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Introduction: The ageing society requires physicians who can deliver integrated care, but it is unclear how they should be prepared for doing so. This scoping review aims to create an overview of educational programmes that prepare (future) physicians to deliver integrated care while addressing components and outcomes of the interventions. Method: We included papers from five databases that contained: (1) integrated care (2) education programme (3) medical students (4) elderly, or synonyms. We divided the WHO definition of integrated care into ten components for the concept of ‘integrated care’. Data were collected with a charting template, and template analysis was used to formulate themes. Results: We found 17 educational programmes in different learning settings. All programmes addressed several components of the WHO definition. The programmes primarily focused on care for individual patients (micro-level), and the outcomes suggested that experiencing the complexity of care is key. Conclusion: This review revealed the limited evidence on educational programmes about integrated care for the elderly. Our findings suggest that educational programmes on integrated care should not be limited to the micro-level, and that students should obtain adaptive expertise by experiencing complexity. Future research should contain an explicit description and definition of integrated care. [ABSTRACT FROM AUTHOR]

Introduction: Social Prescribing has an established recognition regarding the benefits provided to the health-related social needs of adults, but little is known about how the intervention addresses young people's needs. There is optimism regarding the central role of two core mechanisms that allows social prescribing to be effective, such as the empathetic role of Link Workers and the connection with community resources. This paper aims to describe the role played by Link Workers working a Social Prescribing intervention targeting young people. Description: This paper adopts a case study methodology to describe the role of Link Workers addressing young people's needs and implementing Social Prescribing scheme in Sheffield (UK). Data were collected through semi-structured interviews with four of the seven link workers of one organisation based in Sheffield. Data were analysed through an inductive approach for emerging themes. Discussion: We provided a description of the profiles and background of Link Workers and described the three models of referral pathways into the intervention. The paper also shows how Link Workers identify young people's needs and how they connect with the community. Conclusion: Based on the insights and the internationally accepted definition of Social Prescribing, we provide a visual representation of the Social Prescribing model and discuss challenges. The paper highlights lessons learned and future directions regarding the role of Link Workers from the case study. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic disproportionally impacted people experiencing homelessness, including people sleeping rough, people in temporary accommodation and those living in boarding houses. This paper reports on intersectoral responses across six health and social care agencies in Inner Sydney, New South Wales, Australia. Prior to the pandemic the six agencies had established an Intersectoral Homelessness Health Strategy (IHHS), in recognition of the need for intersectoral collaboration to address the complex health needs of people experiencing homelessness. Description: The governance structure of the IHHS provided a platform for several innovative intersectoral responses to the pandemic. A realist informed framework was used to select, describe, and analyse case studies of intersectoral collaboration. Discussion: The resultant six critical success factors (trust, shared ways of working, agile collaboration, communication mechanisms, authorising environment, and sustained momentum), align with the existing literature that explores effective intersectoral collaboration in complex health or social care settings. This paper goes further by describing intersectoral collaboration 'in action', setting a strong foundation for future collaborative initiatives. Conclusion: While there is no single right approach to undertaking intersectoral collaboration, which is highly context specific, the six critical success factors identified could be applied to other health issues where dynamic collaboration and integration of healthcare is needed. [ABSTRACT FROM AUTHOR]

Introduction: Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success. Methods: This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation. Results: 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society. Conclusion: Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts. [ABSTRACT FROM AUTHOR]

Introduction: There are many challenges we must adapt to in healthcare - health inequalities, environmental concern, ageing populations and multimorbidity to name a few. The English health system has responded by restructuring into Integrated Care Systems1. These are collaborative, place-based partnerships tackling health inequalities and improving care coordination. Additional skills are likely needed for professionals to thrive in and potentiate the promise of ICSs for patients. One key component identified in the Future Doctor Report2, was cultivating generalism. This led to the inception of the Enhance programme for generalism3 - a developing multiprofessional educational offer in England. Aim and Method: Any change is best supported by academically rigorous evidence. Some published evidence was anticipated, as the generalism concept has existed for centuries and some professionals practice in this way today. Three literature searches were commissioned from the Health Education England library service around the evidence for generalism. This presentation will focus on "what are the benefits of generalism to patients, the healthcare system and healthcare professionals". A second search was performed by a HEE fellow. All included papers were critically analysed. Results: 32 papers were identified by the library service. No further papers were included from the second search due to their age (approx. 30 years). All were written in English, 19 from the UK and 13 from across Europe, Asia and Africa, published between 2017-2020. Papers were methodologically diverse, predominantly qualitative, reviews, opinion pieces or project evaluations. Common themes included doctor preparedness, CPD and skills learning. Two papers each, respectively, explored professional and patient satisfaction. A subset of 8 papers felt to be of most relevance to the question were then analysed. Article types were similar to the above, originating from the UK, Thailand or Norway. Four common themes were identified: QI; CPD; preparedness and professional satisfaction. Only one examined patient satisfaction. Interestingly, this paper's findings aligned closely with the principles and aims of the Enhance programme and ICSs - person-centred, well-coordinated care, understanding realworld causes of ill health4. Conclusion: Although there are some proponent opinion pieces and indirect evidence, no papers have been identified that examine this question directly. There is a distinct lack of robust academic exploration of the actual (as opposed to posited potential) benefits to patients, professionals other than doctors and system-wide impacts from generalism. Implications: This work highlights several new and exciting areas for future research - likely to be interdisciplinary. How best to research applying a generalist approach for its benefits to stakeholders in terms of the Institute of Medicine's 6 domains of quality may be a future key question to consider. [ABSTRACT FROM AUTHOR]

