1. 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

2. 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

3. Evidence Base

4. 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”

5. 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

6. What is the end goal of Integration?

7. 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)

8. 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)

9. 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

11. Shared Care

12. Treatment experience in last 6 months

13. So what's the problem?

14. 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

15. Evidence based drivers of change?

16. 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

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

18. 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

19. How can success be defined and measured?

20. 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

21. Thank You Email: catherine. darker@tcd
Thank You Phone: