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A guide to physician integration models for sustainable success

Brief analytical summaries or syntheses #49 A guide to physician integration models for sustainable success Summary As health care delivery and financing shifts from a volume-based to a value-based business model, improved alignment between hospitals and physicians becomes essential. This guide, published by Health Research & Educational Trust, describes the prerequisites for successful hospital-physician integration and offers an overview of integration models currently used in American hospitals and health systems. Background This guide offers an overview of physician integration models currently deployed at hospitals and health systems. These models include a wide array of programs, covering customer service offerings, contractual ventures, joint venture/shared equity arrangements and employment/practice acquisition models. The legal, taxation and regulatory issues surrounding hospital-physician integration are complex and changing. Analysis and results As health care delivery and financing shifts from a volume-based to a value-based business model, provider success will be achieved through offering services with the…

Lunch hour conferences 2015

By Michel Perreault, psychologist-researcher, Douglas Mental Health University Institute, associate professor, Psychiatry Department, Université McGill Hélène Provencher, professor, Nursing Faculty, Université Laval, researcher, Groupe de recherche sur l'Inclusion sociale, l'Organisation des services et l'Évaluation en santé mentale (GRIOSE-SM), CSSS de la Vieille-Capitale This conference will address the added value question of the intervention focusing on the contribution of peer helpers in care and services network, particularly in the area of mental health. The major findings from two research projects supported by the MSSS will be presented, one about the peer helpers intervention to facilitate access to clinical treatment for people with anxiety disorders with the support group Phobies-Zéro and the other one addressing the peer helpers integration in teams of support in the community for people with severe mental disorders proposed by the “Peer Helpers Network Program” associated with the Association québécoise pour la réadaptation psychosociale. Peer helpers accompany researchers…

UK - Health and social care integration

Conducted by Britain’s Comptroller and Auditor General, this report looks at the ongoing integration of the UK’s previously separate adult social care and health systems and examines the extent to which integration has benefitted patients. The report discusses the case for integrating health and social care, the progress of national integration initiatives, and plans for increased integration in the future.

Europe - Service Integration across Sectors in Europe: Literature and Practice

This paper presents a preliminary review of service integration across sectors in Europe, between social services, health, employment and education. The review shows that integration may be either tailored to a particular target group or designed for communities in general. Systems to monitor integration are not yet adequately developed and further study is needed to understand the processes involved in cross-sector service integration.

Canada - The Establishment of Ontario's Local Health Integration Networks: A Conflation of Regionalization with Integration of Health Services

In 2006, the province of Ontario introduced health services regionalization with the establishment of Local Health Integration Networks (LHINs). While LHINs were designed to integrate services, this article argues that an implicit objective may have been to shift accountability away from the provincial government by increasing bureaucracy and limiting stakeholder input. To date, there has been no robust evaluation of the LHINs' impact on service integration.

Lunch hour conferences 2016

By Michel Perreault, psychologist-researcher, Douglas Mental Health University Institute, associate professor, Psychiatry Department, Université McGill Hélène Provencher, professor, Nursing Faculty, Université Laval, researcher, Groupe de recherche sur l'Inclusion sociale, l'Organisation des services et l'Évaluation en santé mentale (GRIOSE-SM), CSSS de la Vieille-Capitale This conference will address the added value question of the intervention focusing on the contribution of peer helpers in care and services network, particularly in the area of mental health. The major findings from two research projects supported by the MSSS will be presented, one about the peer helpers intervention to facilitate access to clinical treatment for people with anxiety disorders with the support group Phobies-Zéro and the other one addressing the peer helpers integration in teams of support in the community for people with severe mental disorders proposed by the “Peer Helpers Network Program” associated with the Association québécoise pour la réadaptation psychosociale. Peer helpers accompany researchers…

Canada - The Generation of Integration: The Early Experience of Implementing Bundled Care in Ontario, Canada

Integrated healthcare models bundle services and encourage interprofessional and organizational collaboration to counter fragmented healthcare delivery and rising system costs. In this study, authors interviewed program stakeholders to provide examples of integration strategies in six Ontario pilot programs, suggest contexts that lend themselves to integration initiatives, and explore the generation of integration through the dynamic interplay of contexts, mechanisms, structures and subjects.

UK — Integration in action: four international case studies

This report explores how to strengthen integration between services in order to improve health outcomes, patient experience of care and value for money from available resources. It describes work to improve integration in four international organisations: 1. a government-funded network to improve access to and quality of Medicaid services in North Carolina, United States (US) 2. an independent practice association in upstate New York, US 3. a Dutch organisation providing support to general practitioners (GPs) to deliver integrated care for diabetes and other chronic conditions, 4. a Scottish health and social care partnership.

Lunch hour conferences 2012

Why a good idea as the integration of services is taking so long to implement ? May 25, 2012 By Yves Couturier, holder of Canada Research Chair in Professional Integration Practices of Gerontology Services, Université de Sherbrooke Louis Demers, professor, École nationale de santé publique Francis Etheridge, doctoral student and organizational change specialist This conference will address the results of a study on the implementation status of Quebec’s project to integrate services in three health and social services centres and will allow to reflect on the conditions that affect the ability of institutions to fully achieve the outcomes of the reform. It will also present the opportunity to discuss a new research project aimed at better understanding the role of health and social services agencies in Quebec and health agencies in France in the context of services integration. Strategies for implementing quality indicators for primary care health service professionals and…

UK - Integration 2020: scoping research

Conducted by the Social Care Institute for Excellence (SCIE), this study examines the British government’s recent decision to integrate health and social services. It presents findings from a scoping research program to better understand what integrated health and social care should look like in 2020 and provides feedback and support for the further development of a national standard for integration.

