component in training current health and social care providers to work in increasingly complex health care systems. Extending IPE beyond traditional roles and settings is crucial. Limitations A formal evaluation of the quality of the evidence was not conducted and only papers written in English were included. Future Research More rigorous research designs that clearly link IPE in integrated care to provider and patient outcomes are required. [ABSTRACT FROM AUTHOR]

Introduction: LBP is a leading cause of disability and exerts a considerable burden on healthcare systems. Management is frequently inconsistent with clinical guidelines, which advocate a demedicalised approach in primary care settings for most patients, with easy access to specialised care when necessary. Integrated care pathways have potential to enhance care quality and costeffectiveness through bridging the evidence-practice gap and optimising resource use. Care integration across the primary-secondary care continuum aims to address care fragmentation, reduce duplication, improve clinical outcomes and enhance cost-effectiveness. This review aimed to synthesise the evidence for integrated care pathways for LBP from primary to specialised care. Methods: This review was reported in accordance with Preferred Reporting Information for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Electronic database searches (CINAHL, MEDLINE, Cochrane Library, EMBASE) were conducted (2006 onwards) with further manual and citation searching. Search results were exported to Covidence (systematic review software). Two independent reviewers conducted eligibility assessment and data extraction, as well as quality appraisal using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies or the Critical Appraisal Skills Programme (CASP) qualitative studies checklist. A narrative synthesis of findings is presented. Results: From 18,443 identified studies, 28 papers met inclusion criteria. LBP pathways were reported from high-income countries, primarily to address over-burdened secondary care services with long wait-times for consultant appointments. Pathways almost universally re-organised care using non-consultant interface services to manage the primary-secondary care boundary by triaging patients for surgical opinion or conservative management. Interface services aim to optimise use of the multidisciplinary workforce to ensure judicious use of surgical clinics. Accordingly, evaluation of healthcare resource use and patient flow predominated, with reports of enhanced service efficiency through decreased wait-times and appropriate use of consultant appointments. Interface services were evenly represented across community and hospital settings. Using a model that conceptualises care integration on a five-level continuum, the included pathways demonstrated the two most basic levels of integration, 'full segregation' or 'linkage'. Low quality study designs, heterogenous outcomes and insufficient comparative data precluded definitive conclusions regarding clinical and cost-effectiveness of pathways. Conclusions: Interface services, delivered by non-consultant multidisciplinary team members, to ensure appropriate referrals to specialised care dominated the LBP integrated care pathway literature with enhanced efficiency of care delivery reported. Pathways demonstrated the most basic levels of care integration, 'full segregation' and 'linkage', across traditional healthcare boundaries. Implications: Further exploration of the potential of care pathways as a model for the delivery of integrated, cost-effective, person-centred, guideline-concordant care which improves clinical outcomes for patients with LBP is required, with patient involvement in integrated care pathway development. [ABSTRACT FROM AUTHOR]

Introduction: As in many other countries, the challenges in the health status of the population and in the healthcare system persist in the Netherlands, despite longstanding reforms and integration efforts. This raises questions about the long-term sustainability of the system. As more and more studies describe the implementation of whole system transformation initiatives, approaches such as Population Health Management (PHM) gain traction. This study aims to contribute to the growing area of research by exploring the knowledge in recent literature about these kind of initiatives worldwide, focussing on the different levels of integrated care. Methods: A scoping review was performed using the six-stage methodological framework from Arksey and O'Malley. The electronic databases Embase, PubMed and Academic Search Premier were searched for papers published between January 2016 and January 2021. Structuring of the data was done from a realist analysis perspective, identifying context, mechanism and outcome (CMO) items describing what works for whom under what circumstances. Secondly, these items were then allocated to the levels of the Rainbow model of integrated care to identify the level to which the transformation item pertains. Finally, six topic clusters were formed, which constitute key elements of PHM. This resulted in a matrix of items corresponding to the levels of integrated care, the CMO structure and the six elements of PHM. Results: The literature search generated 531 articles, of which 11 were included. Structuring the data showed that most reported items were normative and functional items on the organizational level about 'accountable regional organization'. Also containing a high number of functional items are 'cross domain business model' and 'emergent implementation strategy', both on system and organizational levels. In contrast to that, items on the clinical level and normative items were overall underreported. The PHM elements 'co-designing workforce and community', 'integrated data infrastructure' and 'population health data analysis' contained overall the lowest number of items. Items that were mentioned by four or more articles were: Data availability, IT infrastructure, additional funding or monetary resources, and financial incentives aligned with system goals. Conclusions: This scoping review demonstrated that recent literature mainly reports on context, mechanisms and outcomes on system and organizational level of integrated care when it comes to PHM initiatives. And while the need for data availability and IT infrastructure are frequently specified, there is limited consideration for the normative side of integration in this regard. Implications for applicability/transferability, sustainability, and limitations: One of the limitations of this study is that many initiatives are not published in scientific literature, and therefore there may be items that are missing in the overview. However, the resultant matrix gives a first comprehensive overview of what needs to be done on what level to achieve what outcome. It also shows the lack of involvement of and attention to providers and patients within these initiatives. [ABSTRACT FROM AUTHOR]

