dr catherine darker , adelaide health foundation, healthy ireland council member
TRANSCRIPT
How will integrated care help the Irish healthcare system? Integrated Care & Quality Summit – Future Health Summit 2016
Dr Catherine DarkerAdelaide Assistant Professor in Health Services Research
27th May 2016
Trinity College Dublin, The University of Dublin
The Challenge
Political will and commitment
Power and advocacy
Confronting problems & failures
Complex changing environmentso Economic climate
o Changing policy arena
o Meeting the needs of a diverse & changing population; e.g. ageing population, dementia, obesity-related ill-health, mental health.
o Rising expectations of population
Trinity College Dublin, The University of Dublin
Evidence Base
Trinity College Dublin, The University of Dublin
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”
Trinity College Dublin, The University of Dublin
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
Trinity College Dublin, The University of Dublin
What is the end goal of Integration?
Trinity College Dublin, The University of Dublin
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)
Trinity College Dublin, The University of Dublin
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)
Trinity College Dublin, The University of Dublin
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
Trinity College Dublin, The University of Dublin
Trinity College Dublin, The University of Dublin
Shared Care
Trinity College Dublin, The University of Dublin
Treatment experience in last 6 months
Trinity College Dublin, The University of Dublin
So what's the problem?
Trinity College Dublin, The University of Dublin
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
Trinity College Dublin, The University of Dublin
Evidence based drivers of change?
Trinity College Dublin, The University of Dublin
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
Trinity College Dublin, The University of Dublin
What tools will help – adoption & mainstreaming ‘at scale’?
Trinity College Dublin, The University of Dublin
Solution focused
2. Implementation Science
1. Plan, Do, Study, Act – Sir John Oldham – NHS National Primary Care Development
Trinity College Dublin, The University of Dublin
How can success be defined and measured?
Trinity College Dublin, The University of Dublin
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
