Definitions
What is integrated care?
This umbrella term describes coordinated care intended to provide the right care, in the right place, at the right time.
Name the 3 main levels of integration and briefly state which population group they address.
micro-->individual patients and caregivers
meso-->specific subpopulations
macro-->entire population
Examples such as payment mechanisms that support cross-organisational care, regulatory policies and political will, are what type of enablers for integrated care? Professional/cultural, organisational or policy enablers?
Policy enablers
What are the 3 main objectives of the Integrated Care Triple Aim
Improving population health, enhancing patient experience, reducing healthcare costs
What is the integration paradox?
The integration paradox is that while integration aims to make healthcare more coordinated and efficient, more integration can also create more complexity, coordination costs and bureaucracy.
According to Garattini et al, What trendy name is often cited as a key aim for integrated care?
patient-centered care
A regional hospital network physically merges its premises, staff and services with a local primary care practice. Is this an example of virtual or "real" integration?
"Real" integration
Which type of barrier can arise when different healthcare professionals have different professional cultures, responsibilities, and priorities? Give one example.
This is a professional/cultural barrier. For example, a GP and a hospital specialist may have different priorities or ways of working, making communication and cooperation more difficult.
What is the fourth aim that was later added to turn the Triple Aim into the Quadruple Aim
Improving work life of healthcare professionals
How can over-standardizing care pathways to achieve system integration negatively impact healthcare workers?
It reduces professional autonomy and clinical decision-making flexibility.
Integrated care has become known as an umbrella term with more than how many recorded definitions?
More than 175
Linking general practices in primary care with hospital wards in secondary care along a care pathway is an example of which direction/breadth of integration?
Vertical integration
Name 2 examples of professional/ cultural enablers for implementing integrated care.
Common purpose and vision, shared professional values, cultures, strong leadership, joint working, trust and willingness to look behind personal interests
According to the systematic review by Zonneveld et al., how many core values underpinning integrated care were identified?
23
What does empirical evidence show regarding the reduction of overall healthcare costs?
Evidence on cost-reduction are weak and non-definitive and they reveal that unmet needs can actually raise initial costs.
How has the focus of care shifted from the early 2000s to today?
Shift from single-disease management and care chains, to inter-organizational networks, population health management and prevention
Name the 2 cross-cutting connectivity dimension in Valentijn's framework that link the 3 levels of integrated care.
Functional integration, normative integration
Which of the 2 healthcare system types (Bismarck or Beveridge) is less favourable to integrated care, and why?
Bismarck because it involves many interdependent actors with competing interests.
How does the systematic review by Zonneveld et al. distinguish value from values?
Value refers to value-based healthcare, which measures patient health outcomes relative to costs, whereas values refer to beliefs, principles or standards of behaviour that impact action.
Shifting care out of acute hospitals into community setting will only produce actual system cost saving under which condition?
If hospital beds are physically closed.
The updated version of the Development Model for Integrated Care introduced 20 new elements grouped into 5 overarching accents. Name 3 of these 5 accents.
(1) service users and social networks, (2) proactive and preventive cross-domain care, (3) digitalisation and eHealth, (4) values and ethics, (5) ecosystem and multi-network governance
An integrated network establishes shared electronic health record platforms and joint financial management tools across primary and secondary care. Is this an example of clinical, functional or normative integration?
Functional integration
Why are financial incentives and payment mechanisms important for successful integrated care, and how can poorly aligned incentives create barriers to integration?
Financial incentives influence how healthcare organisations behave. If payment systems reward collaboration and coordination, organisations have an incentive to work together. If organisations are paid separately for their own services, they may focus on their own performance rather than the overall patient pathway. This can create competition, duplication and fragmented care.
According to Zonneveld et al., what are the 3 most frequently identified values in the literature of integrated care?
Collaborative, coordinated, transparent
Why does holistic assessment of complex patients thorugh integrated care often lead to an initial increase in service utilization and costs?
It uncovers previously hidden or unmet health needs that must now be treated