Sweden - A decade of integration and collaboration: the development of integrated health care in Sweden 2000–2010

This article will explore the recent history of integrated health care in Sweden. Tracing the origins back to the 1990s, the focus will be on the develop¬ment of integration and collaboration in the Swedish health system during the first decade of the 2000s. In addition to the historical account, there will be some analytical reflections in connection with the dif¬ferent stages of the development. There will also be an analysis of the successes and setbacks with the wisdom of hindsight. Finally, some of the challenges of integrated health care for the next decade will be discussed.

UK - Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

An aging population, specialized clinical services, and diverse provider governance all make healthcare coordination difficult in the UK. This research paper examines how organizational integration impacts the coordination of primary care and concludes that integration seems more likely to develop continuity of care than networks that divide hospitals, general practices and community health services.

UK - Four nations united: critical learning from four different systems for the successful integration of social care and health services

This British paper summarizes discussions on best practices in the integration of social care and health care conducted by managers of Adult Social Services in England, Wales, Scotland and Northern Ireland. The paper lists four factors critical for successful service integration: a vision of benefit, flexible organizational arrangements, a realistic financial strategy, and effective leadership.

Lunch hour conferences 2014

By Jean-Pierre Ménard, lawyer Christine Lavoie Patricia Lavoie, Direction des affaires juridiques Ministère de la Santé et des Services sociaux Monique St-Pierre, Direction des services hospitaliers et des affaires universitaires Ministère de la Santé et des Services sociaux The Act respecting end-of-life care, adopted on June 10th 2014, is in line with the unanimous recommendations of the Select Committee on Dying with Dignity and is based on the values of solidarity, compassion and respect for individual wishes. This Act follows three objectives to frame palliative care, to allow medical aid in dying in certain special and exceptional situations, and to establish an advance medical directives regime. This conference will explain why this Act was created. Indeed, the Act respecting end-of-life care is part of a social and legal context. This environment is characterized by the medicine progress, but also by the state of practices (advance wishes, rights and obligations of…

Europe - Promoting better integration of health information systems: best practices and challenges

Produced by the WHO, this report addresses current trends in the 28 member states of the European Union (EU) around the integration of health information systems. To understand what better integration means from a pragmatic perspective, experts from 13 EU countries were interviewed and their views were combined with findings from a literature search.

China - The Luohu Model: A Template for Integrated Urban Healthcare Systems in China

In 2015, the southern city of Luohu introduced a new integrated care system that linked five hospitals with 23 community clinics and specialized medical institutions. China’s government has since encouraged other cities to emulate the highly successful Luohu model. This paper studies Luoho’s integration process, analyzes its core mechanisms, and evaluates the integration of policy development.

China - The Structure and Effectiveness of Health Systems: Exploring the Impact of System Integration in Rural China

Using questionnaires, interviews and health ¬insurance records, this paper employs social network analysis to evaluate health system integration in two rural counties in China’s Qinghai province. The paper finds that certain aspects of system integration remain incomplete in both counties, although information-sharing networks have been developed.

Denmark - Interorganisational Integration: Healthcare Professionals’ Perspectives on Barriers and Facilitators within the Danish Healthcare System

This study used seven focus groups to explore barriers and facilitators in inter-organizational healthcare integration as perceived by healthcare professionals caring for patients with chronic obstructive pulmonary disease within the Danish healthcare system. The barriers and facilitators they identified relate to clinical, professional, functional and normative integration.

International - Indicators and Measurement Tools for Health Systems Integration: A Knowledge Synthesis

Conducted by Brazilian and western Canadian researchers, this knowledge synthesis identifies indicator domains and tools to measure progress towards integrated care. Establishing measurement domains, the researchers reviewed 7,133 studies and identified 114 tools to measure the integration of care across 16 domains. Few tools were found in the domains of performance measurement, information systems, organizational goal alignment and resource allocation.

UK - Improving Outcomes through Transformational Health and Social Care Integration – The Scottish Experience

Scotland's Parliament recently passed legislation to integrate aspects of health and social care in order to improve care quality and outcomes for people with multiple complex needs. Developing a national framework to accelerate progress in care integration, the legislation also provides for tailored local supports and services delivered in partnership with area housing, community, and voluntary sectors.

USA - A Guide to Physician Integration Models for Sustainable Success

As healthcare delivery and financing shifts from a volume-based to value-based business model, improved alignment between hospitals and physicians will be essential. This guide published by the Health Research & Educational Trust describes requirements for successful hospital-physician integration, and offers an overview of models currently being used in US health systems.

Europe - Special Collection. Project INTEGRATE: Lessons for Policy, Management and Implementation of Integrated Care in Europe

Project INTEGRATE was a 2012-2016 research project investigating the leadership, management and delivery of integrated care in Europe. This collection provides some of the papers published by researchers involved, and focuses on work undertaken in the project’s final phases that examined factors in integrated care design, management, and policy. It includes case studies of care integration in four countries.

UK - Organisational culture and post-merger integration in an academic health centre: a mixed-methods study

Studies show that mergers between healthcare providers are complex, especially if an academic institution is involved. This paper surveyed 72 health professionals to examine organizational culture at two merged local providers, one of which is a former university hospital network. The authors found that integration produced continuing culture clashes on issues concerning service-delivery models, clinical services and finances.

