Integrated care

Integrated care – also known as coordinated care, comprehensive care, seamless care and 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.^[1][2][3]

Integrated care covers a complex and comprehensive field and there are many different approaches to and definitions of the concept.^[1] 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.^[2]

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.^[2]

Distinction is also made between horizontal integration (linking similar levels of care, e.g. multiprofessional teams) and vertical integration (linking different levels of care, e.g. primary, secondary and tertiary care).^[2]

The concept of continuity of care is closely related to integrated care; it emphasizes the patient’s perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided in 3 components: 1. Continuity of information (though shared records), 2. Continuity across the secondary-primary care interface (discharge planning from specialist to generalist care), 3. Provider continuity (seeing the same professional each time with value added if there is a therapeutic, trusting relationship).^[2]

The concept of integrated care seems particularly important to service provision to the elderly, as elderly patients often are chronically ill and subjects to co-morbidities and thus in special need of continuous care.^[3]

Examples

• The United States Department of Veterans Affairs is the largest integrated care delivery system in the U.S.^[4]
• Kaiser Permanente and the Mayo Clinic are the two largest private U.S. systems^[5]

See also

• Case management (disambiguation)
• Shared care
• Team nursing

References

1. ^ ^{a b} Kodner, DL & Spreeuwenberg, C (2002): Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care, Vol. 2, 14. Nov. 2002
2. ^ ^{a b c d e} Gröne, O & Garcia-Barbero, M (2002): Trends in Integrated Care – Reflections on Conceptual Issues. World Health Organization, Copenhagen, 2002, EUR/02/5037864
3. ^ ^{a b} Kai Leichsenring (September 2004). "Developing integrated health and social care services for older persons in Europe". International Journal of Integrated Care 4: e10. PMC 1393267. PMID 16773149. http://www.ijic.org/index.php/ijic/article/viewFile/107/214. 
4. ^ Amal N. Trivedi & Regina C. Grebla (June 2011). "Quality and equity of care in the Veterans Affairs health-care system and in Medicare Advantage health plans". Medical Care 49 (6): 560–568. doi:10.1097/MLR.0b013e31820fb0f6. PMID 21422951. 
5. ^ Lawrence, David (2005). Building a Better Delivery System: A New Engineering/Health Care Partnership — Bridging the Quality Chasm. Washington, DC: National Academy of Sciences. p. 99. ISBN 0-309-65406-8. http://www.ncbi.nlm.nih.gov/books/NBK22832/pdf/TOC.pdf#page=114.