Objective: Adults living with Type 2 diabetes (T2D) and severe mental illness (SMI) disproportionally experience premature mortality and health inequality. Despite this, there is a limited evidence-base and evaluation of non-pharmacological integrated interventions that may contribute to improved patient experience and outcomes. To improve our understanding of how to optimise integrated care for this group, this review evaluates the effectiveness, acceptability, and feasibility of non-pharmacological integrated interventions for adults with SMI and T2D. Methods: Studies from nine electronic databases were searched. Of the 6750 papers retrieved, seven papers (five quantitative and two qualitative) met the inclusion/exclusion criteria. A convergent integrated approach was used to narratively synthesise data into four main themes: effectiveness, acceptability, feasibility, integrated care. Results: There is moderate evidence to suggest non-pharmacological integrated interventions may be effective in improving some diabetes-related and psychosocial outcomes. Person-centred integrated interventions that are delivered collaboratively by trained facilitators who exemplify principles of integrated care may be effective in reducing the health-treatment gap. Conclusions: Recommendations from this review can provide guidance to healthcare professionals, commissioners, and researchers to inform improvements to nonpharmacological integrated interventions that are evidence-based, theoretically driven, and informed by patient and healthcare professionals' experiences of care. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes 'Project 8', a campaign that aims to reduce glycated haemoglobin (HbA1c) to 8% or more among patients with diabetes mellitus, utilising healthcare professionals and local community residents and focusing on education and support. The study is based in Uonuma—a small rural city in Japan with a declining population and an increased number of older people. Description: 'Project 8' began in Uonuma's Koide Hospital in 2008. The Uonuma School for Community Health and Social Care was established in 2011 with the cooperation of a clinic's general practitioner. Medical students, trainees, doctors, and health care professionals have been holding 'open schools' (daytime lectures) and 'night schools' (evening lectures) to educate the community residents about various health issues. Through repeated lectures, the residents have been made aware of lifestyle-related diseases, including diabetes, and the meaning of 'Project 8'. Discussion: Over the last decade, the hospital's campaign has expanded within the community, showing a statistically significant reduction of diabetic patients with HbA1c ≥ 8%, which successfully deferred the start of dialysis for many of them. Conclusion: Well-integrated community care requires interprofessional education, collaborative practice, and the participation of community residents in health education. [ABSTRACT FROM AUTHOR]

Introduction: Telemonitoring has been proposed as an effective method to support integrated care for older people with hypertension and type 2 diabetes. This paper examines acceptability of telemontioring, its role in supporting integrated care, and identifies scale-up barriers. Methods: A concurrent triangulation mixed-methods study, including in-depth interviews (n = 29) and quantitative acceptability tool (n = 55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Interviews were analysed using template content analysis (TCA). Results: TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Discussion: Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. However, there were barriers that may limit its further scale-up. Conclusion: For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes. [ABSTRACT FROM AUTHOR]

The population in Singapore is ageing, adding pressure to community care as the health and social needs of its residents increase. This has accelerated the pace at which Regional Health Systems adopt and deliver its population health strategies from early prevention, chronic disease management, crisis care to end-of-life care. To this end, the Central Health Integrated Care Network (ICN) began its journey to develop Communities of Care (CoCs) with other health and social care partners to meet the needs of residents in the Central Zone of Singapore. This paper describes the processes and steps taken by Central Health ICN to build partnerships with other agencies and organisations to build place-based models of care in the local neighbourhoods. The faciliating factors and the barriers faced in the implementation of CoCs were described to allow sharing of such learnings on large scale change. Strategies in overcoming some of the challenges were also presented to demonstrate the iterative processes required in building integrated place-based models of care to meet the needs of the residents in different communities. [ABSTRACT FROM AUTHOR]

Introduction: Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. Methods: This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Results: Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Discussion: Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Conclusion: Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings. [ABSTRACT FROM AUTHOR]

Introduction: This paper analyses and discusses the models and tools in the Finnish health and social care system to identify the individuals who might benefit from integrated multidisciplinary care. Description: The analysis and discussion of the paper is based on a study which mapped and studied the models and tools in practice or under development for identification in the Finnish health and social care organizations. The study used electric survey and structured interviews as research methods. Discussion: There are several different established models of identification in Finland and the experiences of using them are mainly positive. However, only every third of health and social care organizations in Finland have defined a common model or tool. The identification practices and criteria vary by region, municipality and/or organization. The identification is in general unsystematic and insufficient in practice that may inhibit the individuals to access the integrated care they might benefit from. Conclusions: Models and tools are needed for founding and identifying individuals who are outside the service system, those whose client-ship has just begun, and those who already access services. The identification of individuals for integrated multidisciplinary care and the assimilation and understanding of different identification models and tools requires the development of basic and further competence in the different fields of health and social care. Multidisciplinary collaboration requires shared concepts and positive attitudes on the development of integrated professional environments, identification models and services. It is therefore also a question of shared working culture. [ABSTRACT FROM AUTHOR]

Introduction: Non-communicable diseases, such as arterial hypertension (HTN) and type-2 diabetes (T2D), pose a global public health problem. Integrated care with focus on person-centred principles aims to enhance healthcare quality and access. Previous qualitative research has identified facilitators and barriers for scaling-up integrated care, however the lack of standardized terms and measures hinder cross-country comparisons. This paper addresses these gaps by presenting a generic codebook for qualitative research on integrated care implementation for HTN and T2D. Description: The codebook serves as a tool for deductive or deductive-inductive qualitative analysis, organizing concepts and themes from qualitative data. It consists of nine first level and 39 second level themes. First level codes cover core issues; and second level codes provide detailed insights into facilitators and barriers. Discussion: This codebook is more widely applicable than previously developed tools because it includes a broader scope of stakeholders across micro, meso, and macro levels, and the themes being derived from highly diverse health systems across highand low-income countries. Conclusion: The codebook is a useful tool for implementation research on integrated care for HTN and T2D at global scale. It facilitates cross-country learning, contributing to improved implementation, scale-up and outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The healthcare delivery system of Assam faces several challenges to provide affordable, accessible and quality care services. GNRC (Guwahati Neurological Research Center) is the first super-speciality hospital to address many of these gaps by delivering integrated affordable healthcare services to the populations of Assam and other parts of North-eastern India. Description & Discussion: This paper describes the implementation of a care delivery model which provides integrated care delivery services through linking hospitals to primary healthcare services, including preventive, promotive, and curative care, along with delivering easily accessible and affordable care to the people of Assam and other parts of North-eastern India. Conclusion: The proposed model is the first innovative approach from Northeastern India, Assam, to deliver affordable, accessible and patient-centric hospital led community-based preventive, promotive, and primary, secondary, and tertiary hospital-based care. It is anticipated that GNRC's "Affordable Health Mission" will help redesign and integrate the way primary, secondary and tertiary healthcare is delivered to the population of Assam in helping patients manage their own health and reduce the numbers that needs to be admitted to secondary care and tertiary care by improving patients' independence and well-being as well as dramatically reducing the cost to the overall health system. [ABSTRACT FROM AUTHOR]

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: Population Health Management (PHM) focusses on keeping the whole population as healthy as possible. As such, it could be a promising approach for longterm health improvement in type 2 diabetes. This scoping review aimed to examine the extent to which and how PHM is used in the care for people with type 2 diabetes. Methods: PubMed, Web of Science, and Embase were searched between January 2000 and September 2021 for papers on self-reported PHM initiatives for type 2 diabetes. Eligible initiatives were described using the analytical framework for PHM. Results: In total, 25 studies regarding 18 PHM initiatives for type 2 diabetes populations were included. There is considerable variation in whether and how the PHM steps are operationalized in existing PHM initiatives. Population identification, impact evaluation, and quality improvement processes were generally part of the PHM initiatives. Triple Aim assessment and risk stratification actions were scarce or explained in little detail. Moreover, cross-sector integration is key in PHM but scarce in practice. Conclusion: Operationalization of PHM in practice is limited compared to the PHM steps described in the analytical framework. Extended risk stratification and integration efforts would contribute to whole-person care and further health improvements within the population. [ABSTRACT FROM AUTHOR]

In this perspective paper we use publicly-available data to show that, despite much positive rhetoric in support of reforms in Scotland to integrate health and social care, these reforms, in their current state, have failed to meet their stated objectives. Rather than regress to the previous system, we propose continued evaluation of even more radical forms of such integration. This analysis, and set of future proposals, are timely given current considerations with respect to a National Care Service in Scotland and recent similar reforms in England and in other countries. [ABSTRACT FROM AUTHOR]

Inter-disciplinary team working is an essential mechanism for the delivery of integrated care. This paper summarises a narrative review of the research on the ‘work’ that teams do to develop inter-disciplinary practices, addressing the question ‘How do interdisciplinary teams ‘become’ in the context of models of integrated care?’. The narrative review identities a gap in our understanding of the active boundary work that different disciplines working together to deliver care integration engage in when creating new interdisciplinary knowledge, creating an inter-disciplinary team identity and negotiating new social and power relations. This gap is particularly significant in relation to the role played by patients and care-givers. This paper presents a way of examining inter-disciplinary working as a process of creating knowledge, identity and power relations both in terms of a theoretical lens, circuits of power, and a methodology, institutional ethnography. An explicit focus on understanding power relations within inclusive inter-disciplinary teams in care integration will contribute to our understanding of the gap between theory and implementation of care integration by focusing on the ‘work’ that teams do to create new knowledge. [ABSTRACT FROM AUTHOR]