UK - NHS England launches frameworks to increase integration of health and care services and improve the lives of care home residents

The National Health Service (NHS) in England has published details of two frameworks for local health and care systems wishing to extend service integration and improve conditions for care home residents. The frameworks include strategies to strengthen primary care, increase access, improve long-term care and control costs.

UK - Efficiency opportunities through health and social care integration: delivering more sustainable health and care

The Local Government Association (LGA) released this report, which calls for a revamped health and care system based on local priorities that can achieve better outcomes with less money. It describes improvements that can be made by providing locally integrated health and social care and accentuating preventive services. It projects efficiency savings of 7-10% as a result of service consolidation and care integration.

Europe - Mental Health and Integration. Provision for Supporting People With Mental Illness: A Comparison Of 30 European Countries

Intelligence Unit (EIU) created this Mental Health Integration Index comparing mental health services and treatment in 30 European countries. It considers medical service provision, human rights, stigma, quality of life, housing and employment, along with other factors. The index is accompanied by interviews with experts and a literature review.

UK - GPs and social workers: partners for better care

In Britain, many voices are urging the integration of the health and social care systems because of unsustainable costs and funding levels. This report by the Royal College of General Practitioners (RCGP) and The College of Social Work (TCSW) calls for immediate health and social care integration. It includes case studies of existing multidisciplinary physician-social worker teams to show how implementation might work.

USA - Primary Care and Public Health: Exploring Integration to Improve Population Health

This book from the Institute of Medicine (IOM) identifies the best US examples of effective public health and primary care integration. It discusses how primary care systems and public health departments can integrate and coordinate disease prevention efforts.

Canada - Better Healthcare for Albertans

Produced by Alberta's Auditor General, this analysis of Alberta Health Service (AHS) primary care networks and chronic disease management notes barriers to better care resulting from: the health system's fragmented structure, the poor integration of physician services, inadequate sharing and use of clinical information. The analysis calls for further service integration and provides examples of integrated care from Canada's other provinces.

Canada - Providers’ Perspectives on the Implementation of Mandated Local Health Networks for Older People in Québec

The aim of this article is to understand provider perspectives on how and why integrated care for older people has been implemented in different contexts. It looks at three cases in Québec and finds that providers regard government policy and mergers as highly influential in the implementation of organizational integration, but that this occurs to the detriment of clinical integration.

UK - Financial integration across health & social care: evidence review

The Integrated Resource Framework (IRF) has been developed in Scotland jointly by the Scottish Government, NHS Scotland and the Convention of Scottish Local Authorities (COSLA), to help facilitate greater integration of services and re-alignment of resources to improve patient outcomes. This review of empirical studies of IRMs identified several factors critical for the success of the Integrated Resource Framework (IRF). It also highlighted methodological challenges that provide lessons for evaluating the IRF.

Telehealth : what can the NHS learn from experience at the U.S. Veterans Health Administration?

Brief analytical summaries or syntheses #35 Telehealth what can the NHS learn from experience at the U.S. Veterans Health Administration? Summary Published on the website, this comparative study examines the largest implementation of telehealth anywhere, the Veterans Health Administration in the U.S. With the British government's announcement of the positive results of the Whole System Demonstrators and the launch of the 3 Million Lives Programme, this report is timely as U.K. stakeholders plan how to implement telehealth widely and deliver significant benefits. Background As a large publicly funded system delivering comprehensive services to a veteran population of 23m and with an annual budget of over £30bn, the VHA has many parallels with the NHS. Extensive studies show that the VHA consistently provides a better quality of care than other health systems in the U.S., and at a lower cost. Central to its strategy of ‘keeping patients healthy’, the VHA…

UK - Clinical and service integration. The route to improved outcomes

This report summarises relevant evidence about high-profile integrated systems in the United States, such as Kaiser Permanente and Geisinger Health System and outlines examples of integrated care in North America and Europe. It also explores the range of approaches to improving co-ordination for individual patients and carers. The report focuses on examples that are most relevant to the NHS in England in the context of the coalition government's programme. The authors of the study hope that it will help inform the future direction of reform.

Canada - Fostering development of nursing practices to support integrated care when implementing integrated care pathways: what levers to use?

The role of nurses in care integration is a particular focus of health system reform. In this study at a Québec health and social services centre (HSSC), researchers interviewed 37 nurses and managers to identify strategies that support nursing practices aligned with care integration requirements. Findings suggest that clinical and organizational processes should be reconceived along with organizational resources and structures.

Germany - The Health Care Strengthening Act: The next level of integrated care in Germany

Although Germany has traditionally followed a decentralized approach to healthcare services, the government has now introduced legislation to foster the integration of healthcare services. This article describes the change in policy and the annual innovation fund of €300 million ($440 million Cdn) that has been established to start up integrated care programs.

Australia - Practical innovation: Closing the social infrastructure gap in health and ageing

This report from PriceWaterhouseCoopers (PWC) argues that Australia needs a health system model focused on wellbeing as much as illness and a more integrated, preventive and outcomes-focused approach to health care. The report identifies approaches to transform the current health system, improve integration, and implement a facility to fund and support new healthcare partnerships and collaborations.

UK - Horizontal or Vertical: Which way to integrate? Approaches to community services integration and consequences for emergency hospital activity. A case study based on the Transforming Community Services Policy

In 2010, the UK government’s Transforming Community Services Policy required a complete break between policy/funding and provider functions in emergency hospitals. Eight years later, this case study explores the impact this choice had on the use of emergency hospital by older Britons and considers the wider implications for the National Health Service (NHS) as it develops new models of care and integrated care systems.

