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Results for 'integrated care'

Results 1 - 10 of 48

Interventions to promote early discharge and avoid inappropriate hospital (re)admission: a systematic review

COFFEY Alice, et al
2019

Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

The lives we want to lead: the LGA green paper for adult social care and wellbeing

LOCAL GOVERNMENT ASSOCIATION
2018

A consultation paper from the Local Government Association, which seeks views on the future of care and support for adults and their unpaid carers. The paper puts forward options to secure the immediate and long-term funding for adult social care, and makes the case for a shift towards preventative, community-based personalised care, which helps maximise people's health, wellbeing and independence. It also considers the importance of housing, public health, other council services, in supporting wellbeing and prevention. Sections cover: differing views about the future of long-term funding for social care; the wider changes needed across care and health to bring out a greater focus on community-based and person-centred prevention; the role of public health and wider council services in supporting and improving wellbeing; and the nature of the relationship between social care and health, integration, accountability and how the new NHS funding could be used for maximum impact. Thirty consultation questions are included throughout the report. The consultation will run until 26 September 2018.

Review of integrated care: focus on falls

HEALTHCARE INSPECTORATE WALES
2019

Based on a review of integrated care for older people who are at risk of experiencing a fall in Wales, this report highlights learning for staff and for health and social care managers. It focuses on services to help people avoid a fall and how to support people who have had a fall, providing examples of desirable and undesirable pathways through the health and care system. It focuses on the three areas: prevention of falls and promotion of independence, for people living in their own home or in a care home; response to falls when they happen in the community, either for someone living at home or in a care home; and following attendance at hospital due to a fall. It also highlights key themes identified from the review and how the affected service users, service providers and commissioners. The review identified examples of good practice but also found a lack of co-ordination and communication between health, social care and voluntary services could often be a barrier to delivering good quality care. The report has been informed by evidence from six individual falls services, the views of staff and older people. It makes eight recommendations for the Welsh Government, health boards and local authorities. The include a National Falls Framework for Wales, to standardise the approach to preventing, treating and reabling older people who are at risk of falling or have already fallen The report will be relevant for service providers, commissioners and service users.

Health at home: a new health and wellbeing model for social housing tenants

PEABODY
2018

Explores how housing support services and community-based health services can deliver effective services at lower cost; encourage self-care for the most vulnerable customers and reduce dependency on direct support; work with other agencies to ensure a coordinated response to the residents’ complex and multiple health needs. The report sets out the findings of a study which aimed to test a person-centred support model using a randomised control trial of 261 general needs residents aged over 50. The service model employed health navigators and volunteers to coach and connect residents with the relevant health, housing and community services they need. The study used to measurement tools to assess impact: the Patient Activation Measure (PAM) and Coaching for Activation (CFA). The study found that three months of intervention with those who started in PAM Level 2 was sufficient to move them up, on average, an entire PAM level. This increase in activation was sustained for at least nine months after the intervention ended, suggesting that participants gained the skills and confidence to effectively manage their health without further support after the initial intensive intervention. This is significant as one of the largest studies into cost reductions from PAM level changes in the United States found that patients who moved from Level 2 to Level 3 reduced their annual healthcare costs by 12%. Existing evidence also indicates that when people become more active in self-care, they benefit from better health outcomes, and fewer unplanned health admissions. The report concludes that there is a clear and compelling case for continuing to support integrated care and strengthen links between the health and housing agendas.

The (cost‐)effectiveness of preventive, integrated care for community‐dwelling frail older people: a systematic review

LOOMAN Wilhelmina Mijntje, HUIJSMAN Robbert, FABBRICOTTI Isabelle Natalina
2019

Integrated care is increasingly promoted as an effective and cost‐effective way to organise care for community‐dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for community‐dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost‐effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk‐of‐bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom‐reported outcomes such as well‐being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost‐effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.

“It was the whole picture” a mixed methods study of successful components in an integrated wellness service in North East England

CHEETHAM M., et al
2018

Background: A growing number of Local Authorities (LAs) have introduced integrated wellness services as part of efforts to deliver cost effective, preventive services that address the social determinants of health. This study examined which elements of an integrated wellness service in the north east of England were effective in improving health and wellbeing (HWB). Methods: The study used a mixed-methods approach. In-depth semi-structured interviews (IVs) were conducted with integrated wellness service users (n = 25) and focus groups (FGs) with group based service users (n = 14) and non-service users (n = 23) to gather the views of stakeholders. Findings are presented here alongside analysis of routine monitoring data. The different data were compared to examine what each data source revealed about the effectiveness of the service. Results: Findings suggest that integrated wellness services work by addressing the social determinants of health and respond to multiple complex health and social concerns rather than single issues. The paper identifies examples of ‘active ingredients’ at the heart of the programme, such as sustained relationships, peer support and confidence building, as well as the activities through which changes take place, such as sports and leisure opportunities which in turn encourage social interaction. Wider wellbeing outcomes, including reduced social isolation and increased self-efficacy are also reported. Practical and motivational support helped build community capacity by encouraging community groups to access funding, helped navigate bureaucratic systems, and promoted understanding of marginalised communities. Fully integrated wellness services could support progression opportunities through volunteering and mentoring. Conclusions: An integrated wellness service that offers a holistic approach was valued by service users and allowed them to address complex issues simultaneously. Few of the reported health gains were captured in routine data. Quantitative and qualitative data each offered a partial view of how effectively services were working.

