Technique for improving care integration models

Recent developments in technologies and improved life style have had a positive impact on prolonging human life contributing to the increasing elderly population. As a consequence, many countries (particularly developed ones) started to experience higher proportions of elderly people (over 65). This has consequently generated the need for care for the elderly that is necessitating the integration of health and social care to accommodate their complex needs. A number of modelling methods have been employed to assist those concerned to cope with health and social care but albeit separately. The literatures so far, identified several techniques that have been employed mostly to model the care integration. However, literatures also suggest that there are some challenges still persist when modelling integrated care. It can be argued that these techniques are not capable of handling the complexities associated with the requirements of integrated systems. This paper attempts to prove the reason why despite the fact that many models of integrated care have been developed, problems are still exist. Based on the literatures, the problems exist due to the unsuitable techniques used to model the IC systems as most of the developed models are using single technique. Therefore, new technique to improve the care integration model is suggested

Unlocking medical leadership’s potential:a multilevel virtuous circle?

Background and aim: Medical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled. Method: Couched in extant international literature, this paper provides a conceptual framework to analyse ML's potential in the context of healthcare's complex, multifaceted setting. Results: We identify four interrelated levels of analysis, or domains, that influence ML's potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems

A Hybrid Modelling Framework for Real-time Decision-support for Urgent and Emergency Healthcare

In healthcare, opportunities to use real-time data to support quick and effective decision-making are expanding rapidly, as data increases in volume, velocity and variety. In parallel, the need for short-term decision-support to improve system resilience is increasingly relevant, with the recent COVID-19 crisis underlining the pressure that our healthcare services are under to deliver safe, effective, quality care in the face of rapidly-shifting parameters. A real-time hybrid model (HM) which combines real-time data, predictions, and simulation, has the potential to support short-term decision-making in healthcare. Considering decision-making as a consequence of situation awareness focuses the HM on what information is needed where, when, how, and by whom with a view toward sustained implementation. However the articulation between real-time decision-support tools and a sociotechnical approach to their development and implementation is currently lacking in the literature. Having identified the need for a conceptual framework to support the development of real-time HMs for short-term decision-support, this research proposed and tested the Integrated Hybrid Analytics Framework (IHAF) through an examination of the stages of a Design Science methodology and insights from the literature examining decision-making in dynamic, sociotechnical systems, data analytics, and simulation. Informed by IHAF, a HM was developed using real-time Emergency Department data, time-series forecasting, and discrete-event simulation. The application started with patient questionnaires to support problem definition and to act as a formative evaluation, and was subsequently evaluated using staff interviews. Evaluation of the application found multiple examples where the objectives of people or sub-systems are not aligned, resulting in inefficiencies and other quality problems, which are characteristic of complex adaptive sociotechnical systems. Synthesis of the literature, the formative evaluation, and the final evaluation found significant themes which can act as antecedents or evaluation criteria for future real-time HM studies in sociotechnical systems, in particular in healthcare. The generic utility of IHAF is emphasised for supporting future applications in similar domains

Integration and Continuity of Primary Care: Polyclinics and Alternatives, a Patient-Centred Analysis of How Organisation Constrains Care Coordination

Background An ageing population, increasingly specialised of clinical services and diverse healthcare provider ownership make the coordination and continuity of complex care increasingly problematic. The way in which the provision of complex healthcare is coordinated produces – or fails to – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational, relational). Care coordination is accomplished by a combination of activities by: patients themselves; provider organisations; care networks coordinating the separate provider organisations; and overall health system governance. This research examines how far organisational integration might promote care coordination at the clinical level. Objectives To examine: 1. What differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical coordination of care. 2. What difference provider ownership (corporate, partnership, public) makes. 3. How much scope either structure allows for managerial discretion and ‘performance’. 4. Differences between networked and hierarchical governance regarding the continuity and integration of primary care. 5. The implications of the above for managerial practice in primary care. Methods Multiple-methods design combining: 1. Assembly of an analytic framework by non-systematic review. 2. Framework analysis of patients’ experiences of the continuities of care. 3. Systematic comparison of organisational case studies made in the same study sites. 4. A cross-country comparison of care coordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics. 5. Analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute in-patient care. Results Starting from data about patients' experiences of the coordination or under-coordination of care we identified: 1. Five care coordination mechanisms present in both the integrated organisations and the care networks. 2. Four main obstacles to care coordination within the integrated organisations, of which two were also present in the care networks. 3. Seven main obstacles to care coordination that were specific to the care networks. 4. Nine care coordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than were care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care coordination because of its impact on GP workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care coordination, and therefore continuities of care, than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings

Modeling good research practices - overview: a report of the ISPOR-SMDM modeling good research practices task force - 1.