New Zealand - Primary Care Working Group on General Practice Sustainability. Report to the Minister of Health

In 2013, New Zealand’s Ministry of Health established a Primary Care Working Group to provide guidance on primary care funding, sustainability, and workforce arrangements. This report by the Working Group makes 19 recommendations for high needs groups, co-payment targeting, primary care workforce sustainability and service integration.

UK - Stepping up to the place: the key to successful health and care integration

Four UK organizations — the Association of Directors of Adult Social Services, Local Government Association, NHS Clinical Commissioners and NHS Confederation — came together on this report to call for an acceleration of efforts to integrate health and social care. The principle needs to be tested and evaluated by partners across the services spectrum.

Canada - One province, one healthcare system: A decade of healthcare transformation in Alberta

Nearly a decade has passed since Alberta folded nine regional health authorities and three government agencies into one province-wide health system, Alberta Health Services (AHS). This article highlights specific examples of how AHS is strengthening partnerships, standardizing best practices, and driving innovation. It also shows how province-wide integration is being leveraged to change workplace culture, enhance patient safety and find operational efficiencies.

Canada - Measuring Up. A yearly report on how Ontario’s health system is performing

Measuring Up uses the Common Quality Agenda, a set of indicators developed with experts across the province, to see how the quality of care is changing in Ontario — how each local health integration network (LHIN) region is performing, and how the province compares with the rest of Canada and other countries. The report shows that over the past four to 10 years, 13 key performance indicators demonstrate improvement, 20 indicators show no change and two have deteriorated.

International - International profiles of health care systems 2015

This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations.

Denmark - Implementing Integrated Care - Lessons from the Odense Integrated Care Trial

Creating coordination between healthcare sectors is a challenge, and decision makers often replicate models across countries and settings. An example of this is the translation of a London, UK integrated care pilot into a large-scale trial that took place in the Danish city of Odense from 2013-2016, where it produced poor results. This article highlights findings from an evaluation of the project and discusses lessons learned.

Canada - Aligning Outcomes and Spending. Canadian Experiences with Value-Based Healthcare

Value-based healthcare (VBHC) is a delivery model in which provider financing and budgets are based on patient health outcomes instead of the volume of services, processes, and products. This briefing reviews surveys, case studies and the scientific literature to explore the application of VBHC in health care across Canada. It focuses on the use of VBHC in new care models, innovative digital technology, and care integration.

International - A New Resource for Exploring Health Care around the World

This website presents profiles of healthcare systems in 18 countries in Europe, North America, and Asia, along with Australia. Readers can compare health system organization and insurance, financing, quality, coordination, efficiency, integration, information technology use, evidence-based practice, cost containment and recent reforms and innovations.

International - The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care

Presenting a review of the literature on care integration design, this research explores prerequisites to successful implementation across different international contexts. The study analyses 710 prior studies and focuses on chronic conditions (COPD, diabetes, and geriatric and mental health conditions), identifies core dimensions of integrated care and distinguishes 175 elements and factors associated with successful implementation.

USA - NIH releases strategic plan for data science

The National Institutes of Health (NIH) released its first strategic plan for data science as it seeks to upgrade the storage, management, and standardization of data produced by NIH-funded biomedical data scientists. The strategy will address the interoperability, integration and increasing cost of data management, and introduce a new position of NIH Chief Data Strategist.

Australia - Translating the Elements of Health Governance for Integrated Care from Theory to Practice: A Case Study Approach

This Australian case study developed a health governance model for integrated care based on 10 elements linked to healthcare integration. Authors then interviewed participants who held senior governance roles to see if the model’s principles were applicable or already being applied. While all participants agreed the 10 elements were essential to integrated care, most elements were not currently in use.

Europe - Tools and Methodologies for Assessing the Performance of Primary Care

Assembled by an expert panel convened by the European Union, this report on tools and methodologies for assessing primary care performance identifies 10 main organizational domains in primary care, including care coordination and integration, and proposes indicators that could be used for comparative assessment. Procedural steps required for establishment of a performance assessment system are explored, and recent experiences from European countries are considered.

Europe - The Europeanization of Health Care Coverage Decisions. EU-Regulation, Policy Learning and Cooperation in Decision-Making

This German paper presents two cases of Europeanization in health policy, traditionally controlled by national governments and unaffected by European integration. The first case deals with how European Union (EU) transparency directives have forced member states to establish formal healthcare coverage decision-making procedures. The second case looks at health technology assessment and how the EU has successfully promoted the field.

Ireland - National Cancer Strategy 2017 -2026

Following significant progress over the last 10 years, Ireland is determined to make further strides in cancer control such that survival rates reach the top quartile of European countries by 2026. Prevention is a cornerstone, along with integration across primary, acute and social care with enhanced leadership from the National Cancer Control Programme. The strategy describes measures intended to reduce the cancer burden, provide optimal care, and maximize patient involvement and quality of life.

International - Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review

Authored by a German academic, this systematic literature review of 40 studies analyzes barriers to integrated care in inter-organizational settings. The review identifies 20 types of barriers, which are categorized into six groups: administration and regulation, funding, intra-organizational and inter-organizational domains, service delivery, and clinical practices. The review notes that some barriers are set up intentionally.

Canada - Challenge Ahead: Integrating robotics, artificial intelligence and 3D printing technologies into Canada’s healthcare systems

This parliamentary committee report looks at the integration of robotics, artificial intelligence (AI), and 3D printing technologies in Canada’s healthcare system. It lauds the potential for quicker diagnoses and reduced costs, but warns of radical changes to the current delivery of health care, along with ethical and privacy concerns. The report contains 14 recommendations focusing on healthcare delivery, workplace adjustments, and regulatory oversight.

