Search

Introduction: Action 3 of the UN Decade of Healthy Ageing plan is to deliver integrated care to improve older adults' lives. Integrated care is vital in meeting the complex needs of people with dementia but little is known about how this is or could be delivered in low and middle income countries (LMIC). This paper provides insights into previously unknown care system structures and on the potential and reality of delivering integrated care in Central America for people with dementia. Methods: A social network analysis (SNA) methodology was adopted to engage with providers of services for older adults and families with dementia in Guatemala, El Salvador, Honduras, Costa Rica and Panama. Sixty-eight (68) semi-structured interviews were completed, 57 with organisations and 11 with families. Results: Across the five countries there was evidence of fragmentation and low integration within the dementia care systems. A variety of services and types of providers are present in all five countries, and high levels of diversified connections exist among organisations of differing disciplines. However, unawareness among network members about other members that they could potentially form active links with is a barrier on the path to integration. Conclusion: This innovative and robust study demonstrates SNA can be applied to evaluate LMIC care systems. Findings provide baselines of system structures and insights into where resources are needed to fortify integration strategies. Results suggest that Central American countries have the building blocks in place to develop integrated care systems to meet the needs of people with dementia, but the links across service providers are opportunistic rather than context based coordinated integration policies. [ABSTRACT FROM AUTHOR]

Introduction: Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. Policy practice: This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. Discussion and Conclusion: National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors. [ABSTRACT FROM AUTHOR]

Introduction: Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. Policy practice: This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. Discussion and conclusion: National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors. [ABSTRACT FROM AUTHOR]

Introduction: Integrated primary care (IPC) models have empirical support for improving access to and quality of behavioral health care and can be effectively implemented in a diverse range of formats1. Various studies have demonstrated that primary care service providers tend to positively endorse IPC models of pediatric behavioral health care, especially in comparison to traditional, non-integrated care2-3. However, there is a paucity of research evaluating parent perceptions and attitudes towards behavioral health care, especially when delivered in an IPC setting. The present paper describes a survey tool designed to better understand and meet patient care needs. Methods and Aims: The Parent Acceptance of Pediatric Integrated Care Survey (PAPICS) was developed by a multidisciplinary panel of integrated care experts at the University of Michigan Medicine to evaluate parent perceptions and acceptance of integrated primary care (IPC) models for treatment of behavioral health problems in children. In response to the COVID-19 pandemic, the PAPICS was expanded to include more items focused on virtual services in IPC and revised to address items with poor factor loadings. Methods include Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to analyze and validate the survey. Results: The original 35-item PAPICS was distributed to parents pre-pandemic with children under 18 across the United States and was completed by 422 respondents4. Items on this survey largely pertained to face-to-face care within the clinic and an EFA only was conducted to analyze the data. Parents overwhelming favored an IPC model and supported learning skills to help their child. More variability was evidenced for parents' perceptions of one-on-one talk therapy between their child and the psychologist. Some parents had concerns about stigma and privacy, but agreement was more inconsistent. After the World Health Organization (WHO) declared COVID-19 a global pandemic, Michigan Medicine's IPC clinics converted to 100% virtual care. The PAPICS was revised using patient feedback data for applicability to virtual care delivery and was completed by 875 respondents. Conclusions: Data collection from the revised PAPICS was completed in December 2021. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) are presently be conducted and will be reviewed at ICIC22. Results will provide insight into parent perceptions of virtual IPC and allow for comparison to those for face-to-face care. Implications for applicability/transferability, sustainability, and limitations: The PAPICS survey provides a template for assessing beliefs and preferences of families to provide high-quality, patient-centered behavioral health care in an IPC setting. Though certain items on the survey may not be applicable in some settings, the scale can be adapted as needed. [ABSTRACT FROM AUTHOR]

Introduction: Use of substances during pregnancy is a global health concern. Interprofessional care teams can provide an optimal care approach to engage individuals who use substances during the perinatal period. The purpose of this scoping review is to provide a comprehensive summation of published literature reporting on interprofessional care models for perinatal individuals who use substances. Methods: We conducted a systematic search for articles from health-related databases. The Preferred Reporting Items for Systematic Reviews for Scoping Reviews (PRISMA-ScR) was followed. Data were extracted and synthesized to identify the interprofessional care team roles, program and/or provider characteristics, and care outcomes of these models. Results: We screened 645 publications for full text eligibility. Eleven articles met full inclusion criteria and were summarized. Programs were built on co-location of services, partnership with other agencies, available group/peer support and approaches inclusive of cultural care, trauma informed care, and harm reduction principles. Discussion: There is growing evidence supporting integrated care models that are inclusive of relational care providers from multiple health care professions to achieve wraparound care. Conclusions: Many of the interprofessional care models studied have successfully blended social, primary, pregnancy, and addictions care. The success and sustainability of programs varies, and more work is needed to evaluate program and patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models to integrate care, though comparative studies assessing the applicability and transferability of ACOs in Canada are lacking. In this comparative study, we performed a narrative literature review to examine how Canadian health systems could support ACO models. Methods: We reviewed empirical studies (published 2011-2020) that evaluated ACO impacts in the US. Thematic analysis and critical appraisal were performed to identify factors associated with positive ACO impacts. These factors were compared with the Canadian context to assess the applicability and transferability of ACO models within Canada. Findings: Physician-led models, global budgets and financial incentives, and focus on collaborative care may optimize ACO impacts. While reforms towards alternative payments and team-based care are not unprecedented in Canada, significant further reforms to physician remuneration, intersectoral collaboration, and accountability for performance are required to support ACO-like models. Conclusion: This comparative study uncovered several insights on the applicability and transferability of ACOs to the Canadian context. Further comparative research outside the US is needed to infer the essential components of successful ACO models. [ABSTRACT FROM AUTHOR]

Introduction: Current U.S. policy and payment initiatives aim to encourage health care provider accountability for population health and higher value care, resulting in efforts to integrate providers along the continuum. Providers work together through diverse organizational structures, yet evidence is limited regarding how to best organize the delivery system to achieve higher value care. Methods: In 2016, we conducted a narrative review of 10 years of literature to identify definitional components of key organizational structures in the United States. A clear accounting of common organizational structures is foundational for understanding the system attributes that are associated with higher value care. Results: We distinguish between structures characterized by the horizontal integration of providers delivering similar services and the vertical integration of providers fulfilling different functions along the care continuum. We characterize these structures in terms of their origins, included providers and services, care management functions, and governance. Conclusions and discussion: Increasingly, U.S. policymakers seek to promote provider integration and coordination. Emerging evidence suggests that organizational structures, composition, and other characteristics influence cost and quality performance. Given current efforts to reform the U.S. delivery system, future research should seek to systematically examine the role of organizational structure in cost and quality outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Despite evidence that people with serious mental illness benefit from receiving primary care within mental health care settings, there is little research on this type of integration. The objective of this study was to characterize how providers and patients experienced implementation of primary care into specialty mental health services. Methods: During site visits, study team members interviewed staff and conducted focus groups with patients at 10 United States community mental health centres then beginning to integrate primary into their practices. One year later, follow up phone interviews with key centre staff informants validated and updated findings. Data analysis included thematic coding of results from staff interviews and patient focus groups. Results: Findings included the importance of the scope of primary care services provided on site, given limited alternatives available to patients; rapid scale-up; overcoming challenges in provider recruitment and retention; and adaptations to engage patients as well as to improve communication between mental health and primary care providers. Conclusion: Providers and patients perceived improvements through integrated care. However, the majority of patients were uninsured, and the funding was short term. The long-term viability of integrated care for community mental health centre patients may hinge on adequate, predictable public funding. [ABSTRACT FROM AUTHOR]