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BackgroundIn support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions. ObjectiveThe aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction. MethodsA literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction. ResultsPatients’ knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes. ConclusionsThe effect of asynchronous communication is not shown unequivocally in these studies. Patients seem to be interested in using email. Patients are willing to participate and are taking the initiative to discuss health issues with their providers. Additional testing of the effects of asynchronous communication on self-management in chronically ill patients is needed.

Preliminary findings from the Dutch Health Care Demonstration Project in the town of Almere suggest that a primary care-based health care system is functional and practical. The first 100 families moved to the town of Almere in 1976. Its health care system was established separately from the rest of the Netherlands, and it incorporates the principles of regionalization and structuralization. Primary care in Almere has been decentralized to 15 health centers, each serving 6,000 to 8,000 people. All general practitioners and most other primary care workers work for one organization: the Almere Foundation for Primary Care. As in the rest of the Netherlands, general practitioners serve as a gatekeeper, and patients see specialists or are admitted to the hospital after referral from a general practitioner. A preliminary study that compared Almere's system of general practice with that of the rest of the Netherlands found that hospital admission rates were lower in Almere and so were the referral and prescription rates.

In addition to 'fixed' patient demographic and background variables, treatment process constructs play an important role in the prediction of treatment retention in substance dependence treatment. The objective of this paper is to analyze the predictive role of repeated measures of treatment readiness and behavioral intention, and of patients' perception of the therapeutic alliance, while controlling for fixed patient-oriented variables. Ninety-three patients, both alcohol and drug dependents, enrolled in this study, which was conducted in an inpatient treatment setting. Patients completed questionnaires shortly after admission (t = 0) and approximately 2 weeks later (t = 1). Using these measures, 35% of variance of a length of stay in treatment of up to 30 days could be explained. Fixed patient-oriented variables accounted for 21% of variance. Of the cognitive factors, helping alliance was the most important, accounting for an additional 8% of variance. The implications of these results are discussed. Keywords: Substance dependence; Noncompliance; Helping alliance; Treatment motivation; Behavioral intention

A 24-item multidimensional nurse-administered Nursing Home Disabilities Instrument (NHDI) was developed to measure disabilities in nursing home residents. We present the psychometric features and value of this instrument, with the following domains assessed: Mobility, Activities of Daily Living (ADLs), Alertness, Resistance to Nursing Assistance, Incontinence, Cognition, and Perception. Test-retest and interrater reliability was assessed using the Spearman correlation coefficient. Internal consistency was examined by Cronbach's alpha. Criterion validity tests were performed by comparing the scales with scales of the Elderly Residents Rating Scale (BOP). Test-retest reliability correlation coefficients ranged from 0.63 to 0.94. Interrater reliability was high for the scales Cognition, Mobility, ADL, and Incontinence (0.79 to 0.93), moderate for Resistance (0.51), and low for Perception (0.33). Cronbach's alpha of the scales was high, ranging from 0.78 (Alertness) to 0.93 (Mobility); only Perception showed a low alpha: 0.54. Criterion validity was high for Cognition, ADL, and Mobility (0.75 to 0.78), and moderate for Alertness (0.59). The NHDI appears to be a valid and efficient multidimensional instrument for measuring disabilities in nursing home residents. These findings imply that the NHDI is a useful instrument for nursing homes to achieve a reliable assessment of cognitively impaired elders.

A substantial amount of research has been published on the association between the use of electronic medical records (EMRs) and quality outcomes in U.S. hospitals, while limited research has focused on the Western European experience. The purpose of this study is to explore the association between the use of EMR technologies in Dutch hospitals and length of stay after colorectal cancer surgery. Two data sets were leveraged for this study; the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) and the Dutch surgical colorectal audit (DSCA). The HIMSS Analytics EMRAM score was used to define a Dutch hospital's electronic medical records (EMR) capabilities while the DSCA was used to profile colorectal surgery quality outcomes (specifically total length of stay (LOS) in the hospital and the LOS in ICU). A total of 73 hospitals with a valid EMRAM score and associated DSCA patients ( n = 30.358) during the study period (2012-2014) were included in the comparative set. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. A significant negative association was observed to exist between the total LOS (relative median LOS 0,974, CI 95% 0.959-0,989) of patients treated in advanced EMR hospitals (high EMRAM score cohort) versus patients treated at less advanced EMR care settings, once the data was adjusted for the case mix, year of surgery and type of surgery (laparoscopy or laparotomy). Adjusting for complications in a subgroup of general hospitals ( n = 39) yielded essentially the same results (relative median LOS 0,934, CI 95% 0,915-0,954). No consistent significant associations were found with respect to LOS on the ICU. The findings of this study suggest advanced EMR capabilities support a healthcare provider's efforts to achieve desired quality outcomes and efficiency in Western European hospitals. [ABSTRACT FROM AUTHOR]