Lunch hour conferences 2017

PPT_-_Stratégies_motivation_2017-02-02.pdf [b][i]Motivational and communication strategies to promote healthy behaviors February 2nd, 2017 Motivation-MSSS-02_02_2017-pdf.jpg By Michel Perreault, psychologist-researcher, Douglas Mental Health University Institute, associate professor, Psychiatry Department, Université McGill Hélène Provencher, professor, Nursing Faculty, Université Laval, researcher, Groupe de recherche sur l'Inclusion sociale, l'Organisation des services et l'Évaluation en santé mentale (GRIOSE-SM), CSSS de la Vieille-Capitale This conference will address the added value question of the intervention focusing on the contribution of peer helpers in care and services network, particularly in the area of mental health. The major findings from two research projects supported by the MSSS will be presented, one about the peer helpers intervention to facilitate access to clinical treatment for people with anxiety disorders with the support group Phobies-Zéro and the other one addressing the peer helpers integration in teams of support in the community for people with severe mental disorders proposed by the “Peer Helpers Network Program”…

Canada - Nurse Practitioners Propose New Primary Health Care Model for B.C.

The BC Nurse Practitioner Association (BCNPA) has released a comprehensive plan to more fully integrate nurse practitioners (NPs) into the provincial healthcare system. The plan proposes two distinct funding paradigms, illustrated by case studies, to guide the integration of NPs within a new primary care model for British Columbia.

UK - Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme

This article presents learning from a UK-based improvement program that moves hospital diagnostic and treatment services into the community. It focuses on program components such as per capita funding mechanisms, monthly learning sessions between advanced programs, and formative evaluations. The program demonstrates that transformation of primary care requires careful redesign, changes in clinician and provider paradigms, and deployment of relevant infrastructure improvement methodologies.

Europe - Organization and financing of public health services in Europe: country reports (2018)

Describing the public health services of nine European countries, this study explores organization and financing along with training and workforce concerns. Covering England, France, Germany, Italy, the Netherlands, Slovenia, Sweden, Poland and Moldova, the study illustrates two different approaches to public health services: integration with curative health services (as in Slovenia or Sweden), or organization and provision through a separate parallel structure (Moldova and Poland).

UK - Saving STPs: achieving meaningful health and social care reform

This report, from the think tank Reform, looks at the progress of sustainability and transformation plans (STPs) in England. They have been developed in 44 jurisdictions to break down barriers between different levels of health and social service on a local basis. Interviews with experts across the system reveal some progress, especially in places that already had integration efforts in place, and raise issues that contribute to difficulties.

UK - The effects of integrated care: a systematic review of UK and international evidence

This review of 167 prior studies examined the effects of health services integration on delivery outcomes. There was evidence of improved quality of care, patient satisfaction, and access to care. Overall, the literature was limited when it came to consideration of the effects on service users.

Australia - Coordinating Mental and Physical Health Care in Rural Australia: An Integrated Model for Primary Care Settings

Based on staff interviews at a small town clinic providing primary healthcare to people using community mental health services, this article examines factors driving successful primary care integration in rural settings. It finds that the necessary processes and structures (including a booking system and team-based approach) evolved locally from supportive professional and organizational relationships. Strong collaborative relationships also led to the upskilling of local staff.

International - International Profiles of Health Care Systems, 2014

This publication presents overviews of the healthcare systems of Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the US. Each overview covers insurance, financing, organization, care quality, cost containment, efficiency and integration, and use of information technology and evidence-based practice. Data is provided on key health system characteristics and performance indicators.

Europe – Is migration the solution to staff shortages in the health care sector?

La migration : la solution aux pénuries de personnel dans le secteur des soins et de la santé ? The King Baudouin Foundation seeks to develop a clear framework on migration and integration in Belgium. This report discusses, in particular, the international recruitment of health workers to meet the growing needs in this sector. The report looks closely at the phenomenon of foreign-born health care workers, identifies how many are currently in Belgium, their country of origin, how they arrived at their jobs, and the impact of their departure on their country of origin.

Canada - Canadian Primary Healthcare Policy: The Evolving Status of Reform

This report from the Canadian Health Services Research Foundation (CHSRF) provides an update on the current status of primary health care policy and reform across Canada. Much work has been undertaken since the late 1990s in the context of service integration and health system reform, but there is some impatience with the slow pace of change. This study was undertaken to allow decision-makers to better understand the current picture, consider the legitimacy of significant recent primary health care investments and showcase and promote positive change and progress. It also enables scrutiny of what might not be working in Canadian primary health care today.

UK - Competition, integration and incentives: the quest for efficiency in the English NHS

Recent government health reforms in England have paved the way for a significant extension of market mechanisms in health care. Published in December 2011, the second issue of Nuffield Trust Viewpoints looks at new forms of care provision that stand to benefit British patients and taxpayers. The report examines areas where competition might improve quality and efficiency.

