ⓘ Integrated care, also known as integrated health, coordinated care, comprehensive care, seamless care, or transmural care, is a worldwide trend in health care r ..

                                     

ⓘ Integrated care

Integrated care, also known as integrated health, coordinated care, comprehensive care, seamless care, or transmural care, is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems.

Integrated care covers a complex and comprehensive field, and there are many different approaches to and definitions of the concept. WHO gives the following definition: "Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency."

                                     

1. Central concepts

The integrated care literature distinguishes between different ways and degrees of working together and three central terms in this respect are autonomy, co-ordination, and integration. While autonomy refers to the one end of a continuum with least co-operation, integration the combination of parts into a working whole by overlapping services refers to the end with most co-operation and co-ordination the relation of parts to a point in between.

Distinction is also made between horizontal integration linking similar levels of care like multiprofessional teams and vertical integration.

Continuity of care is closely related to integrated care and emphasizes the patients perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided into three components:

  • continuity across the secondary-primary care interface discharge planning from specialist to generalist care, and
  • continuity of information by shared records,
  • provider continuity.

Integrated care seems particularly important to service provision to the elderly, as elderly patients often become chronically ill and subject to co-morbidities and so have a special need of continuous care.

The NHS Long Term Plan, and many other documents advocating integration, claim that it will produce reductions in costs or emergency admissions to hospital but there is no convincing evidence to support this.

                                     

2. Collaborative care

Collaborative care is a related healthcare philosophy and movement that has many names, models, and definitions that often includes the provision of mental-health, behavioral-health and substance-use services in primary care. Common derivatives of the name collaborative care include integrated care, primary care behavioral health, integrated primary care, and shared care.

The Agency for Healthcare Research and Quality AHRQ published an overview of many different models as well as research that supports them. These are the key features of collaborative care models:

  • Integration of mental health professionals in primary care medical settings
  • Close collaboration between mental health and medical/nursing providers
  • Focus on treating the whole person and whole family.

There are various national associations committed to collaborative care such as the Collaborative Family Healthcare Association.

                                     

2.1. Collaborative care Contrast to merging roles

The proper integrating of care does not mean the merging of roles. It remains uneconomical to make a physician serve as a nurse. Besides, the opposite approach is strictly prohibited by accreditation and certification schemes. The mix of staff for the various roles is maintained to enable a profitable integration in caring.

                                     

3. Examples

  • Essential for the implementation of the integrated care programme is a framework that guides the process. In Ireland, the Health Service Executive HSE is implementing an integrated care programme according to a 10-Step Framework. This Framework is created along the recommendation of the WHO.
  • The United States Department of Veterans Affairs is the largest integrated care delivery system in the US.
  • Kaiser Permanente and the Mayo Clinic are the two largest private systems in the US.