Introduction Internationally, the Triple Aim agenda (improved health of populations, improved patient experience, and reduced per capita health care expenditures) is gaining momentum in reforming healthcare systems. Towards implementing accountable care, policymakers, insurances, and managers need information about population health status to allocate resources, set priorities, plan interventions, and measure outcomes. To this extent, consolidated tools from public health research are attracting renewed interest. This paper aims to analyze the Burden of Diseases (BoD) tool and how it could be deployed to pursue the Triple Aim agenda, nationally or regionally. The Global BoD (GBoD) was introduced in the 1990s and then developed by the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation (IHME), relying on aggregated data, population samples, and surveys. Nevertheless, to achieve more accurate and calibrated estimates, several countries have started to develop the BoD with different methodologies, which could influence the results and the tool's deployment within accountable care. Methods An Arksey and O'Malley approach was used in this scoping review. Electronic database MEDLINE and search engine Google were searched from January 2010 to February 2021. National BoD reports were included, and data and methodologies were extracted. The scoping review addressed three main goals: 1) benchmarking international and national or local development of the BoD; 2) analyzing and comparing the methods and data sources; 3) comparing the deployment strategies and the tool's scope. Results The IHME and WHO approaches are the most consolidated hitherto. National experiences are increasing, while local applications are still limited to pilot research. Calculation methods vary based on age-weighting, discount rates, the number of included diseases and risk factors, reported advantages and disadvantages, data sources, and data computations. The deployment strategies are very fragmented and still at an embryonic stage compared to the debate on accountable care. Discussion Whereas the utilization of a nation-based BoD is promising, experiences are still limited. The national implementation could be more reliable and calibrated on targeted populations to guide health interventions and measure population health outcomes. Multiple factors hamper the tool's development, such as costs, human and time resources, less meticulous methodology, and health analytics availability and robustness at the country level. Also, population health strategies and outcomes measurement are not yet institutionalized within accountable care. The tool deployment is fragmented across multiple entities and governance patterns. National and private insurance players are the most active, pioneering new strategies. Conclusions The BoD is an efficient way to assess the impact of diseases and risk factors in populations' life and quality of life. GBoD remains an essential benchmark for researchers and public health institutions worldwide. Lessons Learned National tools development is increasing and could be deployed for evaluating and planning healthcare interventions at the national or sub-national level. Limitations This study does not use systematic review criteria, and access to tools methodologies and deployment strategies is limited through published sources. Suggestions for future research Assessment of the development, methods, and deployment of a national-based BoD compared to the accountable care aims and agenda. [ABSTRACT FROM AUTHOR]

Introduction Internationally, the pursuit of the Triple Aim is leading the reform of healthcare systems. To implement accountable care, a target population and its health assessment must first be identified. This assessment should address resource allocation, program planning, healthcare delivery, and measure outcomes to achieve value-based care. Health Needs Assessment (HNA) tools are around since the '90s, but gained policymakers' attention as the accountable care movement spreads. HNA systematically reviews a population's health issues by defining their unmet needs. This paper reviews HNA tools used internationally and their implementation to assess population health compared to accountable care requirements. The analysis of HNA tools considers both demand and supply and examines them through comprehensive international tools. Methods An Arksey-O'Malley approach was used in this scoping review. Electronic database MEDLINE and search engine Google were searched combined with snowballing strategies. HNA reports were included, and methodologies were extracted. The scoping review addressed four: 1) reviewing frameworks, domains, and subdomains deployed in HNA tools to assess needs, demand, and supply; 2) how the tools achieved population-health assessment vs. an aggregated measure of quality, access, and health services utilization?; 3) how tools were deployed in program planning and priority setting of interventions to improve population health?; 4) Who is accountable for measuring and improving population health? Results Results were organized in comparative tables benchmarking domains and subdomains of HNA for both demand and supply. Few tools assessed both demand and supply; however they relied on utilization data while using targeted surveys for an actual needs assessment. Supply tools result more developed with high accuracy in data collection to assess access, readiness, coverage, and targeted sub-populations. The institutional deployment of HNA tools focuses on program planning of health policies and interventions, while supply tools are exploited for benchmarking the productivity and availability of services. National tools are more accurate and calibrated on the local epidemiology and health services organization. Discussions The use of HNA to pursue accountable care remains limited. Tools retrieved measuring population health for accountable care were excluded from the review because they represent performance framework and not HNA. The use of HNA for implementing accountable care is expanding, exploiting health analytics and routine analysis, foremost applying utilization data. The development of comprehensive whole-population HNA tools to inform health policymaking and interventions is hampered by the time and resources required, especially for needs assessment and data available for routine analysis. Lessons Learned With accountable care, population HNA is a requirement. What matters is how to perform it on whole-population to inform the policymaking and health interventions. Multiple tools can be applied and combined to analyze the dimensions of supply, demand, and needs within the scope of ACOs. Nevertheless, a key challenge for a comprehensive assessment is the coordination and governance of data sharing from multiple stakeholders to collect community-level data. Collaboration among players is required for deploying HNA and sharing the accountability for measuring and monitoring. Limitations The review included only published tools in English, which may undermine the collection of relevant experiences. [ABSTRACT FROM AUTHOR]