A review of telehealth in Scotland

Brief analytical summaries or syntheses #30 A review of telehealth in Scotland Summary This government review, prepared for Scotland’s Auditor General, focuses on National Health Service (NHS) telehealth initiatives that deliver care to patients. It determines that, targeted appropriately, telehealth has the potential to help NHS boards deliver clinical services more efficiently and effectively. Background The use of technology in the NHS has the potential to improve the quality, delivery and efficiency of healthcare services. Telehealth is the provision of healthcare to patients at a distance using a range of technologies, such as mobile phones, internet services, digital televisions, video-conferencing and self-monitoring equipment. Telehealth can offer a number of potential benefits to patients and NHS boards, such as reducing the need to travel to outpatient clinics, providing a quicker diagnosis, and avoiding referrals to hospital for diagnosis or treatment. It also has the potential to help NHS boards deliver clinical…

International Profiles of Health Care Systems

Brief analytical summaries or syntheses #32 International Profiles of Health Care Systems Summary This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.S. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views. Background The Commonwealth Fund is a private foundation that promotes a high performance health care system providing better access, improved quality, and greater efficiency. The Fund carries out…

Australia - The Australian Experiment: How Primary Health Care Organizations Supported the Evolution of a Primary Health Care System

Australian primary health care has undergone 20 years of change since the establishment of local Divisions of General Practice. This article from the Journal of the American Board of Family Medicine (JABFM) identifies how these organizations have helped the primary care system evolve by supporting national practice accreditation, quality improvement, regional integration, IT adoption, and improved access to care.

Canada - Mergers and integrated care: the Quebec experience

This study, published in the International Journal of Integrated Care, examines mergers undertaken in Quebec in the name of promoting system integration. The authors review studies on mergers and integrated care projects in the Quebec healthcare system, and show that mergers cannot facilitate integrated care unless they are desired and represent for all of the actors involved an appropriate way to deal with service organisation problems.

Health policy responses to the financial crisis in Europe

Brief analytical summaries or syntheses #47 Health policy responses to the financial crisis in Europe Summary This August 2012 report by the Health Evidence Network (HEN) identifies key challenges for European health policy makers in the wake of the ongoing financial crisis. The report focuses on responses to essential service cuts and interruptions in revenue streams, as well as on inefficiencies and exacerbations of adverse effects evident in national health systems. Background The global financial crisis that began in 2007 can be classified as a health system shock – that is, an unexpected occurrence originating outside the health system that has a large negative effect on the availability of health system resources or a large positive effect on the demand for health services. Economic shocks present policy-makers with three main challenges Health systems require predictable sources of revenue with which to plan investment, determine budgets and purchase goods and services.…

UK - All together now: competitive integration in the NHS

Britain’s National Health Service (NHS) is comprised of many autonomous organizations. This report from Policy Exchange proposes reintegrating the NHS, beginning with a program of integrated care organisations (ICOs) to drive system-wide efficiency and exert competitive pressure. ICOs would bring together primary, community and acute services with a single budget for purchase and provision.

Time for Transformative Change: A review of 2004 Health Accord

Brief analytical summaries or syntheses #40 Time for Transformative Change A review of 2004 Health Accord Summary Canada is no longer seen as a model of innovation in health care delivery and financing, says this report from the Standing Senate Committee on Social Affairs, Science and Technology. The committee’s review revealed that real systematic transformation of health care systems across the country had not yet occurred, despite more than a decade of government commitments and increasing investments. The committee made 46 recommendations it believes will truly transform the way health care professionals do business and will achieve lasting reform. Background On January 31, 2011, the Minister of Health requested that the Standing Senate Committee on Social Affairs, Science and Technology initiate the second parliamentary review of the 10-Year Plan to Strengthen Health Care (10-Year Plan), an agreement reached by First Ministers on September 16, 2004 that focuses on federal/provincial/territorial (F/P/T)…

Canada - Integrated Health Care: The Importance of Measuring Patient Experience and Outcomes

This Conference Board of Canada report reviews the literature on evaluation and measurement efforts being undertaken in Canada and abroad, and focuses in on three Canadian examples of integrated health care systems for a more detailed exploration. The briefing concludes with four recommendations on actions health leaders can take to improve the measurement and evaluation of health system integration.

International - International profiles of health care systems

This publication from the Commonwealth Fund presents overviews of health care systems in nine European countries, Japan, Australia, Canada, and the U.S. Each overview covers insurance, financing, organization, quality of care, health disparities, efficiency and integration, information technology usage, use of evidence-based practice, cost containment, and reform and innovation. Summary tables provide data on key characteristics and performance indicators.

Governance for health in the 21st century : a study conducted for the WHO Regional Office for Europe

Brief analytical summaries or syntheses #27 Governance for health in the 21st century a study conducted for the WHO Regional Office for Europe Summary The WHO Regional Office for Europe recently presented conclusions from an in-depth study of current thinking and innovative practices in governance for health in the 21st century. The study recommends different ways that public authorities can strengthen health governance through collaboration. Background In this study, ‘governance for health’ is defined as the attempts of governments or other actors to steer communities, countries or groups of countries in the pursuit of health as integral to well-being through both a ‘whole-of-government’ and a ‘whole-of-society’ approach. It positions health and well-being as key features of what constitutes a successful society and a vibrant economy in the 21st century and grounds policies and approaches in values such as human rights and equity. Governance for health promotes joint action of health…

Canada - McGuinty Government Proposes New Rules, Higher Standards for Broader Public Sector

Ontario is proposing strict new rules that would prevent organizations funded with taxpayer dollars from using public funds to hire external lobbyists to ask for more funding. The proposed Broader Public Sector Accountability Act would, if passed, bring in new rules and higher accountability standards for hospitals, Local Health Integration Networks (LHINs) and the broader public sector around the use of external lobbyists, consultants and expenses. Hospital and LHIN executives could see reductions in pay, should they fail to comply with the requirements under the proposed Act. In addition to ending the use of taxpayer dollars to hire lobbyists, the new rules would: 1. Expand Freedom of Information legislation to cover hospitals, 2. Require hospitals and LHINs to post expenses of senior executives online, 3. Require hospitals and LHINs to report annually on their use of consultants.

UK - Where next for integrated care organisations in the English NHS?

Lord Darzi’s NHS Next Stage Review introduced the concept of integrated care organisations (ICOs), various models of which are now being piloted across England as a way of exploring whether better coordination can reduce utilisation and ultimately healthcare costs. This report, published jointly by The Nuffield Trust and The King’s Fund, examines some of these new models and their potential for delivering better outcomes at lower cost.

Italy - EU integration and health systems: challenges and opportunities for patients, professionals and policy-makers

The Observatory Venice Summer School brings together high-level policy-makers in a stimulating environment. Organized by the European Observatory on Health Systems and Policies and one of its partners, the Veneto Region of Italy. it draws on their experiences of promoting evidence-based policy-making and of providing a unique platform for European health policy debate in action. The Summer School will take place in Venice on July 25-31, 2010.

Republic of Korea: Health system review. Health Systems in Transition, 2009

This paper produced by the European Observatory on Health Systems and Policies focuses on major health care reforms carried out in the last (ten)10 years. These include the integration of existing health insurance funds into a single insurer system in 2000 and the incremental expansion of the benefit package.

Australia - Implementing Health in All Policies: Adelaide 2010

The concepts, examples and practical experiences documented in this volume provide essential learning for moving towards a clearer conceptual framework for Health in All Policies. National and sub-national country case studies shed light on how nations as diverse as Australia, Canada, Finland, France, Norway and Thailand are incrementally working towards better policy integration and governance for social wellbeing and equity.

International – International Journal of Integrated Care. Vol 11, Special 10th Anniversary Edition

In celebration of IJIC's 10th anniversary, the articles in this special edition examine the experiences, evidence and lessons from different countries (Switzerland, Sweden, England, Quebec) in the integration of care over the past decade.

Europe — Health Systems Governance in Europe: The Role of EU Law and Policy

The study looks into different areas of EU policy and law-making that have an impact on national healthcare systems. It provides policy-makers with a compelling and rigorous analysis of the real and potential impacts of EU integration on the organisation of healthcare provision and the protection of public health, highlighting the need to balance economic and social imperatives.

Reforming health sector resource allocation and financing in Ireland

Brief analytical summaries or syntheses #4 Reforming health sector resource allocation and financing in Ireland Summary This report from the Expert Group on Resource Allocation and Financing in the Health Sector examines how the health system can be changed to support core objectives of the health reform program. The report presents 34 recommendations grouped under seven guiding principles. Background Like most other developed countries, Ireland is grappling with the challenges of providing health care for it's population at a cost it can afford. This report shows how these challenges are set in a context of a growing and aging population; rising individual expectations in relation to healthcare provision; rising incidence of chronic disease; greater provision of first-line care in the community; the need for people to be involved in the management of their own health alongside health professionals. The response to these issues across developed countries has been to develop…

The impact of global processes on health systems in Europe

Brief analytical summaries or syntheses #11 The impact of global processes on health systems in Europe Summary The relationship between globalization and health systems is a complex one, where both positive and negative influences are reported. This unsystematic literature review explores the impact of globalization on European health systems and emphasizes the need for national policy-makers and leaders to consider global processes when designing national health systems. Background The world is changing rapidly with increasing life expectancies and improving child survival rates. Globalization has contributed to economic growth. In addition to global economic integration, globalization entails the mobility of capital, goods, services and labour, and can be said to be part of an ideological process justifying neo-liberal economic policies. Globalization is also a dynamic process of global interconnectedness influenced by a number of driving and constraining forces such as technological developments, political influences, economic pressures, changing ideas, and greater awareness…

International - A systematic approach to the planning, implementation, monitoring, and evaluation of integrated health services

Published by BMC Health Services Research, this study develops a systematic country-specific approach to the development of integrated health services. It applies principles from existing monitoring and evaluation frameworks to country-specific health challenges, which integration is meant to improve, and includes recommendations about improvements to health information systems and data usage.

UK - Delivering The Better Care Fund In Counties

This report by the County Councils Network (CCN), a UK body of 37 county local governments, summarizes a recent survey of member counties on the delivery of better social and health care. The report also contains case studies of eight counties’ experience with health and social care integration.

UK - Care Bill becomes Care Act 2014

Britain’s Parliament has passed the 2014 Care Act creating a single care and support framework built on user wellbeing, quality and safety reform, and service integration. The legislation imposes limits on care costs, introduces new rights for caregivers, and establishes an eligibility threshold for care.

USA - Do Integrated Health Care Systems Provide Lower-Cost, Higher-Quality Care?

Obamacare has introduced accountable care organizations (ACOs) based on integrated delivery system (IDS) models as a way to reduce costs and improve care through better service integration. This article analyzes the costs and quality of care provided by 52 Midwestern ACOs using IDS practices. Results show important variations in the costs of care provided by different medical groups serving local communities.

Belgium - Stakeholders' perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms

This study examines stakeholder perceptions on the organization of chronic care in Belgium. The lack of care integration was identified as a major weakness, along with the unclear roles and functions of health professionals throughout the care process. Patient education measures to support self-management were also found to be insufficient.

Canada - Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

Poorly defined roles can reduce the effectiveness of clinical teams. This paper outlines effective processes for introducing the role of primary healthcare nurse practitioners (PHCNPs) to clinical teams. Data collection included 34 interviews with informants involved in PHCNP implementation. The paper concludes that role clarification is both an organizational process and a key primary care team member competency.

Australia - New Primary Health Networks to deliver better local care

Australia’s local frontline health services are being reorganized into new Primary Health Networks (PHNs) that begin operations on July 1, 2015. Administered by subcontracted provider organizations, the 31 PHNs will replace the existing Medicare Local system of 61 regions and work with Australian state Local Hospital Networks (LHNs) to ensure better outcomes and service integration.

USA - Case studies in emergency medicine: Integrating care for the acutely ill and injured

The Brookings Institute offers this look at ways to improve emergency medicine in the US. While the authors find that the acute care itself is excellent, patient education and care coordination are not reimbursed and this works to the detriment of integration, follow-up and post-discharge services. Case studies highlight successful care models in emergency medicine developed for a May 2015 event by medical and health policy experts.

UK - Putting patients in charge: the future of health and social care

Although recent reforms have integrated aspects of the British health and social care systems, this report calls for the complete integration of the two systems. It argues this is the only way to ensure patient-centred care and care continuity, and make overall funding fairer and more sustainable. Most people in the UK cover their own social care costs.

Working Together for Health: Achievements and Challenges in the Kaiser NHS Beacon Sites Program

A comparison of the NHS and Kaiser Permanente published in the British Medical Journal in 2002 has stimulated a pilot program to adapt the experience of Kaiser in three areas of England. These three areas – Birmingham and Solihull, Northumbria and Torbay – have drawn on the work of Kaiser Permanente in various ways, including improving care for people with long-term conditions, achieving closer integration of primary and secondary care and health and social care, and strengthening the role of clinical leaders. There has been continuing progress since the last report in 2006 on the work in these three areas and many examples of innovation.

Canada - Innovative practices from coast to coast to coast now fully integrated in the Leading Practices Database at Accreditation Canada

On February 17, 2014, Accreditation Canada completed the integration of the contents of the Health Innovation Portal (developed and launched by the Health Council of Canada 2012) with its own Leading Practices Database. The Database features more than 900 innovative practices submitted from health care organizations across Canada.

UK - Networks That Work: Partnerships for integrated care and services

This report from NESTA looks at how different sectors can collaborate to create services and pathways that meet the holistic needs of patients. Case studies detail how networks can support the integration of care and services in different ways, including purchasing services together, providing services together and delivering services together.

International - Series of five papers on integrated primary health care

In this this policy issue review, the Primary Health Care Research and Information Service examine policies that have an impact on the integration of care at the macro, meso and micro levels.

USA - Federal and State Policy to Promote the Integration of Primary Care and Community Resources

This document from the National Academy for State Health Policy in the US presents key themes that emerged from a consultation held with state and federal officials on potential measures each level of government could take to promote linkages between primary care and community services.

UK - Integrated care in Northern Ireland, Scotland and Wales: lessons for England

The aim of this King’s Fund report is to describe the approach taken to integrated care in Northern Ireland, Scotland and Wales with a view to drawing out the lessons for England as it seeks closer integration of care within the National Health Service (NHS) and between health and social care. Authors from each of the three countries contributed papers to the report.

Canada - Report on Ontario’s Cancer System Highlights Need for Better Integration for Patient Care

The Cancer Quality Council of Ontario finds that Ontarians receive some of the best cancer care in the world. More needs to be done, however, to integrate the individual pieces of the cancer system and the overall health system to improve the patient experience.

France – A global national healthcare reform strategy. 19 recommendations from a committee of wise men

Nineteen experts in health and social services in France collaborated to produce this report. They call for a rethinking of the system’s organization as a whole to bring services closer to users, including patients and people experiencing loss of autonomy. Their 19 recommendations cover areas ranging from health promotion to the training of professionals to the development of tools to promote integration and information sharing.

International - International Profiles of Health Care Systems, 2013

This publication presents overviews of health systems in Australia, Canada, Denmark, Great Britain, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the US. Each overview covers health insurance, public and private financing, system organization and governance, healthcare quality and coordination, efficiency and integration, information technology use and evidence-based practice, cost containment, and recent reforms and innovations.

International - A governance model for integrated primary/secondary care for the health-reforming first world - results of a systematic review

Internationally, key healthcare reform elements rely on improved integration of care between primary and secondary sectors. This systematic review synthesized 21 studies on elements of integrated primary/secondary healthcare. Elements included: joint planning; integrated information technology; shared clinical priorities; incentives; innovation; population focus; professional development; and patient and community engagement.

Canada - Non-Profit Community-Based Specialty Clinics in Ontario

Ontario is establishing new community-based specialty clinics offering select OHIP-insured, low-risk routine procedures. These clinics will focus on providing high volume services, such as cataract and colonoscopy procedures that do not require an overnight hospital stay. Moving low-risk routine procedures from hospitals to community specialty clinics will help improve the overall patient experience while resulting in better value for taxpayers. Specialty clinics will work closely with Local Health Integration Networks (LHINs) and hospitals and operate under existing legislation and quality assurance frameworks to ensure oversight and accountability.

Canada - Unleashing Innovation: Excellent Healthcare for Canada Report of the Advisory Panel on Healthcare Innovation

This panel, chaired by Dr. David Naylor for Health Canada, undertook wide-ranging consultations and commissioned research in order to identify the five most promising areas for innovation in Canadian healthcare to be acted upon by the federal government. Top among them is patient engagement and empowerment, with system integration, technological transformation, better procurement and regulation also found to be key to breaking the gridlock. The report examines how federal institutions can be restructured to support the spread of innovative practices.