Models—mathematical frameworks that facilitate estimation of the consequences of health care decisions—have become essential tools for health technology assessment. Evolution of the methods since the first ISPOR modeling task force reported in 2003 has led to a new task force, jointly convened with the Society for Medical Decision Making, and this series of seven papers presents the updated recommendations for best practices in conceptualizing models; implementing state–transition approaches, discrete event simulations, or dynamic transmission models; dealing with uncertainty; and validating and reporting models transparently. This overview introduces the work of the task force, provides all the recommendations, and discusses some quandaries that require further elucidation. The audience for these papers includes those who build models, stakeholders who utilize their results, and, indeed, anyone concerned with the use of models to support decision making

An integrated approach to evaluate the risk of adverse events in hospital sector: from theory to practice

Purpose: The risk of adverse events in a hospital evaluation is an important process in healthcare management. It involves several technical, social, and economical aspects. The purpose of this paper is to propose an integrated approach to evaluate the risk of adverse events in the hospital sector. Design/methodology/approach: This paper aims to provide a decision-making framework to evaluate hospital service. Three well-known methods are applied. More specifically are proposed the following methods: analytic hierarchy process (AHP), a structured technique for organizing and analyzing complex decisions, based on mathematics and psychology developed by Thomas L. Saaty in the 1970s; decision-making trial and evaluation laboratory (DEMATEL) to construct interrelations between criteria/factors and VIKOR method, a commonly used multiple-criteria decision analysis technique for determining a compromise solution and improving the quality of decision making. Findings: The example provided has demonstrated that the proposed approach is an effective and useful tool to assess the risk of adverse events in the hospital sector. The results could help the hospital identify its high performance level and take appropriate measures in advance to prevent adverse events. The authors can conclude that the promising results obtained in applying the AHP–DEMATEL–VIKOR method suggest that the hybrid method can be used to create decision aids that it simplifies the shared decision-making process. Originality/value: This paper presents a novel approach based on the integration of AHP, DEMATEL and VIKOR methods. The final aim is to propose a robust methodology to overcome disadvantages associated with each method

Disrupting Illicit Supply Networks: New Applications of Operations Research and Data Analytics to End Modern Slavery

Report from a 2017 National Science Foundation workshop on promising research directions for applications of operations research and data analytics toward the disruption of illicit supply networks like human trafficking. The workshop was funded by the NSF’s Operations Engineering (ENG) and the Law & Social Sciences Program (SBE) under grant # CMMI-1726895. The report addresses the opportunity to apply advances from the fields of operations research, management science, analytics, machine learning, and data science toward the development of disruptive interventions against illicit networks. Such an extension of the current research agenda for trafficking would move understanding of such dynamic systems from descriptive characterization and predictive estimation toward improved dynamic operational control.Bureau of Business Researc

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

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

Addressing Childhood Adversity and Social Determinants inPediatric Primary Care:Recommendations for New Hampshire

Research has clearly demonstrated the significant short- and long-term impacts of adverse childhood experiences (ACEs) and the social determinants of health (SDOH) on child health and well-being.1 Identifying and addressing ACEs and SDOH will require a coordinated and systems-based approach. Pediatric primary care* plays a critical role in this system, and there is a growing emphasis on these issues that may be impacting a family. As awareness of ACEs and SDOH grows, so too does the response effort within the State of New Hampshire. Efforts to address ACEs and the SDOH have been initiated by a variety of stakeholders, including non-profit organizations, community-based providers, and school districts. In late 2017, the Endowment for Health and SPARK NH funded the NH Pediatric Improvement Partnership (NHPIP) to develop a set of recommendations to address identifying and responding to ACEs and SDOH in NH primary care settings caring for children. Methods included conducting a review of literature and Key Informant Interviews (KII). Themes from these were identified and the findings are summarized in this report