Introduction (short description of the SIG to include in the Conference Programme) The SIG 'Evidence Based Integrated Care' is for healthcare researchers who are interested in support healthcare professionals with joined evidence for effective interventions and evidence for effective application in Integrated Care trajectories. Earlier with the members of this SIG, we debated that Integrated Care is aimed at well-organized, cost-effective processes of care delivery, provided by committed professionals which must be able to count on well-established evidence for the care interventions they provide in integrated trajectories to their patients. In providing a reference for research for creating knowledge supporting integrated care, the SIG members defined 'Evidence Based Integrated Care' covering the description of the care problem with the underlying working mechanisms, the test acceptance by patients and care providers, of both the concept of interventions and the (cost) effectiveness in the context where the complex interventions are provided. It also covers the organization of the complex interventions in the trajectory and the quality of life and societal participation of citizens or patients. Aims and Objectives Citizens want to feel supported in being able to participate as optimally as possible in society with the highest possible quality of life, at the lowest possible cost (triple aim) and with more meaning for care providers (quadruple aim). In the meantime, citizens' care needs are becoming increasingly complex, still mostly approached by more individual acting professionals at the same time resulting in fragmented care. In research regarding evidence base integrated care, practical questions are asked about the contexts in which the care under study must be provided or to which the context under study must be adapted. As such in research for evidence base integrated care for integration knowledge there is thus a constant balance between practical orientation and theoretical orientation. This concerns the ""proof in context"" (care provision) versus the ""proof of concept"" (care content). In this session we will discuss the meaning of incorporating both the perspective of ""proof of concept"" and the ""proof in context"" in integrated care research. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that advanced electronic medical record (EMR) capabilities are associated with better quality and safety of hospital care. Methods and Findings: We used data from the HIMSS Analytics EMR Adoption Model (EMRAM) to measure the adoption and use of information technology in Dutch hospitals. To measure the quality and safety of healthcare in Dutch Hospitals we used select data from the publicly available basic set and the safety set of the Health Care Inspectorate (IGZ) and the Dutch Health Care Transparency Program 'Zichtbare Zorg' (ZIZO) program. The quality and safety measures selected reflect the measures used to score Dutch hospitals as presented in Elsevier's annual 'The Best Hospitals' publication. The scores of this publication are based upon 542 of the 1516 available indicators from this basic set and safety set. Almost all indicators from the hospital-wide indicator sets are included in the selection, as are a large portion of indicators for acute care delivered by all hospitals. Of the 84 non-academic hospitals in the Netherlands, 67 (80 %) were included in this study. Results: There is no statistically significant association found between a hospital's EMRAM score and their overall quality/safety performance in the Elsevier hospital scoring model. Conclusion: There is no evidence found to support the research hypothesis at this point in time. This outcome maybe the result of a multiplicity of factors to include the (limited) use of the methodologies used in this study, the fact that no fully digitalized hospital (EMRAM stage 7) is yet present in the NL, and/or the organizational competency of the NL hospitals in fully leveraging the EMR to facilitate patient care. Further research is needed to explore these findings. [ABSTRACT FROM AUTHOR]

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Background: Health care systems aim to involve as much informal care as possible and dementia patients prefer to stay home as long as they can. In this context, perseverance time (Pt)-the period that the informal carer indicates to be able to maintain current care if the situation remains stable-is an important concept. Objective: The aim of this study was to introduce the concept Pt and validate it in a sample of informal carers of dementia patients living at home. Methods: Data were collected from 223 informal carers of dementia patients. Convergent validity was assessed by looking at associations of Pt with validated instruments for measuring subjective burden (CSI, CarerQol-7D, and SRB) and happiness (CarerQol-VAS). Content validity was evaluated by performing multivariate correlations between Pt and characteristics of dementia patients, informal carers, and care situations. The Medical Ethics Committee of Utrecht MC advised positively about the study protocol. Results: Correlation coefficients between Pt and the measures of burden CSI, SRB, and CarerQol-VAS were -0.46, -0.63, and 0.23 (p < 0.01), respectively. Health of dementia patient, informal carer living apart from the patient, and male gender of caregiver were positively associated with Pt; need for supervision, intensity of informal care provision, and reductions in working hours and hobbies in order to be able to provide care were negatively associated. Conclusions: Pt is helpful in monitoring need for support and planning the transition of care from home to nursing home. This study provides a first indication of its validity, but replication is necessary. [ABSTRACT FROM AUTHOR]

Introduction: In this article we describe the history and present state of integrated care for people with depression in the Netherlands. The central question is: what are the developments in integrated care for people with depression in the Netherlands? Methods: We describe these developments from the role of an observer, and make use of several sources: important Dutch policy documents and research documents, our own national survey carried out in 2007, a number of reports and project descriptions and searches in PubMed and Google. Also key people were contacted to supply additional information. Results: In the Netherlands two separate phases can be distinguished within integrated care for people with depression. From the beginning of the 1990s, specialized secondary Mental Health Care (MHC) began to develop care programmes, including programmes for people with depression. The implementation of these care programmes has taken years. Mass usage of care programmes only went ahead once the large-scale mergers between ambulatory and clinical MHC organizations around 2000 had taken effect. An analysis of these programmes shows, that they did not lead to integration with primary care. This changed in the second phase from around 2000. Then attention was directed more towards strengthening the GP within the treatment of depression, collaboration between primary and specialized care and the development of collective integrated care packages. Discussion: We relate these developments to projects in other countries and discuss the scientific basis by using evidence of international literature reviews and metastudies. Some general recommendations are given about functional costing, the physical presence of MHC specialists in the primary care sector and the use of a common national standard for both primary care and specialized MHC. [ABSTRACT FROM AUTHOR]

In the Dutch decentralised delivery system, choices of technical aids and mobility services as provided by the Service for the Disabled Act are limited and the potential user population is diverse. In this study, the satisfaction with outdoor mobility provisions and the extent to which mobility problems were met were assessed with a retrospective questionnaire. Areas in the delivery process needing special attention were highlighted. Respondents (516 out of 973) received either a device, access to the shared taxi system or both types of provisions. These 3 groups differed significantly both in their respondent characteristics and the degree of satisfaction. In general, overall satisfaction was high but the percentage of users being `not fully satisfied' varied from 0% satisfaction items, combinations of mobility provisions and types of devices. Of the respondents, 23% had not been solved as expected. Service deliverywaiting times for arrival of the taxi were frequent sources of not being fully satisfied. [ABSTRACT FROM AUTHOR]

In these financial difficult years many European governments used global ceilings to control costs of health services. Two scenarios are thinkable. The first is that all individual providers get a budget for their own costs: general practitioners, specialists, hospitals, nursing homes and mental health institutes. The second scenario is to work with global budgets for health care providers servicing a total population. Scientists and policy makers in Europe, North America and Asia need time to design new payment systems based on the idea of global budgeting, bundled payment and shared savings. [ABSTRACT FROM AUTHOR]

Focuses on the integration of preventive services and treating doctors and nurses. Outline of examples of the integration of health and social services; Common characteristics of the examples; Efforts of the "International Journal of Integrated Care" to contribute to the integration of prevention, treatment, long term care and social care.

In 2012, Kahneman united Smith's two views in one readable book titled Thinking Slow and Fast. Kahneman, who won the Nobel Prize in 2002, distinguishes two systems used by the brain to form thoughts. System 1 thinks fast, in stereotypes and emotions. This system works unconsciously. Nowadays, this system is referred to as intuition. System 2, in other words the rational mind, is slow, calculates logically and works consciously. Pushing and nudging the consumer into the direction of rational, long-term thought according to Kahneman's system 2 is called libertarian paternalism. This term is discussed at length by Rice, who published an overview article about the use of behavioural economics in healthcare.4 Behavioural economics is the science of the effects of knowledge and of social and emotional factors on economic decisions and the use of resources, costs and revenue. Important concepts are Nudging and Framing. A nudge is a small financial, or other, change in the supply of goods or services that significantly changes the behaviour of consumers. Framing is a technique of persuasion that uses words and images to implicitly accentuate certain aspects of a person or object and thereby influence a decision. The creator of the term nudging,Richard Thaler received in 2017 the Nobel Prize. In this proposed presentation I will give the theory, background and application of behavorial in integrated care experiments. Five imitatives are discussed: 1- Traditionally, Dutch parents who bring their children to the dentist for a semi-annual check-up do not have to pay for dental treatment if oral health problems occur in the meantime. Without this check-up, parents do have to pay for the treatment. 2- A more modern example is a German nudge aimed at people with a chronic condition. Subscribed patients with a chronic condition subscribe to a disease management programme. In doing so they commit themselves to participating at least once a year in a course about their condition and how to deal with it. Subscribed members are exempted from paying individual contributions for primary healthcare use. 3- A third example is the South African Vitality Health Promotion Programme. It uses financial incentives and cooperates with supermarkets, gyms and health insurance companies. The Vitality programme is successful in achieving its goals: increasing participants' health and lowering their costs of care. 4- A similar option is provided by the American Affordable Care Act. This law makes it possible to offer insurants who live healthy lives do not smoke and/or have a healthy body weight an insurance premium discount of 30 percent or even 50 percent in special cases. 5- Some Accountable Care organizations working with population based on integrated primary ena hospital care realize a reduction in cost growth. One these has the name of Alternative Quality Contract. The lecture is based on: 1- Kahneman D., Thinking, Fast and Slow, Penguin Books Ltd, 2012. 2- Thaler R.H. & C.R. Sunstein, Nudge. Improving decisions about health, health and happiness, New York: Penguin Books, 2009 revised and expanded edition. 3- Refrences on the initiative are gviven during the presentation. [ABSTRACT FROM AUTHOR]

