Choice and competition are thought to be essential elements in health policies designed to put the patient first and to improve health outcomes. The importance of integrated care was highlighted in Lord Darzi’s final report of the NHS Next Stage Review.
This report explores the whole concept of integrated care, by:
- Identifying the different forms that integrated care might take.
- Exploring the different levels at which this care might operate within the system.
- Establishing the evidence for the different systems.
The main sections of this report cover:
- Definitions and forms of integration.
- Macro-level integration.
- Meso-level integration.
- Micro-level integration.
- Implications for the NHS.
This report summarises evidence on certain high-profile integrated systems in the United States, such as the Kaiser Permanente and Geisinger Health System. Examples of integrated care in North America and Europe for particular groups are provided, such as schemes for older people or patients with long-term conditions; including the integrated health and social care teams in Torbay.
PACE (Programme for All-inclusive Care for the Elderly)
This report mentions briefly the US PACE (Programme for All-inclusive Care for the Elderly) model. This is an integrated provider model, which aims at maintaining frail older people in the community for as long as possible. PACE focuses on community-dwelling older people (even though the people receiving the care are certified as needing nursing home-level care). The typical PACE enrolee matches average nursing home residents: i.e. female, aged 80 years with 7.9 medical conditions and limited to about 3 activities of daily living. Half of PACE enrolees have a diagnosis of dementia yet, despite their high levels of need, over 90 per cent are able to continue to live in the community.
PACE services are co-ordinated by adult health day centres run by directly employed staff. The day centre delivers most care services and operates similarly to a geriatric outpatients clinic, whereby primary medical care is provided with ongoing clinical oversight. Further information is available via the PACE website.
At the heart of PACE is the multidisciplinary team, comprising nurses, physicians, therapists, social workers, nutritionists, etc. The team manages patients, dispenses services, promotes co-ordination and continuity of services, and collectively takes clinical responsibility for each individual in PACE’s care. The interdisciplinary team approach facilitates group decision-making and consensus. It facilitates better care management and performance.
Patient care is facilitated further by a suitable information system, which is able to collect information on all aspects of each patient’s health and thereby provides the basis for the patient’s care plan.
Curry, N and Ham, C. (2010). Clinical and service integration: the route to improved outcomes. London: The King’s Fund, 2010.
Possibly also of interest:
Integrated Care: Starter for Ten
The King’s Fund‘s recommended ten integrated care resources on this subject are listed on a visual bookshelf (on Pinterest), with links to these integrated care resources selected by the King’s Fund.