Introduction: Spain is one of the leading countries in the application of proactive and personalised telecare to help support frail and vulnerable service users to live independently in their own homes for longer*. Concern was however noted regarding potential impacts on ambulance mobilisations as time in the service, and mean age at cessation, increased by 1.3 years. Aims, Objectives, Theory and Methods: The purpose of this study was to investigate these impacts. A longitudinal study of a telecare service user population in Spain (n=202.1k to 247.9k) was undertaken using anonymised operational data collected in the delivery of proactive and personalised telecare services by Televida Servicios Sociosanitarios over the period 2014-18. The population was subject to change over time as new service users became eligible to register for the service, and others ceased the service. Each of these factors were also studied to assess potential confounding or covariate factors in the population also influencing the mobilisation of ambulances. Key Findings: For the studied population, ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced over the period despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. Overall mobilisations reduced by 27.9% (0.665 to 0.479 pp/pa) over the period whilst for ambulances there was a reduction of 33.3% (0.461 to 0.307 pp/pa). There were also smaller reductions in the number for family and state security mobilisations. The study identified the positive correlation coefficient between ambulance mobilisations and service user's dependency levels, and marginal negative correlation in older age bands. We are aware of no other studies which have investigated the impact on ambulance mobilisations of advanced proactive telecare and the increasing age of the services users supported to continue living independently. We believe this paper, therefore, contributes new insight which extends the existing research literature. Conclusions: The increasing age at cessation has not correlated with an increased proportion of higher dependency service users. The share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service contributing to increased time living independently may also have helped service users remain in lower risk bands. Limitations: There is a risk that use of mean annual measures may obscure important variations within the data. Changes in levels of proactivity, personalisation and increased use of sophisticated monitoring sensors of the telecare services are not the subject of this paper, but addressed in part in allied research. [ABSTRACT FROM AUTHOR]

Addressing new population needs, many countries are moving toward tighter integration of health and social care. Research has made considerable progress in identifying the core dimensions of integrated care, emphasising, for instance, the need for close provider relationships and coordinating care practices around patients' needs [1]. While these dimensions are widely known, we lack insight into how they emerge and change over time. Without a deep understanding of these dynamics, however, we cannot explain why initiatives fail or succeed. This paper explores the dynamics of integrated care, addressing an important gap in the literature [2]. To explore the dynamics of integrated care, the paper draws on pragmatist organisation studies [3]. Adopting a process ontology, pragmatism is well suited for this purpose. From this perspective, core dimensions of integrated care emerge and change as inter-dependent actors experience local break-downs, problems, or opportunities in their everyday work and care practices and continuously adapt these practices in communication-based deliberation [3]. The paper draws on a longitudinal single-case study conducted in the Swiss healthcare sector. It describes the emergence and change of a cutting-edge outpatient primary care centre, in which legally autonomous primary care and specialist providers jointly refer, diagnose and care for patients with complex needs. It includes data from 19 interviews, three days of non-participant observation, and 37 archival records, analysing how provider relations and care coordination emerged and changed over thirteen years. The data show that inter-dependent actors included not only a paediatrician turning quality problems in his practice into an opportunity to found the centre, but also architects, investors and other service providers. Over time, they experienced a series of problems including fragmented care, restrictive land use regulations, sceptical peers, cash drain, and rapid growth. They addressed this steady stream of problems in cycles of deliberation, recurrently restoring order from disruption, gradually building relationships, and increasingly coordinating care around patients' needs. Deliberation was typically based on bilateral conversations between the founder and other actors. While this communicative practice was initially helpful, it started impairing actors' problem-solving capacity as the founder became overwhelmed by the rapid growth of the centre, stalling advances in care coordination and straining provider relationships. The paper contributes to research by exploring the dynamics of integrated care, theorising the emergence and change of its core dimensions as grounded in inter-dependent actors' everyday work and deliberation practices amid a steady stream of problems and opportunities. The findings are relevant for theorists and policy makers alike, offering new glimpses into the "black box" of complex care integration [1, 2]. [ABSTRACT FROM AUTHOR]

Introduction: Observational data are increasingly seen as a valuable source for integrated care research. Especially since the growing availability of routinely collected data and quasi-experimental methods. The aim of this paper is to describe the potentials and challenges when using observational data for integrated maternity care research, based on our experience from developing and working with the Data-InfrAstructure for ParEnts and childRen (DIAPER). Methods and Results: We provide a description of DIAPER, which is a linked datainfrastructure on the individual level based on maternity care claims data, quality and utilization of maternity care and data from municipal registries, covering the life course from preconception to adulthood. We then discuss potentials and practical applications of DIAPER such as to evaluate alternative payment models for integrated maternity care, to set the policy agenda regarding postpartum care, to provide insights into value of care and into provider variation, and to evaluate (policy) interventions designed to promote and support integrated maternity care. This is relevant for several stakeholders: policy makers, payers, providers and clients/patients. Based on experiences with DIAPER, we identify remaining challenges: missing data sources (especially self-reported outcomes), suboptimal quality of data, privacy concerns and potential biases introduced during data linkage, and describe how these challenges were tackled within the applications of DIAPER. Conclusions: With DIAPER we demonstrated that using observational data can be of added value for integrated care research, but also that challenges remain. It is essential to keep exploring and developing the possibilities of observational data and continue the discussions in the scientific community. Learning from each other's successes and failures will be critical. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this paper was to describe the vision of death from the perspective of families of children who experienced palliative care, and team members working in one unit, and to explore the roles of healthcare clowns in working with life and death. The major research of which this paper is part was a requirement of one healthcare clown organization, that since 2008 works as members of the palliative care unit in a public hospital in Chile. Description: Using a qualitative methodology, and an emergent and descriptive design, 26 people, including mothers and team members of one palliative care unit, participated in in-depth interviews and discussion groups separately. Data analysis was performed using grounded theory and critical discourse analysis techniques. Results: The roles played by healthcare clowns in palliative care were accompanying, mediating between team members and families, facilitating to process death, provision of humane care using socioemotional competences, promotion of social relationships, and being complementary therapy. Conclusion: The six roles of healthcare clowns identified by this research have implications for public policies and actions in palliative care. There is also a need to expand this type of work to other public health services in Chile. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Integrated Care (IJIC) is the property of Ubiquity Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of International Journal of Integrated Care (IJIC) is the property of Ubiquity Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: It is currently the most cost-effective management model to have multiple professionals from relevant institutions collaborate so as to provide integrated chronic disease management services. The "classified, color-coded, hierarchical and regionalized" chronic disease management model in Youxi County, Fujian Province is a typical case in China. However, related research is limited. This paper aims to analyze the practice measures and lessons learned in Youxi County, focusing on the professional integration of service providers. Methods: From January to March 2021, interviews with 15 key informants in Youxi County were conducted to collect qualitative data, which was analyzed by the thematic framework method as well as the policy data, using the professional integration dimension in the evaluation framework of the integrated healthcare system. Results: A series of measures were taken, such as improving the professional division and collaboration mechanism, establishing the incentive and restraint mechanism geared toward chronic disease management, formulating norms and standards of chronic disease management for patients with different color labels, and promoting the compatibility of inter-professional value and culture under the governmental institutional supply and the organizational support of the tight county healthcare alliance in Youxi County, to prompt professionals of different levels and types to collaborate in order to provide integrated chronic disease management services. However, some problems remained, such as limited capacity of primary health care, the relatively narrow range and weak effect of the incentive and restraint mechanism, inadequate implementation of the norms and standards, and so forth. Conclusions: Our findings provide reference for other regions in China and other lowand middle-income countries in exploring the integrated chronic disease management model. Long-term follow-up surveys and mixed research designs are required in the future to enrich relevant evidence. [ABSTRACT FROM AUTHOR]

Public-private partnerships (PPPs) are increasingly used to develop, finance, and provide public health infrastructure and service delivery [1]. They combine the strengths of private actors, e.g., innovation, technical knowledge, and entrepreneurial spirit, with the knowledge and social responsibility of public actors to develop beneficial health outcomes However, literature indicates that further research is necessary to understand the conditions and impact of such collaborations to suggest when, how and to what extent PPPs should be favored [2]. This paper presents a PPP between the Region Zealand University Hospital, Køge and Blue Ocean Robotics. The result of this innovative collaboration is the Patient Transfer and Rehabilitation (PTR) Robot that has been developed to reduce healthcare professionals' injuries and support them in their work, providing patients a higher quality of care. Hospitals spend a lot of resources on conventional patient handling procedures and manual patient handling is not an effective way to reduce injuries to caregivers, due to high risks of musculoskeletal overexertion and acute onset. Thus, the hospital looked for more efficient and flexible alternatives that would benefit both patient and caregiver and integrate rehabilitation in the daily care routines. The project began in 2016 and included a mix of methodologies that had patients and caregivers in focus. This paper presents the results collected in the last phase of the project during the introduction of the new technology into the hospital's wards. In 2021, two PTR Robots were delivered to the hospital. Two main actions were planned to onboard the users: a) introductory workshop with 211 healthcare professionals from different wards (orthopedic, surgical, and geriatric) and b) "superusers" training. Besides the need to gather qualitative feedback from real users, the workshop sessions were strategic to arouse curiosity, engagement, and motivation about the robot in their workplace. At the end of the introductory workshop, participants filled out a usability questionnaire, which was applied to quantify their experiences: • 93% of participants agreed that PTR Robot is easy to use. • 94% of participants agreed they would use PTR Robot again in their workplace. • 88% of participants agreed that PTR Robot is quick to learn. In the second stage, small groups from the hospital's staff were educated as "superusers". Based on the ethnographic approach, the "superusers" act as the key-informants of the development team, as well as "coaches" of the rest of the hospital staff. The paper gives insights into practices of a successful PPP. The results can guide healthcare institutions to better understand how to enable new collaborations and what activities have higher possibility for success. Limitations concern the applicability of the results as these are based on a single PPP with two partners from the same country focusing on the development of robotics technology. [1] Anderson, S. (2012). Public, private, neither, both? Publicness theory and the analysis of healthcare organisations. Social Science & Medicine, 74(3), 313-322. [2] Roehrich, J. K., Lewis, M. A., & George, G. (2014). Are public-private partnerships a healthy option? A systematic literature review. Social science & medicine, 113, 110-119. [ABSTRACT FROM AUTHOR]

Introduction: In the worldwide COVID-19 pandemic, healthcare workers (HCWs) caring for people with intellectual disabilities (ID) face a unique risk above the already heightened occupational risk all HCWs are exposed to, but literature on this specific group is lacking. Understanding why individuals are hesitant to be vaccinated for COVID-19 is essential in order to provide the right measures in improving vaccination numbers. This article reviews the influencing factors of COVID-19 vaccine willingness and hesitancy in HCWs who work with people with ID. Methods: CINAHL, APA PsycArticles, APA PsycInfo, Web of Science, Semantic Scolar, Prospero, Outbreak Science, Cochrane and Scopus were searched for papers including the attitudes on COVID-vaccination of HCWs in the field of ID-care. Only two papers were found on HCWs working with people with ID, therefore the search was broadened to HCWs in general. Twenty-six papers were identified containing quantitative and qualitative data on 43,199 HCWs spread over 16 countries worldwide. Socio-demographical predictors of vaccine willingness were extracted and analysed, as well as attitudes of vaccine willingness and hesitancy. Results: Medical doctors, people of older age, men, and those previously vaccinated with the influenza vaccine were most willing to take the COVID-vaccine. Health factors and ethics were drivers of vaccine willingness; characterised by perceived COVID-threat and wanting to protect family members and others. Distrust and lack of information were the most common drivers of vaccine hesitancy; characterised by concerns on side effects, vaccine safety, vaccine efficacy, and speed of vaccine development. Limiting to the two papers investigating HCWs in the care of people with ID, some similarities were found: (1) only older age was a predictor for vaccine willingness and (2) concerns about possible side effects and the fast development of the vaccine were the main drivers for vaccine hesitancy. Additionally, vaccine willingness and hesitancy in HCWs are not stable over time and are affected by information sources and contextual factors. Conclusions: To achieve the highest COVID-vaccination degree worldwide amongst HCWs, recommendations are made for interventions on distrust-topics to nursing staff, people of younger age, women, and those not previously vaccinated within the HCW-population. Implications: Additional research is needed to specify more precisely the attitudes of HCWs caring for people with ID in general and in more countries worldwide. [ABSTRACT FROM AUTHOR]

Introduction: East Toronto Health Partners (ETHP) is a network of organizations that serve residents of East Toronto, Ontario, Canada. ETHP is a newly formed integrated model of care in which hospital, primary care, community providers and patients/ families work together to improve population health. We describe and evaluate the evolution of this emerging integrated care system as it responded to a global health crisis. Description: This paper begins by describing ETHP’s pandemic response mapping out over two years of data. To evaluate the response, semi-structured interviews were conducted with 30 decision makers, clinicians, staff, and volunteers who were part of the response. The interviews were thematically analyzed, and emergent themes mapped onto the nine pillars of integrated care. Discussion: The ETHP pandemic response evolved rapidly. Early siloed responses gave way to collaborative efforts and equity emerged as a central priority. New alliances formed, resources were shared, leaders emerged, and community members stepped forward to contribute. Interviewees identified positives as well as many opportunities for improvement post-pandemic. Conclusion: The pandemic was a catalyst for change in East Toronto that accelerated existing initiatives to achieve integrated care. The East Toronto experience may serve as a useful guide for other emerging integrated care systems. [ABSTRACT FROM AUTHOR]

Background: Cooperation is a core feature of integrated healthcare systems and an important link in their value-creating mechanism. The premise is that providers who cooperate can promote more efficient use of health services while improving health outcomes. We studied the performance of an integrated healthcare system in improving regional cooperation. Methods: Using claims data and social network analysis, we constructed the professional network from 2004 to 2017. Cooperation was studied by analyzing the evolution of network properties at network and physician practice (node) level. The impact of the integrated system was studied with a dynamic panel model that compared practices that participated in the integrated system versus nonparticipants. Results: The regional network evolved favourably towards cooperation. Network density increased 1.4% on average per year, while mean distance decreased 0.78%. At the same time, practices participating in the integrated system became more cooperative compared to other practices in the region: Degree (1.64e-03, p = 0.07), eigenvector (3.27e-03, p = 0.06) and betweenness (4.56e-03, p < 0.001) centrality increased more for participating practices. Discussion: Findings can be explained by the holistic approach to patients’ care needs and coordination efforts of integrated healthcare. The paper provides a valuable design for performance assessment of professional cooperation. Highlights •Using claims data and social network analysis, we identify a regional cooperation network and conduct a panel analysis to measure the impact of an integrated care initiative on enhancing professional cooperation. •Physician practices participating in the integrated system became more cooperative and improved their influence in the regional network more than non-participating practices. •Integrated healthcare systems effectively incentivize cooperation through a holistic approach to patient care needs and coordination efforts. [ABSTRACT FROM AUTHOR]

Background: To reduce overall healthcare costs, several countries have attempted to shift services from specialist to primary care. This was also the main strategy of the Coordination Reform introduced in Norway in 2012. An important part of the reform was the introduction of Municipal Acute Wards (MAWs), a type of community hospital aimed at reducing admissions to general hospitals. The main objective of this paper is to investigate whether the implementation of MAWs had a causal effect on hospital admissions. Methods: Monthly admission rates in total and by age groups for patients admitted with acute or elective conditions at internal medicine or surgical departments were analyzed using panel data regression techniques. We identified causal effects by exploiting the sequential roll out of the MAWs within fixed effect analyses. Our data covered all municipalities from start of 2010 until the end of 2017. Results: The sequential implementation of the MAWs started during the summer of 2012. By the beginning of 2016 close to all municipalities had an operative MAW. The introduction of MAWs significantly reduced acute hospital admissions. The effect was strongest for patients ≥80 years admitted acutely to internal medicine departments. The effects were even stronger if the MAW had a physician on site 24/7 or was located close to a local emergency center. Conclusion: Our findings suggest that this type of intermediate care unit is a viable option to alleviate the burden on hospitals by reducing acute secondary care admission volumes. [ABSTRACT FROM AUTHOR]

Introduction: Children’s Health Queensland (CHQ) established a telementoring hub in Queensland, using the Project ECHO® model, to pilot and scale a range of virtual communities of practice (CoP) to empower the Australian workforce to integrate care. Description: The establishment of the first Project ECHO hub in Queensland facilitated the implementation of a variety of child and youth health CoP that strategically aligned to the organisation’s approach to integrate care through workforce development. Subsequently, other organisations nationally have also been trained to implement and replicate the ECHO model to effect more integrated care through CoPs in other priority areas. Discussion: Findings from a database audit and desktop analysis of project documentation highlighted that using the ECHO model was effective in establishing co-designed and interprofessional CoP to support a cross-sector workforce to deliver more integrated care. Conclusion: CHQ’s use of Project ECHO highlights an intentional approach to establishing virtual CoP to build workforce capability to integrate care. The approach explored in this paper highlights the value of workforce collaboration amongst nontraditional partners to foster more integrated care. [ABSTRACT FROM AUTHOR]

Introduction: China is promoting integrated care. However, incomplete payment methods led to medical insurance overspending and intensified service fragmentation. Sanming implemented Integrated Medicare Payment Methods (IMPM) in October 2017, which integrates multi-level payment policies. Sanming’s IMPM works well and has been promoted by the Chinese government. Therefore, in this paper, we aim to systematically analyze Sanming’s IMPM, and conduct preliminary evaluations of Sanming’s IMPM. Policy Description: IMPM integrates two levels of policy that are implemented simultaneously: (1) The payment policy for healthcare providers refers to how to calculate the global budget (GB) of the medical insurance fund paid to the healthcare providers and the policy guidance for the healthcare providers on how to use GB. (2) The payment policy for medical personnel refers to the adjustment of the evaluation index of the annual salary system (ASS) according to the IMPM’s purpose and the payment policy that adjust pay levels based on performance. Discussion and lessons learned: After the IMPM reform, county hospitals (CHs) may reduce over-providing dispensable healthcare, and cooperation between hospitals may increase. The policy guidance (Determining GB according to population; Medical insurance balance can be used for doctors’ salary, cooperation between hospitals, and promotion of residents’ health; Adjusting ASS assessment indicators according to IMPM purposes) increases CHs’ motivation to promote balances of medical insurance fund by cooperating with primary healthcare and increasing health promotion actions. Conclusion: As a model promoted by the Chinese government, the specific policies of Sanming’s IMPM are better matched with policy goals, which may be more conducive to promoting medical and health service providers to pay more attention to cooperation among medical institutions and population health. [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: Demographic and epidemiological transitions of industralized countries mean health systems have to integrate health and social services to respond to the changing needs of their populations. Efforts to integrate care involve important policy and structural changes. This paper examines whether integration efforts are lost in translation during the bureaucratic appropriation of models, or, in an allegorical way, do they reveal genes of bureaucracy? Description: Since the 1960s, the health system of Québec has undergone four major structural and progressively integrative transformations, characterized as - modernization, shock of reality, explicit integration, and centralization phases. Discussion: Although integration efforts progressively transformed Québec's health and social services system, embedded bureaucracies impeded the realisation of these projects. Notably, inadequate change management strategies and lack of integrated funding models hindered integration efforts. Furthermore, there was variability in government prioritisation and support of different aspects of the model by making some components happen, helping others happen and letting others happen. Conclusion: Drawing insights from bureaucratic obstacles to integration efforts may improve implementation strategies. This paper highlights important policy and administrative challenges that have to be taken into consideration in improving the implementation of integrated care initiatives in a real-life context. [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]