Innovative models of health, care and support for adults

SOCIAL CARE INSTITUTE FOR EXCELLENCE
2018

This briefing explains that innovative, often small-scale models of health, social care and support for adults could be scaled up to benefit as many people as possible. The challenge is to make scaling up successful. The briefing is based on research conducted during the spring of 2017 by Nesta, SCIE, Shared Lives Plus and PPL. It includes real life examples and case studies to show how stakeholders are involved in building and growing successful and sustainable innovations in health, care and support which provide new ways of delivering relationship-based care. It also identifies key challenges and facilitators to scaling up innovative models and makes recommendations to help make impactful innovative models become part of mainstream care. It includes case studies from North London Carers – a community network of young professionals and older neighbours which helps to reduce loneliness and increase wellbeing; Age UK’s Personalised Integrated Care programme – which brings together voluntary organisations and health and care services to support for older people living with multiple long-term conditions who are at risk of recurring hospital admission; Shared lives - adults either live with or regularly visit their chosen carer; North Yorkshire Innovation Fund – which provides funding to support voluntary and community organisations providing innovative intervention or prevention measures; and Wigan’s place-based approach. To help innovative models to flourish and scale up, it identifies keys to success as: a shared ambition to embed person- and community-centred ways of working; co-production; a new model of leadership which is collaborative and convening; investment and commissioning in approaches which result in high quality outcomes; and use of data to drive change a willingness to learn from experience.

Housing adaptations

AUDITOR GENERAL FOR WALES
2018

This report assesses whether organisations with responsibilities for delivering housing adaptations in Wales - which include local authorities, housing associations and Care and Repair agencies - have an effective approach that delivers value for money. It finds that the current system needs to change in order to meet the needs of older and disabled people. The review involved fieldwork at five local authorities and four housing associations, a survey of people who had received adaptations; and an analysis of data and expenditure on current services. It reports that although users express high levels of satisfaction with housing adaptations, the system is complex, reactive and results in people with similar needs often receiving different standards of service because of where they live and who is providing the service. Although public bodies are aware of the benefits of adaptations in supporting independence, ineffective partnership working results in missed opportunities to address needs and avoid and reduce demand and costs in health and social care services. The report makes nine recommendations for improvement, including: for the Welsh Government to set a minimum standard for adaptation work, so people can receive the same standard wherever they live; for local authorities to work more closely with partner agencies who deliver adaptations and streamline the application and delivery processes; and the provision of more accessible versions of information to the public.

Chief Social Worker for Adults annual report 2017-18. From strength to strength: strengths-based practice and achieving better lives

Chief Social Worker for Adults
2018

This report sets out progress in improving the education, training and practice of social work with adults in England during 2016-17 and outlines priorities to further raise the quality and profile of adult social work in 2018-19. Themed around strengths-based social work practice, the report offers examples of social workers using asset and strengths-based practice approaches. It also reviews how adult social work is reshaping the culture of adult social care and the way organisations collaborate across health, community and voluntary sectors to maintain people’s quality of life and independence. It highlights a number of practice developments in the sector, covering strengths-based approaches, initiatives working to develop the social care workforce, integrated care, and work by hospital social work teams to reduce delayed transfers of care from hospital. Key priorities identified by the Chief Social Work for Adults for 2018-19 include promoting the value of social work practice with adults in personalising high quality health and social care integrated outcomes for people and their carers; to raise the quality of practice; and to improve productivity through social work practice that works in partnership with people to co-produce support.

Tapping the potential: lessons from the Richmond Group's practical collaborative work in Somerset

NEW PHILANTHROPY CAPITAL
2018

This report captures early learning from a project to building meaningful collaboration between the voluntary and statutory sector in Somerset. It is the latest report from the Doing the Right Thing programme, which aimed to achieve better outcomes for people living with long-term health conditions and reduced demand on health and social care services through collaborative design and delivery. The report identifies benefits of collaboration and system change led by the voluntary and community sector. It also highlights some of the challenges around sustainability, measuring outcomes and ensuring involvement of large national charities is inclusive of the wider voluntary sector in a place. Key findings highlight the benefits of coming to collaboration with no pre-conceived ideas about products or providers; that turning an open-ended conversation between the voluntary sector and public bodies into a productive collaboration requires resource; the benefits of bridging organisations, such as the Richmond Group, and people who make it their job to connect divergent cultures, languages, and priorities; and the agility and stability that voluntary sector leadership can offer to place-based collaborations in a changing healthcare landscape. The report also discusses the wider implications of the research, and the issues it raises around health and care transformation, placed-based collaboration, and evidence for complex interventions. The report will be of particular interest to those seeking to improve collaboration and commission services across the health and care system and also provides practical insights into cross-sector collaboration.

Results 1 - 10 of 48

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News

Moving Memory

Moving Memory Practice example about how the Moving Memory Dance Theatre Company is challenging perceived notions of age and ageing.

Chatty Cafe Scheme

Chatty Cafe Scheme Practice example about how the Chatty Cafe Scheme is helping to tackle loneliness by bringing people of all ages together

Oomph! Wellness

Oomph! Wellness Practice example about how Oomph! Wellness is supporting staff to get older adults active and combat growing levels of social isolation

KOMP

KOMP Practice example about how KOMP, designed by No Isolation is helping older people stay connected with their families

LAUGH research project

LAUGH research project Practice example about a research project to develop highly personalised, playful objects for people with advanced dementia
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