Abstract:
Introduction:Not surprisingly given their multi-component nature, initiatives to improve integrated care often evolve to find the best way to bring about change. This paper provides an example of how an evaluation evolved alongside such an initiative designed to better integrate care across primary, community and hospital services in South Auckland, New Zealand. Theory and methods:Using the explanatory power of a realist evaluative approach, theories of new ways of working that might be prompted by the initiative were explored in: (i) interviews with stakeholders in 2012 and 2015, (ii) online surveys of general practices and local care organisations, and (iii) a purposive sample of ten general practices. Results:The results highlighted the institutional contexts that led to difficulties in implementing population health initiatives. They also revealed that changes in work practices focussed mostly on activities that improved the coordination of care for individuals at risk of hospital admissions. Discussion:Multi-component complex interventions can vary in their delivery and be vulnerable to one or more components not being implemented as originally intended. In the case of this intervention, the move towards strengthening local relationships arose when contractual arrangements stalled. Realist evaluative approaches offer a logic that helps unpick the complexity of the relationships and politics in play, and uncover the assumptions made by those developing, implementing and assessing health service changes. Conclusion:Given the multi-component and evolving nature of initiatives seeking to better integrate care, the realist evaluative emphasis on surfacing early the theories to explain how change is expected to occur helps overcome the challenge of evaluating "a moving target".
journal_name
Int J Integr Carejournal_title
International journal of integrated careauthors
Middleton L,Rea H,Pledger M,Cumming Jdoi
10.5334/ijic.4183subject
Has Abstractpub_date
2019-04-05 00:00:00pages
4issue
2issn
1568-4156journal_volume
19pub_type
杂志文章abstract:BACKGROUND:Joint training for interagency working is carried out by Local Safeguarding Children Boards in England to promote effective local working to safeguard and promote the welfare of children. PURPOSE:This paper reports on the findings of the outputs and outcomes of interagency training to safeguard children in ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.548
更新日期:2010-11-16 00:00:00
abstract:Background:Most current care models are disease- or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. Meth...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.4646
更新日期:2020-04-22 00:00:00
abstract:Introduction:In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.4217
更新日期:2019-07-25 00:00:00
abstract:PROBLEM STATEMENT:Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. Wh...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.311
更新日期:2009-04-20 00:00:00
abstract:Introduction:Primary care is increasingly being confronted with complex health care demands stemming from both biomedical and psychosocial problems of people with chronic diseases. Interprofessional collaboration is needed to enhance person-centredness and coordinate care provision in an efficient manner, which should ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.4179
更新日期:2018-12-13 00:00:00
abstract::This article explores legislative provisions in relation to patient privacy in the context of integrated health and social care and the development of multidisciplinary health care teams that include practitioners from private sector and government agencies in the health, education, child protection, family welfare, d...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.5591
更新日期:2020-11-19 00:00:00
abstract:INTRODUCTION:A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care com...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.2944
更新日期:2017-07-21 00:00:00
abstract::The WHO European Office for Integrated Health Care Services in Barcelona is an integral part of the World Health Organizations' Regional Office for Europe. The main purpose of the Barcelona office is within the integration of services to encourage and facilitate changes in health care services in order to promote heal...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
abstract:PURPOSE:This paper reports on some of the findings of a literature review commissioned to explore integrated care for older people. METHODS:The process of revising included finding and selecting literature from multidisciplinary sources, and encompassed both published papers and 'grey' literature, i.e. material which ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.119
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Improving the healthcare for patients with depression is a priority health policy across the world. Roughly, two major problems can be identified in daily practice: (1) the content of care is often not completely consistent with recommendations in guidelines and (2) the organization of care is not always int...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.314
更新日期:2009-06-15 00:00:00
abstract:INTRODUCTION:The variable success of integrated care initiatives has led experts to recommend tailoring design and implementation to the organizational context. Yet, organizational contexts are rarely described, understood, or measured with sufficient depth and breadth in empirical studies or in practice. We thus lack ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.2502
更新日期:2017-06-27 00:00:00
abstract:BACKGROUND:Integration involves the coordination of services provided by autonomous agencies and improves the organization and delivery of multiple services for target patients. Current measures generally do not distinguish between agencies' perception and expectation. We propose a method for quantifying the agencies' ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.835
更新日期:2012-09-18 00:00:00
abstract::The International Foundation for Integrated Care (IFIC) recently celebrated its 20th International Conference (ICIC20) through a virtual event that brought together patients and carers, academics, care professionals, NGOs, policy-makers and industry partners from across the global integrated care community [1]. The In...
