How will integrated care help the Irish healthcare system? Integrated Care & Quality Summit – Future Health Summit 2016 Dr Catherine Darker Adelaide Assistant Professor in Health Services Research 27th May 2016

The Challenge Political will and commitment Power and advocacy Confronting problems & failures Complex changing environments Economic climate Changing policy arena Meeting the needs of a diverse & changing population; e.g. ageing population, dementia, obesity-related ill-health, mental health. Rising expectations of population

Evidence Base

A difficult start Operational definition? 175 definitions of ‘Integrated Care’ WHO definition “The organization and management of health services so that people get the care that they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money”

Who is integrated care for? Necessary for any individual for whom a lack of care co-ordination leads to an adverse event (care experiences or outcomes) Best suited for e.g., : frail older people, children and adults with disabilities, people with addictions, people with multi-morbidities, people with chronic disease, people with mental health difficulties Also urgent care – where fast and coordinated care response can sig improve outcomes, e.g., Strokes, TIA Transient ischemic attack

What is the end goal of Integration?

Types of Integration Levels of Integration: Clinical, Professional, Organisational Functional Breadth of Integration: horizontal (e.g., multi-disciplinary teams) and vertical (e.g., primary and secondary care) Newer ideas: Integration between payers and providers (e.g., coordination of care planning, commissioning and delivery)

3 degrees of Integration (Leutz, 1999) Linkage (ad-hoc; e.g., referral of patients between services) Coordination (structured response; e.g., PCT – mechanism for sharing of information, and collaboration) Full integration (transformative approach; e.g., typically requires formation of a ‘new’ entity that consolidates responsibilities, resources, finance etc)

How will integrated care help the Irish healthcare system? Future proofing – increasing demand for care Bridging the gap between health and social care Social integration of vulnerable groups Mental health service users Better system efficiency Improvements in Quality, Safety and Continuity of Care

Shared Care

Treatment experience in last 6 months

So what's the problem?

Challenges and Barriers – Policy Level Competing policy agendas Integrating social care and healthcare Healy report (2014) – calls for strengthening of integration between primary and secondary care Social care not funded under UHC NHS – separate NICE – recent recommendations Scottish Gov – moving towards integration of social and healthcare

Evidence based drivers of change?

Evidence – what works? Integrated Care Pathways Funding models MFTP Commissioning of services Organization models Regionalization of hospital, community & primary care services for geographic coverage Strengthening of Primary Care services Human capacity models MDT Clinical leadership (i.e., clinical care programmes) Aligning system incentives Developing ICT

What tools will help – adoption & mainstreaming ‘at scale’?

Solution focused 1. Plan, Do, Study, Act – Sir John Oldham – NHS National Primary Care Development Creation of an environment that facilitates the uptake of ideas Systematic transfer of knowledge Won a Knighthood for services to the NHS! Extra: Plan – Do – Study – Act Diffusion of innovation – Rogers curve – early adopters; early majority; late majority; laggards

How can success be defined and measured?

Balance of perspectives Balance scorecard (Kaplan & Norton; adapted by Devers) – used to track progress towards integration Clinical microsystem (Armitgae et al) – developed through systematic analyses of 20 high preforming systems – allows benchmarking Scale of functional integration (Ahgren et al) – measures intra, inter-org, horizontal & vertical

Thank You Email: catherine. darker@tcd Thank You Email: catherine.darker@tcd.ie Phone: 01-896 8510 Twitter: @CatherineDarker