Integrated care at the crossroads—defining the way forward

Introduction and background: The non-existence of a common terminology or standards in Integrated Care makes it difficult to compare experiences and results, whether on a national or international level, while the interdisciplinarity of the concept, both in theory and practice, proves to be a curse when it should be a blessing. Thus, we found it high time to bridge the gap, bring practice to theory and discuss the pressing issues of future Integrated Care research. <br><br> Workshop report: During the expert workshop, discussions were held concerning four overarching topics: (1) defining the common base for integrated care, evaluation and quality; (2) discussion on methods and tools, healthy environs; (3) governing and managerial prerequisites for integrated care and the future of integrated care; and (4) research questions arising from the workshop. The results were formulated into actions and research questions for the future. <br><br> Discussion: The workshop proved the necessity of consolidation in the area in order to foment the concept. Researchers should improve coordination and cooperation among themselves and draw from the various fields which deal with similar questions. <br><br> Conclusion: It remains to be seen whether integrated care manages to grow out of its baby shoes and establish itself as an independent and interdisciplinary field of research

East-West gradient in cardio-vascular mortality in Austria: how much can we explain by following the pattern of risk factors?

<p>Abstract</p> <p>Background</p> <p>Various studies show major regional differences in the prevalence of cardio-vascular disease morbidity and mortality, both in Europe and within European countries. In Austria, these differences are documented by an East-West gradient with declining morbidity and mortality rates when moving from the East to the West of the country. It was the aim of this study to analyse if, and to what extent, socio-demographic and socio-economic determinants, social resources and health behaviour can contribute to the clarification of this East-West gradient by conducting secondary analyses of an existing Austrian health dataset.</p> <p>Results</p> <p>The data were analysed using bivariate analyses, as well as univariate and multivariate logistic regression models. These analyses revealed significant East-West gradients for various risk factors, as well as socio-demographic and socio-economic health determinants. There was a gradual decrease of hypertension, diabetes mellitus, obesity, and psycho-social discomfort in both sexes, with the highest prevalences in those Austrian regions with the highest cardio-vascular mortality and a stepwise decrease to the regions with the lowest cardio-vascular mortality. Controlling for educational level significantly raised the odds for diabetes, hypertension and obesity. In the results of the multivariate analyses, factors that significantly and independently predicted diabetes mellitus were geographic location, psycho-social discomfort, lack of physical exercise, and age in both sexes. For women these factors additionally included a low educational level, lack of social support, and being born abroad.</p> <p>Conclusions</p> <p>Our study shows a clear gradual decline of cardio-vascular mortality and some of its risk factors from East to West in Austria. Concerning these risk factors, the geographic region and psycho-social discomfort showed the greatest association with diabetes mellitus, hypertension, and obesity. Hence, they contribute to the explanation of the variance in spatial cardio-vascular disease mortality. Yet, a large proportion of this variance remains unexplained. It would be of great importance to public health and preventive measures to take a closer look at spatial differences in cardio-vascular disease morbidity and mortality to better tailor programmes to the regional environments and settings. Our results also call for a greater importance of preventative measures for psycho-social discomfort and increase of social support.</p

Prioritising integrated care initiatives on a national level. Experiences from Austria

Introduction and background: Based on a policy initiative and the foundation of the Competence Centre for Integrated Care by the Austrian Social Security Institutions in 2006, the aim of the project was to identify and prioritise potential diseases and target groups for which integrated care models should be developed and implemented within the Austrian health system. The project was conducted as a cooperation between the Competence Centre for Integrated Care of the Viennese Health Insurance Fund and the Institute of Social Medicine of the Medical University Vienna to ensure the involvement of both, theory and practice. <br><br> Project report: The focus of the project was to develop an evidence-based process for the identification and prioritisation of diseases and target groups for integrated care measures. As there was no evidence of similar projects elsewhere, the team set out to design the prioritisation process and formulate the selection criteria based on the work in a focus group, literature reviews and a scientific council of national and international experts. The method and criteria were evaluated by an expert workshop. <br><br> Discussion: The active involvement of all stakeholders from the beginning was crucial for the success. The time constraint proved also beneficial since it allowed the project team to demand focus and cooperation from all experts and stakeholders included. <br><br> Conclusion: Our experience demonstrates that, with a clear concept and model, an evidence-based prioritisation including all stakeholders can be achieved. Ultimately however, the prioritisation is a political discussion and decision. Our model can only help base these decisions on sound and reasonable assumptions

Fairness als zentrale Herausforderung moderner Aufnahmeverfahren

In der Praxis wird zumeist angenommen, dass die Ergebnisse in einem Aufnahmeverfahren individuelle Unterschiede in den zu erfassenden Fähigkeiten fair messen. Der vorliegende Beitrag gibt einen Überblick über Modelle zur Fairness von Aufnahmeverfahren und deren Überprüfung in der Praxis anhand von Beispielen zum Aufnahmeverfahren für Medizinische Studiengänge in Österreich (MedAT). Der Beitrag arbeitet zudem auch den engen Zusammenhang zwischen Fairness und anderen Gütekriterien heraus und veranschaulicht die Vorteile einer stark theoriegeleiteten automatischen Itemgenerierung (AIG), um auf die erhöhten Qualitätsanforderungen bei modernen Aufnahmeverfahren reagieren zu können