Impact of person-centered and integrated care for community-living older adults on quality of care and service use and costs:Two sides of the same coin

Our healthcare system faces the challenges of coping with changing demands of a growing population of older adults while maintaining quality of care at lower costs. A crucial question, then, will be how to organize care and support to handle these challenges. Therefore, Embrace was developed: a person-centered and integrated-care service for community-living older adults. Research described in this thesis was performed in a number of rural communities in the north-east of The Netherlands . It aimed at evaluating effects of Embrace on quality of care and service use, as well as cost-effectiveness. Moreover, we examined change in the roles of healthcare professionals. The implementation of Embrace was successful. Case managers indicated that Embrace enables them to reduce the negative effects of fragmentation of care. Older adults judged their care as having improved. According to current accounting standards, Embrace was not yet cost-effective after 12 months, compared to usual care. Our research demonstrates that person-centered and integrated-care services such as Embrace may contribute to solving the challenges currently facing the Dutch healthcare system. It may be a growth model for improving population health and care as perceived by older adults

Відкритість економік: фактори, показники та переваги

In de 'Kennismontage Hitte en Klimaat in de Stad' is een overzicht gemaakt van de huidige kennis rond de thema’s ‘stedelijk hitte-eiland’ en ‘hittestress’ relevant voor de uitvoeringspraktijk. De kennismontage is uitgevoerd door het Climate Proof Cities consortium in opdracht van de Alliantie Klimaatbestendige Steden, een samenwerkingsverband tussen de vier grote steden (Amsterdam, Rotterdam, Den Haag en Utrecht) en het Ministerie van Infrastructuur en Milieu. De kennismontage dient als informatiebasis voor de gemeenteambtenaar die met het thema hitte in de stad aan de slag wil

Влияние криоаппликации на фрактальную организацию ультраструктуры мягких тканей пародонта в зоне деструкции и пенумбра

Методами электронной, оптической, лазерной микроскопии в сочетании с компьютерной морфометрией доказана морфологическая информативность фрактальной размерности для оценки общего состояния тканей ротовой полости. Показано, что применение дозированного криовоздействия ведет к усилению трансцитоза, повышению лабильности, фрактализации ультраструктурных элементов гематосаливарного барьера.Методами електронної, оптичної, лазерної мікроскопії в поєднанні з комп’ютерною морфометрією доведена морфологічна інформативність фрактальної розмірності для оцінки загального стану тканин ротової порожнини. Показано, що застосування дозованого кріовпливу веде до посилення трансцитозу, підвищення лабільності, фракталізації ультраструктурних елементів гематосаліварного бар’єра.With the methods of electron, optical, laser microscopy in combination with computer morphometry there has been proved morphological informativeness of fractal dimensions to estimate a general state of the tissue of oral cavity. It has been shown that the application of dosed cryoeffect leads to the strengthening of trans-cytosis, increase in lability, fractalization of ultra-thin elements of hematosalivary barrier

Development of the GeriatrICS, an ICF-based and person-centred assessment tool for evaluation of health-related problems in community-living older adults

Introduction: Ideally, older adults should receive person-centred care and support that meets their individual needs and wishes, taking all relevant health-related problems into account. The International Classification of Functioning, Disability and Health ICF might offer a basis for identification of these problems as it provides a unified language for evaluation of functioning and disability associated with someone’s health status. ICF Core Sets have been developed to describe the spectrum of disabilities of specific patient populations. Therefore, aim of this study was to develop a valid Geriatric ICF Core Set GeriatrICS reflecting all relevant health-related problems of community-living older adults without dementia. Methods: This study consisted of two sub-studies: 1 a written Delphi study to select ICF categories, and 2 assessing content validity in a cross-sectional study. For the Delphi study, a representative panel of experts older adults and non-medical experts on health-related problems due to ageing was constituted. Panel members had to select second-level categories from the ICF-classification relevant to community-living, non-demented older adults 75+, and had to reach consensus on this selection. For the validation study, older adults frail or with complex care needs were visited by a case manager district nurse or social worker who used the initial GeriatrICS as an assessment tool. Older adults had to rate all categories on a scale ranging from 0 no problem to 10 complete problem. Content validity of a category was guaranteed if ≥10% indicated a problem with that category. Results: 41 Delphi panel members obtained consensus in two rounds on 30 ICF-categories. Next, 267 older adults participated in the validation study. All categories met the criterion for content validity except for d530 Toileting. The final GeriatrICS consists of 29 categories: fourteen Body Functions categories, nine Activities and Participation categories and six Environmental Factors categories. Discussions and conclusions: This study resulted in a valid ICF Core Set GeriatrICS including 29 ICF categories representing the most relevant health-related problems among community-living older adults without the diagnosis of dementia. The GeriatrICS included categories from all ICF components, showing that older people’s health is a multidimensional construct. Compared to commonly used, profession-based tools, the GeriatrICS is unique as it is a population-based, cross-domain tool. Therefore, the GeriatrICS is a good starting point for the delivery of person-centred and integrated care. Lessons learned: The GeriatrICS may be used in person-centred and integrated care practice as an assessment tool, in order to tailor care and support to the needs of older adults. Analysis and interpretation of an older adult’s outcomes, and translation into an appropriate care plan, requires highly competent and experienced professionals. Limitations: Older adults with dementia or cognitive impairments may have been included in the validation study since dementia was not an exclusion criterion. Impact on the results is expected to be trivial as case managers were experienced interviewers and a partner or family member participated in the assessment in case of cognitive problems. Suggestions for future research: Future research should investigate the health-related problems of older adults with dementia and robust older adults

Experiences of case managers in providing person-centered and integrated care based on the Chronic Care Model:A qualitative study on embrace

<div><p>Background</p><p>Due to the rise in the number of older adults within the population, healthcare demands are changing drastically, all while healthcare expenditure continues to grow. Person-centered and integrated-care models are used to support the redesigning the provision of care and support. Little is known, however, about how redesigning healthcare delivery affects the professionals involved.</p><p>Objectives</p><p>To explore how district nurses and social workers experience their new professional roles as case managers within Embrace, a person-centered and integrated-care service for community-living older adults.</p><p>Methods</p><p>We performed a qualitative study consisting of in-depth interviews with case managers (district nurses, n = 6; social workers, n = 5), using a topic-based interview guide. Audiotaped interviews were transcribed verbatim and analyzed using qualitative content analysis.</p><p>Results</p><p>The experiences of the case managers involved four major themes: 1) the changing relationship with older adults, 2) establishing the case-manager role, 3) the case manager’s toolkit, and 4) the benefits of case management. Within these four themes, subthemes addressed the shift to a person-centered approach, building a relationship of trust, the process of case management, knowledge and experience, competencies of and requirements for case managers, and the differences in professional background.</p><p>Discussion</p><p>We found that this major change in role was experienced as a learning process, one that provided opportunities for personal and professional growth. Case managers felt that they were able to make a difference, and found their new roles satisfying and challenging, although stressful at times. Ongoing training and support were found to be a prerequisite in helping to shift the focus towards person-centered and integrated care.</p></div

Integrated Care for Older Adults Improves Perceived Quality of Care:Results of a Randomized Controlled Trial of Embrace

BACKGROUND: All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care. To examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care. Stratified randomized controlled trial. Integrated care and support according to the "Embrace" model was provided by 15 general practitioners in the Netherlands. Based on self-reported levels of case complexity and frailty, a total of 1456 community-living older adults were stratified into non-disease-specific risk profiles ("Robust," "Frail," and "Complex care needs"), and randomized to Embrace or control groups. Embrace provides integrated, person-centered primary care and support to all older adults living in the community, with intensity of care dependent on risk profile. Primary outcome was quality of care as reported by older adults on the Patient Assessment of Integrated Elderly Care (PAIEC). Effects were assessed using mixed model techniques for the total sample and per risk profile. Professionals' perceived level of implementation of integrated care was evaluated within the Embrace condition using the Assessment of Integrated Elderly Care. Older adults in the Embrace group reported a higher level of perceived quality of care than those in the control group (B = 0.33, 95 % CI = 0.15-0.51, ES d = 0.19). The advantages of Embrace were most evident in the "Frail" and "Complex care needs" risk profiles. We found no significant advantages for the "Robust" risk profile. Participating professionals reported a significant increase in the perceived level of implementation of integrated care (ES r = 0.71). This study shows that providing a population-based integrated care service to community-living older adults improved the quality of care as perceived by older adults and participating professionals