Introduction: Both in literature and in practice there is debate about defining Integrated Care. The WHO for example, defines Integrated Care as a process, not covering the perspective of cost-effectiveness. From the perspective of research into evidence in Integrated Care this is rather awkward. Triple aim focusses on 1 quality of life of citizens; 2 quality and continuity of care and, 3 cost effective care. Integrated Care is aimed at well-organized, cost-effective processes of care delivery, provided by committed professionals which must be able to count on well-established evidence for the care interventions they provide in integrated trajectories to their patients. Research should support them both with evidence for effective interventions and evidence for effective application. A basis for thorough research in Integrated Care is narrowed by a lack of a comprehensive definition. Theory/Methods: Since Integrated Care is considered as sets of complex interventions targeting triple aim, we compared definitions of Integrated Care reported in literature with a definition of complex interventions and a model for evidence based developing, testing and implementing complex interventions. This definition and the accompanied model are issued by the British Medical Research Council MRC in 2008 and are nowadays worldwide established. During the session at the conference, after a short introduction, we will discuss our proposal with the participants for improving a new definition of evidence based integrated care. Results: Our preparation resulted in a proposal for a definition for 'Evidence Based Integrated Care' which covers defining the care problem with the underlying working mechanisms and the test acceptance by patients and care providers. Furthermore, it covers test effect of both the concept of interventions and the cost effectiveness in the context were the complex interventions are provided, the organization of the complex interventions in the trajectory and the quality of life and societal participation of citizens or patients. Discussions: On one hand, the perspective of the content of the interventions moves mostly in the domain of healthcare research. On the other hand, the perspective of the organisation of Integrated Care process is predominantly moving in the domains of social sciences and healthcare business research. In order to achieve triple aim care and welfare, a third perspective of directing the content of the interventions and the way of organising the Integrated Care process is necessary. Unfortunately, this remains rather underexposed in research. Conclusions: In order to meet triple aim, research in Integrated Care should focus on three perspectives at ones: the content of the interventions; the organisation of the Integrated Care process; to strengthen both, creating synergy between content and context. Lessons learned: By directing content and context, research in Integrated Care will make a vital contribution to accomplishing triple aim Integrated Care. Limitations: This is a theoretical exercise for starting a discussion for establishing a research basis, needed for focussing research in Integrated Care. Suggestions for future research: Developing research methods for Integrated Care research covering the perspectives of content context and the direction of these. [ABSTRACT FROM AUTHOR]