journal_title:International journal of integrated care
pub_type: 社论
doi:10.5334/ijic.5627
更新日期:2020-10-21 00:00:00
abstract:BACKGROUND:Disease management programs (DMP) aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes ma...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.675
更新日期:2011-10-01 00:00:00
abstract:Introduction:To meet the needs of vulnerable people, the integration of services across different sectors is important. This paper presents a preliminary review of service integration across sectors in Europe. Examples of service integration between social services, health, employment and/or education were studied. A f...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.3107
更新日期:2018-04-19 00:00:00
abstract:Introduction:Current U.S. policy and payment initiatives aim to encourage health care provider accountability for population health and higher value care, resulting in efforts to integrate providers along the continuum. Providers work together through diverse organizational structures, yet evidence is limited regarding...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.4635
更新日期:2020-01-20 00:00:00
abstract:CONTEXT:In 2006 the Labour Government in England published its long awaited White Paper on 'community services', following on from the 2005 Green Paper on the future of social care. The policy envisages an unprecedented shift of activity and resources from acute care to community settings, along with a much stronger fo...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.158
更新日期:2006-08-17 00:00:00
abstract::This paper aims to identify problems in estimating and the interpretation of the magnitude of intervention-related change over time or responsiveness assessed with health outcome measures. Responsiveness is a problematic construct and there is no consensus on how to quantify the appropriate index to estimate change ov...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.65
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:The use of case studies in health services research has proven to be an excellent methodology for gaining in-depth understanding of the organisation and delivery of health care. This is particularly relevant when looking at the complexity of integrated healthcare programmes, where multifaceted interactions o...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.1980
更新日期:2014-12-15 00:00:00
abstract:Aim:To explore health professionals' perspectives on communication, continuity and between-service coordination for improving cancer care for Indigenous people in Queensland. Methods:Semi-structured interviews were conducted in a purposive sample of primary health care (PHC) services in Queensland with Indigenous and ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.5456
更新日期:2020-06-08 00:00:00
abstract:INTRODUCTION:In 2002 the Republika Srpska of Bosnia and Herzegovina adopted goals for reducing the burden of chronic disease through a new screening program in its publicly funded health centers ("Dom Zdravljas"). This study evaluated the first year of program implementation. METHODS:The evaluation used in-depth inter...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.227
更新日期:2008-02-11 00:00:00
abstract:BACKGROUND:The literature on integration indicates the need for an enhanced theorization of institutional integration. This article proposes path dependence as an analytical framework to study the systems in which integration takes place. PURPOSE:PRISMA proposes a model for integrating health and social care services ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.544
更新日期:2010-06-30 00:00:00
abstract:Introduction:Dyspnea is a common complaint and in 70 to 90% the origin is pulmonary or cardiovascular. However, referral to the "wrong" specialism could result in diagnostic- and treatment delay. Integrated care by a cardiologist and a pulmonologist could improve this. The aim of the present study was to evaluate wheth...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.3983
更新日期:2018-12-31 00:00:00
abstract:INTRODUCTION:Multidisciplinary group meetings are one of the key drivers of facilitating integrated care. Health care professionals attending such groups have a key role in the success of these discussions and hence, in the forming of multi-professional integrated care. The study aimed to explore the professionals' exp...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.2019
更新日期:2015-09-02 00:00:00
abstract:INTRODUCTION:The aim of this study is to explore the obstacles to collaborations between nurses in hospital and municipal care in the discharge of hospital patients who need continuing care. METHODS:First, we conducted in-depth interviews of nurses in hospitals and nurses in municipal care. Second, we developed questi...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.858
更新日期:2013-03-14 00:00:00
abstract:BACKGROUND:As the prevalence of long-term and multimorbid conditions is increasing, patients increasingly require consultations with multiple health care professionals and coordination of their care needs. METHODS:This study is based on a 2011 survey of older Australians which draws on sub-populations of people with d...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.1598
更新日期:2015-05-14 00:00:00
abstract:Introduction:China has adopted a people-centred integrated care model to reform its severely hospital-centric and fragmented delivery system. As a template of this model in urban China, the Luohu Hospital Group has generated considerable public and academic interest to scale it up. Methods:Guided by a policy triangle ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.4673
更新日期:2020-03-16 00:00:00
abstract::By the introduction of a public, mandatory program of Long-Term Care Insurance (LTCI) on April 1, 2000, Japan has moved towards a system of social care for the frail and elderly. The program covers care that is both home-based and institutional. Fifty percent of the insurance is financed from the general tax and the o...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.39
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVE:We analysed the integrated planning model adopted by the Italian region Emilia Romagna in year 2000 to cover the entire range of treatment of cardiovascular disease. This model, called "hub and spoke", provides for the transfer of patient care and treatment from peripheral units (the spokes) to central units ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.82
更新日期:2003-01-01 00:00:00
abstract:Background:Chronicity, and particularly complex care needs for people with chronic diseases is one of the main challenges of health systems. Objective:To determine the population prevalence of people with chronic diseases and complex care needs and to characterize these needs considering features of health and social ...
journal_title:International journal of integrated care
pub_type: 杂志文章
doi:10.5334/ijic.3292
更新日期:2018-05-25 00:00:00