Introduction: There is a gap between aspiring to co-produce and co-create value in integrated healthcare and realising that in practice, particularly with complex needs and multiple stakeholders. Key principles from literature on value-based healthcare offer a conceptual framework for building suitable care platforms to support practice. This paper outlines the Complex Care and Recovery Management Framework (CCaRM) as an example of co-platforming value-based healthcare within case level practice. Description: The CCaRM was co-produced with clinicians and service users in a learning disability service. Highlighted are 6 value-making themes for building collaborative value over time, alongside case management. "Experience-in-use" was that it made sense to participants, and activated service-users and clinicians. Further empirical evaluation is needed. Discussion: There was encouragement that the CCaRM approach was implementable. Alongside further evaluative work, key issues would be: collaborating with local participants; supporting training; reconciling case-level perspectives with wider systems. Progressing integrated value-based healthcare involves: refreshing focus on the case-based view; ways of operationalising complexity; value-based case management; customisation of care styles and "democratic outcomes" within coplatforming systems. Conclusion: In principle, the CCaRM contributes to operationalising collaborative valuebased healthcare for complex cases. It surfaces further research themes to refocus value and integrated care thinking. Further empirical work is needed. [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 Telehealth, or virtual care (VC), includes the provision of healthcare using the telephone and/or videoconferencing and is an important service delivery method for healthcare providers working in the community. VC enhances access to services, promotes patient engagement and improves outcomes. However, healthcare providers can be hesitant to transition from face-to-face services to virtual care, based on inexperience using technology and concerns about patient safety. Short Description This paper presentation focuses on the implementation and evaluation of a homecare organization's rehabilitation VC program. This program required the development of multiple training and educational tools, as well as significant inter-departmental collaboration, to support rapid uptake of VC amongst the organization's occupational therapists, physiotherapists, speechlanguage pathologists, dietitians and social workers. A survey was administered to SPs and patients to evaluate the perceived efficacy of VC, which informed changes to workflow, training, and patient support. Finally, patient interviews added depth to the survey findings. Aim and theory of change The aim of this paper presentation is to highlight the change management processes contributing to healthcare provider uptake of VC using the ADKAR model. This paper presentation will also highlight the findings from the client and clinician surveys, as well as the client interviews. Targeted population and stakeholders This program focused on the uptake and utilization of VC amongst the organization's healthcare providers. The targeted population for this presentation are program developers, educators and healthcare providers. Timeline This program was implemented in April 2020, with all rehabilitation service providers trained on the new VC platform by May 2020. Highlights The healthcare provider and patient survey suggested that telephone and videoconferencing were appropriate and effective tools to meet patient needs. Some healthcare providers expressed concerns about the effectiveness of communication over telephone and they reported feeling concerned about information security. However, patients reported they felt their information was secure and protected. Interviews with patients added depth to the survey results, highlighting that patients value the integration of VC in their care plan. Comments on sustainability The sustainability of this VC program relies on feedback from frontline healthcare providers, a commitment to client and family centered care, and the ongoing collaboration between departments. Comments on transfer-ability Findings from this VC program's implementation may be used to help other organizations hoping to enhance healthcare provider uptake for other medical professions and/or in other healthcare sectors. Conclusions VC can facilitate patient and family engagement, as well as access to healthcare. VC is a safe and effective service delivery option for rehabilitation providers working in the community. Discussions This presentation will conclude with a description of how the evaluation results informed ongoing modifications to sustain the rehab VC program. Lessons learned Stakeholder engagement and departmental collaboration was essential to the success of this program. Maintaining an open dialogue with frontline healthcare providers also ensured that meaningful changes were implemented to support workflow efficiency and patient safety. [ABSTRACT FROM AUTHOR]

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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]

This paper examines the proposition that temporary project-based organizations that operate across the formal boundaries and hierarchies of health and social care organizations can create 'trading zones' in which different types of knowledge can come together as new multi-disciplinary practices are constructed. The paper presents new case study evidence that shows how small project-based teams of care professionals from previously separate provider organizations were able to create dialogic 'spaces' and strong project identities that facilitated the sharing of useful knowledge. These teams included senior social care managers whose ability to make effective use of population health data was mediated and facilitated by their ability to form 'guiding coalitions' that allowed them to claim and demarcate new operating jurisdictions. Middle managers played a proactive role as 'horizontal integrators' that were able to orchestrate divergent skills and learning capabilities. Project-based teams also included supervisory grade service managers whose involvement allowed the design and subsequent routinization of new services to be directly informed by the situated knowledge and experience of those working at, or close to, the front-line of care provision. [ABSTRACT FROM AUTHOR]

Introduction: Network platforms are interesting for integrated care governance as they seek solutions for the problem of competition and tensions between networks. In this paper, we analyse how a network platform functions for the actors involved, and how it is used in their work. Methods: We employed a case study in a Dutch urbanised hospital region, and conducted 17 interviews with hospital physicians, directors, and supporting staff who are involved in a network platform called “BeterKeten” (BK). Results: Actors assign different functions and purposes to BK: facilitating and legitimising professional (learning) communities; adapting to a changing policy context; enlarging professionals’ and the networks’ circle of influence; and extending governing possibilities. Network platform’ dynamics and frictions entail changing professional and managerial practices; embedding a BK network in a partner network; and alignment of (conflicting) network platforms. Discussion: Network platforms are a promising strategy to govern, facilitate, and nurture network-building actions to enhance integrated care, offering new ways of working to cope with its multi-level nature. Conclusion: BK is a dynamic actor with steering capacities that enables the coexistence of multiple purposes. Further research could pay attention to how network platforms are able to develop modalities of integrated care governance that suit healthcare system’s networked character. [ABSTRACT FROM AUTHOR]