Background: Realist philosophy and methodology is increasingly being explicitly used in the field of integrated care to research the extant context, structure and mechanisms at play, and to design and evaluation interventions. Philosophic realism is the view that entities exist independently of our perception or our theories about them. While the realist philosophy underpins much of modern health and social science, it is only recently that this philosophical approach has been popularised within main stream health and social science literature. Realist research methodology is increasingly being described in research areas that are relevant to the study of integrated care, namely, organisational management, information science, social epidemiology, economics, and health services evaluation. Importantly realist approaches are increasingly being used in mixed method research designs and to elucidate the processes at play in experimental and quasi-experimental studies. Realist researchers seek to explain the underlying "cause" or mechanisms that generate observed phenomenon. The realist understanding of how the world is ontology includes the notion of a hidden or "real" domain where mechanisms generate forces that result in the phenomena which we observe. Realists also view the world as consisting of strata or layers of reality which may interact with other layers to produce new mechanism. This approach is proving useful for studying and developing theory about complex health and social care systems, and then designing and evaluating possible interventions. Over the last number of years a number of realist studies have been presented at the International Foundation of Integrated Care conferences including: realist studies of context and mechanisms; realist design of integrated care interventions; realist synthesis of literature; and realist evaluations of integrated-care interventions. The methodologies, and the dialectical debates, are complex, and therefore, deserving of special consideration within the Integrated Care community. This preliminary workshop will support evaluators and researchers to use realist methods in integrated care and other complex evaluations. Because realist evaluation was initially developed using smaller-scale programs, methods need to be modified for large scale programs, while remaining consistent with underlying methodological principles. The workshop will discuss the value of and the dilemmas involved in using realist methods for large and complex programs, and demonstrate strategies to address the dilemmas. Aims and Objectives: 1- Present and discuss the basic tenants of realist research, design and evaluation as it applies to the large scale and complex programs such as integrated care 2- Discuss the scope and purpose of a Realist Research, Design and Evaluation for Integrated Care Special Interest Group RIC-SIG 3- Modify the scope and purpose of a Realist Research, Design and Evaluation for Integrated Care - SIG Format: Group Discussion Target Audience: Integrated care practitioners and researchers who are familiar with realist research including the current focus on critical realism and realist evaluation Learning and Takeaway: The workshop will define the scope and purpose of a SIG for Realist Research, Design and Evaluation for Integrated Care. [ABSTRACT FROM AUTHOR]

Background: Home-dwelling elderly patients with multimorbidity are at risk of fragmentation of care because of the many different professionals involved and a potentially unclear level of communication. Multidisciplinary communication seems to occur incidentally. Mutual feedback is needed for a professional team to provide consistent care and adequate support to the patient system. eHealth technology can improve outcomes. Objective: The aim of this study was to evaluate the use of a tool, Congredi, for electronic communication by professionals for the care of home-dwelling elderly patients. Methods: The research group was recruited through general practices and home care organizations. Congredi, a tool designed for multidisciplinary communication, was made available for professionals in primary care. It consists of a care plan and a communication channel (secure emailing). Professionals opened Congredi records for elderly patients who had 2 or more professionals involved. The records were the unit of analysis. Data were gathered from the Congredi system over a period of 42 weeks. Results: An inclusion rate of 21.4% (203/950) was achieved; nearly half of the participants were nurses. During the study, professionals were active in 448 patient records; female professionals were prevalent. In the patient records, 3 types of actions (care activities, emailing, and process activities) were registered. Most activities occurred in the multidisciplinary records (mean 12.2), which had twice the number of activities of monodisciplinary records (6.35), and solo records had a mean of 3.43 activities. Most activities were care activities (mean 9.14), emailing had a mean of 0.89 activities, and process activities had a mean of 0.29. Conclusions: An e-communication tool (Congredi) was usable for improving multidisciplinary communication among professionals. It even seemed to yield results for 40% of the professionals who used the e-care plan on their own. The content of the tool provided an active communication practice, with significant increases observed in the actions that must be shared for the effective coordination of care. [ABSTRACT FROM AUTHOR]

Introduces the on-line International Journal of Integrated Care (IJIC) to the subscribers of the "Journal of Integrated Care." History and focus of IJIC; Definition of integrated care; Categories of the journal's manuscripts.

In 2007 the Netherlands introduced bundled payments for diabetes care. Under this BP system, health insurers pay a single fee to a contracting entity - the care group - which serves as the general contractor for DMPs and which is responsible for organizing care and ensuring its delivery. Care groups subcontract care services by individual health care providers or employ providers to deliver these services themselves. Health insurers freely negotiate with care groups about the fee for the DMP in a BP contract. The care services included in the BP contracts are determined by the Dutch Diabetes Federation Health Care Standard. Principal investigator dr. Jeroen Struijs shows in the first half of the lecture the effects of this payment reform on health care delivery process, quality of care and health care expenditures. Then health economist Guus Schrijvers compares these results with the theory of Triple Aim, aiming at 1. More health 2. More quality of care and 3. Less per capita costs. At the end Schrijvers places the Theory of Triple Aim in the domain of behavioural economics. He gives suggestions for new research and demonstration projects. [ABSTRACT FROM AUTHOR]

The article presents a preface to the journal "International Journal of Integrated Care".

The article offers the author's perspective on the use of integrated care across health systems and countries in response to the common challenges of the 21st century. The author comments on the efforts to overcome the barriers to health care quality which include an ageing society, chronic disease and multi-morbidity. An overview of the 9th Annual Conference on Integrated Care held in Vienna, Austria, including the agenda and the objective is also presented.