Norton Healthcare: A Strong Payer-Provider Partnership for the Journey to Accountable Care

Examines the progress of an integrated healthcare delivery system in forming an accountable care organization with payer partners as part of the Brookings-Dartmouth ACO Pilot Program, including a focus on performance measurement and reporting

A whole-health-economy approach to antimicrobial stewardship: Analysis of current models and future direction.

Antimicrobial stewardship (AMS) strategies are widely implemented in single healthcare sectors and organisations; however, the extent and impact of integrated AMS initiatives across the whole health economy are unknown. Assessing degree of integration of AMS across the whole health economy and its impact is essential if we are to achieve a ‘One Health’ approach to addressing antimicrobial resistance (AMR), and therefore we searched systematically for and analysed published examples of integrated AMS initiatives to address this gap. Application of a system-level framework to analyse integration of AMS initiatives across and within healthcare sectors shows that integration is emerging but needs strengthening. Findings from a small number of evaluations in high-income countries suggest that antimicrobial prescribing and healthcare-associated infections can be reduced using a multisectoral integrated AMS approach. More robust research designs to evaluate and understand the impact of multisectoral integrated AMS are needed, particularly with respect to differing health systems in different countries and local organisational contexts. Our analysis highlights a number of challenges and ways forward for enhancing the delivery of AMS through an integrated approach

Legal and professional implications of shared care: a case study in oral anticoagulation stroke prevention therapy.

Policy initiatives and technological advances enable the use of integrated shared care models of healthcare delivery whereby the focus of care is moved from the hospital to the community, and also of models where patients take increasing responsibility for monitoring and treatment. Such shifts may or may be perceived to change professional roles and responsibilities with implications to the delivery of a professionally and legally acceptable standard of care. We focus on oral anticoagulation and stroke prevention therapy to examine some possible professional and legal implications of the increasing use of shared care

Measurement of integrated healthcare delivery: a systematic review of methods and future research directions

Background: Integrated healthcare delivery is a policy goal of healthcare systems. There is no consensus on how to measure the concept, which makes it difficult to monitor progress. <br><br> Purpose: To identify the different types of methods used to measure integrated healthcare delivery with emphasis on structural, cultural and process aspects. <br><br> Methods: Medline/Pubmed, EMBASE, Web of Science, Cochrane Library, WHOLIS, and conventional internet search engines were systematically searched for methods to measure integrated healthcare delivery (published – April 2008). <br><br> Results: Twenty-four published scientific papers and documents met the inclusion criteria. In the 24 references we identified 24 different measurement methods; however, 5 methods shared theoretical framework. The methods can be categorized according to type of data source: a) questionnaire survey data, b) automated register data, or c) mixed data sources. The variety of concepts measured reflects the significant conceptual diversity within the field, and most methods lack information regarding validity and reliability. <br><br> Conclusion: Several methods have been developed to measure integrated healthcare delivery; 24 methods are available and some are highly developed. The objective governs the method best used. Criteria for sound measures are suggested and further developments should be based on an explicit conceptual framework and focus on simplifying and validating existing methods

Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform

As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a vertically integrated delivery system for healthcare has demanded that healthcare executives have a new set of skills and competencies. These competencies include management skills across hospitals, ancillary providers, physician practices, ambulatory settings, as well as skills in risk management and quality. Healthcare organizations can transform healthcare delivery through the power of technology and systems oriented care. This will require a new type of healthcare executive with new skill sets. This paper examines the skill sets of leaders of some of the leading integrated delivery systems in the United States through key interviews with twelve top executives. Based upon those interviews, c-suite executives in large healthcare systems were surveyed to identify the core competencies of the successful healthcare executive of the future and the graduate education requirement needed to achieve those competencies. The results of the study are used to provide suggestions on how the curricula of healthcare administration programs can be revamped

Accounting And Economic Implications Of Healthcare Information Technology

There is a growing consensus that interoperability of health care technology is greatly needed so that data can be effectively and accurately exchanged across provider groups and organizations to provide quality healthcare while reducing the cost of healthcare delivery. Benefits are expected for physician groups, organizations, and patients.&nbsp; Perhaps most exciting is the opportunity for integrated patient and population level data leading to clinical decision support systems which assist with the management of patients by integrating medical knowledge with patient characteristics and generating computer based reminders, alerts, and guidelines.&nbsp; While research supports a multitude of benefits, challenges exist that require long-term commitment before the reality of an integrated healthcare information technology will exist. This article explores the benefits, the barriers, and the long term impact of Healthcare Information Technology on future healthcare delivery systems

It Takes More than a Village: Building a Network of Safety in Nepal's Mountain Communities.

Purpose This report from the field details the ways that one small maternal child health NGO, which began its work in Tibet and now works in the mountain communities of Nepal, has established a model for integrated healthcare delivery and support it calls the "network of safety." Description It discusses some of the challenges faced both by the NGO and by the rural mountain communities with whom it partners, as well as with the government of Nepal. Conclusion This report describes and analyzes successful efforts to reduce maternal and infant mortality in a culturally astute, durable, and integrated way, as well as examples of innovation and success experienced by enacting the network of safety model

Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform

Background There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs). Aims To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs. Method Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks. Results Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation. Conclusions Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important

Integrated Mobile and web-based Application for Enhancing delivery of HIV/AIDS Healthcare Information in Tanzania

This study aims to develop an integrated e-health platform for enhancing delivery of HIV/AIDS healthcare information in Tanzania, which consists of a mobile application and a web-based system. The study is based on the system's functional and non-functional requirements for an e-health system for delivery of HIV/AIDS healthcare information. The Rapid Application Development (RAD) model was adopted during the system development. The system requirements were modelled into Data Flow Diagram (DFD) in order to obtain the clear flow of the HIV/AIDS healthcare information between the clients and HIV/AIDS healthcare practitioners. With the use of different software development tools and environment such as Android studio and Symfony framework; both android application and web-based system were developed. Finally, the developed system was tested for individual module functioning as well as the functioning of the fully integrated system. The user acceptance survey gave the mean score of above 4 on the scale of 5 for each tested aspect of the system. These scores show that the developed system was positively accepted by the users and commended the Ministry of Health and to deploy the system for enhanced delivery of HIV/AIDS healthcare information