Integrated Care
Encyclopedia
Integrated care – also known as coordinated care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems.
Integrated care covers a complex and comprehensive field and there are many different approaches to and definitions of the concept. WHO gives the following definition: Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency.
Distinction is also made between horizontal integration
(linking similar levels of care, e.g. multiprofessional teams) and vertical integration (linking different levels of care, e.g. primary, secondary and tertiary care).
The concept of continuity of care is closely related to integrated care; it emphasizes the patient’s perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided in 3 components: 1. Continuity of information (though shared records), 2. Continuity across the secondary-primary care interface (discharge planning from specialist to generalist care), 3. Provider continuity (seeing the same professional each time with value added if there is a therapeutic, trusting relationship).
The concept of integrated care seems particularly important to service provision to the elderly, as elderly patients often are chronically ill and subjects to co-morbidities and thus in special need of continuous care.
Integrated care covers a complex and comprehensive field and there are many different approaches to and definitions of the concept. WHO gives the following definition: Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency.
Central concepts
The integrated care literature distinguishes between different ways and degrees of working together and three central terms in this respect are autonomy, co-ordination and integration. While autonomy refers to the one end of a continuum with least co-operation, integration (the combination of parts into a working whole by overlapping services) refers to the end with most co-operation and co-ordination (the relation of parts) to a point in between.Distinction is also made between horizontal integration
Horizontal integration
In microeconomics and strategic management, the term horizontal integration describes a type of ownership and control. It is a strategy used by a business or corporation that seeks to sell a type of product in numerous markets...
(linking similar levels of care, e.g. multiprofessional teams) and vertical integration (linking different levels of care, e.g. primary, secondary and tertiary care).
The concept of continuity of care is closely related to integrated care; it emphasizes the patient’s perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided in 3 components: 1. Continuity of information (though shared records), 2. Continuity across the secondary-primary care interface (discharge planning from specialist to generalist care), 3. Provider continuity (seeing the same professional each time with value added if there is a therapeutic, trusting relationship).
The concept of integrated care seems particularly important to service provision to the elderly, as elderly patients often are chronically ill and subjects to co-morbidities and thus in special need of continuous care.
Examples
- The United States Department of Veterans AffairsUnited States Department of Veterans AffairsThe United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
is the largest integrated care delivery system in the U.S. - Kaiser PermanenteKaiser PermanenteKaiser Permanente is an integrated managed care consortium, based in Oakland, California, United States, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield...
and the Mayo ClinicMayo ClinicMayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
are the two largest private U.S. systems