Opening the Black Box of Integrated Care: The underlying mechanisms of integrated care delivery to hospitalized elderly

__Abstract__ The rapid increase in the prevalence of multiple chronic diseases in older people has irrevocably altered medical care. Previous studies have shown that between 65% and 88% of those aged 65 years or older suffer from more than one chronic disease (Hoffman, Rice, & Sung, 1997; Wolff, Starfield, & Anderson, 2002). These older patients suffer from a mixture of problems in multiple life domains, concerning not only physical health, but also social and psychological well-being (Rowe & Kahn, 1997). Hospitalisation is a risk for this vulnerable group of patients: about 35% of people aged 70 and over admitted to the hospital function less well after discharge than before their admission. This percentage increases with age (Covinsky et al., 2003). Once admitted to the hospital, older patients are at an increased risk of poor outcomes such as readmission, increased length of stay, iatrogenic complications, and nursing home placement (Forster, Murff, Peterson, Gandhi, & Bates, 2003; Palmer, 1998). As a result, hospitalisation is often followed by a decline in the ability to perform activities of daily living (Sager et al., 1996; Wu et al., 2000). To retain their ability to cope and their quality of life, it is necessary to prevent loss of function among older patients. Since only 20% of these losses in function are related to hospital diagnosis (Covinsky et al., 2003), one of the most important starting points to prevent function loss among older patients is encapsulated in care delivery itself

A framework for understanding outcomes of integrated care programs for the hospitalised elderly

__Abstract__ __Introduction__: Integrated care has emerged as a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. Therefore, we developed a framework to identify the underlying mechanisms of integrated care delivery. We should understand how they operate and interact, so that integrated care programmes can enhance the quality of care and eventually patient outcomes. Theory and methods: Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. A review of integrated care components brings to light a distinction between the cognitive and behavioural components of interprofessional collaboration. __Results__: Effective integrated care programmes combine the interactin

The relationship between older adults' self-management abilities, well-being and depression

This study aimed to identify the relationship between self-management abilities, well-being and depression. Our study was conducted among older adults (>65 years of age) who were vulnerable to loss of function after hospital discharge. Three months after hospital admission, 296/456 patients (65 % response rate) were interviewed in their homes. The 30-item Self-Management Ability Scale was used to measure six self-management abilities: taking initiative, investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality, being self-efficacious and having a positive frame of mind. Well-being was measured with the Social Production Function (SPF) Instrument for the Level of Well-being (SPF-IL) and Cantril's ladder. The Geriatric Depre

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients

Aim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods: This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed. Results: Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination. Conclusions: The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals