Open Access
Subscription Access
Outcomes of integrated chronic care interventions including workforce changes
Abstract
Background: Integrated care is seen as a promising approach to deal with the current mismatch between people’s increasing demand for complex, long-term and person-centred care and a traditional supply of acute, episodic and single-disease-focused care. Given the involvement of health professionals in all aspects of integrated care delivery, changes to the health workforce are seen as a key enabler of integrated health services delivery.
Objectives: The first aim of this study was to investigate the outcomes of integrated care interventions for people with chronic conditions that included workforce changes. The second aim was to develop preliminary insights into the relative benefits of measuring the outcomes of workforce changes that are part of integrated care interventions as opposed to measuring integrated care interventions that included workforce changes.
Method: Data were collected by means of an expert questionnaire and a literature review. While the expert questionnaire investigated the outcomes of the workforce changes that were part of an integrated care intervention, the literature review investigated the outcomes of integrated care interventions that included workforce changes.
Results: Overall, both approaches found positive outcomes, in particular for quality of care (including clinical patient outcomes and process measures), patient satisfaction and staff satisfaction. Outcomes were reported for the same categories in the studies as in the questionnaires.
Conclusion: We recommend that health managers and policy makers invest in workforce changes and to (re-)consider strategies that may be detrimental to the health workforce and which could thereby adversely affect patient health and patient experiences of care.
Keywords
References
Anderson, G. & Hopkins, J. (2011). The latest disease burden challenge. In: OECD (Ed.), Heath reform: Meeting the challenge of ageing and multiple morbidities, pp. 15-35. Paris: OECD Publishing.
Valentijn, P.P. (2015). A rainbow of chaos: a study into the theory and practice of integrated primary care. In: Tranzo Scientific Center for Care and Welfare. Tilburg: Tilburg University.
Barnett, K., Mercer, S.W., Norbury, M., Watt, G., Wyke, S. & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional survey. Lancet 380, 37-43.
Kodner, D.L. (2009). All together now: a conceptual exploration of integrated care. Healthcare Quarterly 13 Spec No, 6-15.
Elissen, A.M.J. (2013). Going beyond the 'grand mean': Advancing disease management science and evidence. Dissertation. Universitaire Pers Maastricht, Maastricht.
Minkman, M.M. (2012). Towards a development model for integrated care: developing integrated care. Rotterdam: Erasmus Universiteit Rotterdam.
Tsiachristas, A. (2015). Payment and economic evaluation of integrated care. International Journal of Integrated Care 15, e013.
Busetto, L., Luijkx, K.G. & Vrijhoef, H.J.M. (2014). Implementation of integrated care for type 2 diabetes: a protocol for mixed methods research. International Journal of Integrated Care 14 (Oct-Dec) e033.
Wagner, E.H. (1998). Chronic disease management: what will it take to improve care for chronic illness? Effective Clinical Practice 1 (1) 2-4.
Schrijvers, G. & Goodwin, N. (2010). Looking back whilst moving forward: observations on the science and application of integrated care over the past 10 years and predictions for what the next 10 years may hold. International Journal of Integrated Care 10 pii e057.
Kodner, D.L., Kyriacou, C.K., (2000). Fully integrated care for frail elderly: two American models. International Journal of Integrated Care 1, e08.
Nolte, E. & McKee, M. (2008). Caring for people with chronic conditions: A health system perspective. In: European Observatory on Health Systems and Policies Series. Brussels: European Observatory on Health Systems and Policies.
Valentijn, P.P., Schepman, S.M., Opheij, W. & Bruijnzeels, M.A. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care 13, e010.
Strandberg-Larsen, M. (2011). Measuring Integrated Care: An International Comparative Study. Danish Medical Bulletin 58 (2) B4245.
Leutz, W.N. (1999). Five Laws for Integrating Medical and Social Services: Lessons from The United States and United Kingdom. The Milbank Quarterly 77 (1) 77-110.
Curry, N. & Ham, C. (2010). Clinical and service integration: The route to improved outcomes. London: King's Fund.
Kodner, D.L. & Spreeuwenberg, C. (2002). Integrated care: meaning, logic, applications, and implications - a discussion paper. International Journal of Integrated Care 2 e12.
Berwick, D.M., Nolan, T.W. & Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs (Millwood) 27 (3) 759-769.
Bodenheimer, T. & Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine 12 (6) 537-576.
Langins, M. & Borgermans, L. (2015). Strengthening a competent health workforce for the provision of coordinated/integrated health services: working document. Copenhagen: WHO Regional Office for Europe.
Heslop, L., Power, R. & Cranwell, K. (2014). Building workforce capacity for complex care coordination: a function analysis of workflow activity. Human Resources for Health 12, 52.
Segal, L. & Leach, M.J., (2011). An evidence-based health workforce model for primary and community care. Implementation Science 6, 93.
Osborn, R., Moulds, D., Squires, D., Doty, M.M. & Anderson, C. (2014). International Survey Of Older Adults Finds Shortcomings In Access, Coordination, And Patient-Centered Care. Health Affairs (Millwood) 33 (12) 2247-2255.
National Center for Chronic Disease Prevention and Health Promotion, 2015. Addressing Chronic Disease through Community Health Workers: A Policy and Systems-Level Approach.
Sheer, B. & Wong, F.K.Y. (2008). The Development of Advanced Nursing Practice Globally. Journal of Nursing Scholarship 40 (3) 204-211.
Dixon, S., Kaambwa, B., Nancarrow, S., Martin, G.P. & Bryan, S. (2010). The relationship between staff skill mix, costs and outcomes in intermediate care services. BMC Health Services Research 10, 221.
Firth-Cozens, J. (2001). Multidisciplinary teamwork: the good, bad, and everything in between. Quality in Health Care 10, 65-69.
Lemmens, L., de Bruin, S., Struijs, J., Rijken, M., Nijpels, G. & Baan, C. (2015). Patient involvement in diabetes care: experiences in nine diabetes care groups. International Journal of Integrated Care 15, e044.
Elissen, A.M.J., Steuten, L.M.G., Lemmens, L.C., Drewes, H.W., Lemmens, K.M.M., Meeuwissen, J.A.C., Baan, C.A. & Vrijhoef, H.J.M. (2012). Meta-analysis of the effectiveness of chronic care management for diabetes: investigating heterogeneity in outcomes. Journal of Evaluation in Clinical Practice 19 (5) 753-762.
Drewes, H.W., Steuten, L.M., Lemmens, L.C., Baan, C.A., Boshuizen, H.C., Elissen, A.M., Lemmens, K.M., Meeuwissen, J.A. & Vrijhoef, H.J. (2012). The effectiveness of chronic care management for heart failure: meta-regression analyses to explain the heterogeneity in outcomes. Health Services Research 47 (5) 1926-1959.
Lemmens, K.M., Lemmens, L.C., Boom, J.H., Drewes, H.W., Meeuwissen, J.A., Steuten, L.M., Vrijhoef, H.J. & Baan, C.A. (2013). Chronic care management for patients with COPD: a critical review of available evidence. Journal of Evaluation in Clinical Practice 19 (5) 734-752.
Kabene, S.M., Orchard, C., Howard, J.M., Soriano, M.A. & Leduc, R. (2006). The importance of human resources management in health care: a global context. Human Resources for Health 4, 20.
Squires, A., Aiken, L.H., Heede, K.v.d., Sermeus, W., Bruyneel, L., Lindqvist, R., Schoonoven, L., Stromseng, I., Busse, R., Brozstek, T., Ensio, A., Moreno-Casbas, M., Rafferty, A.M., Schubert, M. & Zikos, D. (2013). A systematic survey instrument translation process for multi-country, comparative health workforce studies. International Journal of Nursing Studies 50 (2) 264-273.
Acquadro, C., Conway, K., Hareendran, A. & Aaronson, N. (2008). Literature Review of Methods to Translate Health-Related Quality of Life Questionnaires for Use in Multinational Clinical Trials. Value in Health 11 (3) 509-521.
The KIDSCREEN Group. (2004). Translation & Validation Procedure: Guidelines and Documentation Form.
Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A. & Erikson, P. (2005). Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value in Health 8 (2) 94-104.
Antoline, C., Kramer, A. & Roth, M. (2011). Implementation and methodology of a multidisciplinary disease-state-management program for comprehensive diabetes care. The Permanente Journal 15 (1) 43-48.
Birke, J.A., Horswell, R., Patout, C.A. Jr. & Chen, S.L. (2003). The impact of a staged management approach to diabetes foot care in the Louisiana public hospital system. Journal of the Louisiana State Medical Society 155 (1) 37-42.
Borgermans, L., Goderis, G., Broeke, C., Verbeke, G., Carbonez, A. & Ivanova, A. (2009). Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project. BMC Health Services Research 9, 179.
Cannon, H.E. (2005). Best practices in innovative type 2 diabetes program management: a case study. Journal of Managed Care Pharmacy 11 (Supplement 6 B) S23-28.
Courtenay, M., Carey, N., James, J., Hills, M. & Roland, J. (2007). An evaluation of a specialist nurse prescriber on diabetes in-patient service delivery. Practical Diabetes International 24 (2) 69-74.
Carey, N., Courtenay, M., James, J., Mimi, M. & Roland, J. (2008). An evaluation of a Diabetes Specialist Nurse prescriber on the system of delivering medicines to patients with diabetes. Journal of Clinical Nursing 17, 1635-1644.
Carter, E.L., Nunlee-Bland, G. & Callender, C. (2011). A patient-centric, provider-assisted diabetes telehealth self-management intervention for urban minorities. In: Perspectives in health information management, pp. 1b. AHIMA, American Health Information Management Association.
Cottingham, Alder, C., Austrom, M., Johnson, C.S., Boustani, M.A. & Litzelman, D.K. (2014). New Workforce Development in Dementia Care: Screening for “Caring”: Preliminary Data. Journal of the American Geriatric Society 62, 1364-1368.
de Mul, M., de Bont, A. & Berg, M. (2007). IT-supported skill-mix change and standardisation in integrated eyecare: lessons from two screening projects in The Netherlands. International Journal of Integrated Care 7, e15.
Eijkelberg, I.M., Spreeuwenberg, C., Wolffenbuttel, B.H., Wilderen, L.J. & Mur-Veeman, I.M. (2003). Nurse-led shared care diabetes projects: lessons from the nurses’ viewpoint. Health Policy 66 (1) 11-27.
Flamm, M., Panisch, S., Winkler, H., Johansson, T., Weitgasser, R. & Sonnichsen, A.C. (2012). Effectiveness of the Austrian disease management programme "Therapie Aktiv" for type 2 diabetes regarding the improvement of metabolic control, risk profile and guideline adherence: 2 years of follow up. Wiener klinische Wochenschrift 124 (17-18) 639-646.
Fletcher, J., Hogg, W., Farrell, B., Woodend, K., Dahrouge, S., Lemelin, J. & Dalziel, W. (2012). Effect of nurse practitioner and pharmacist counseling on inappropriate medication use in family practice. Canadian Family Physician 58, 862-868.
Gabbay, R.A., Lendel, I., Saleem, T.M., Shaeffer, G., Adelman, A.M., Mauger, D.T., Collins, M. & Polomano, R.C. (2006). Nurse case management improves blood pressure, emotional distress and diabetes complication screening. Diabetes Research and Clinical Practice 71 (1) 28-35.
Ganz, D.A., Koretz, B.K., Bail, J.K., McCreath, H.E., Wenger, N.S., Roth, C.P. & Reuben, D.B. (2013). Nurse Practitioner Co-Management for Patients in an Academic Geriatric Practice. American Journal of Managed Care 16 (12) e343–e355.
Hill-Briggs, F., Batts-Turner, M., Gary, T.L., Brancati, F.L., Hill, M., Levine, D.M. & Bone, L. (2007). Training community health workers as diabetes educators for urban African Americans: value added using participatory methods. Progress in Community Health Partnerships : Research, Education, and Action 1 (2) 185-194.
Nasmith, L., Cote, B., Cox, J., Inkell, D., Rubenstein, H., Jimenez, V., Rodriguez, R., Larouche, D. & Contandriopoulos, A.P. (2004). The challenge of promoting integration: conceptualization, implementation, and assessment of a pilot care delivery model for patients with type 2 diabetes. Family Medicine 36 (1) 40-45.
Nuovo, J., Balsbaugh, T., Barton, S., Davidson, E., Fox-Garcia, J., Gandolfo, A., Levich, B. & Seibles, J. (2004). Development of a diabetes care management curriculum in a family practice residency program. Disease Management 7 (4) 314-324.
Rumenapf, G., Geiger, S., Schneider, B., Amendt, K., Wilhelm, N., Morbach, S. & Nagel, N. (2013). Readmissions of patients with diabetes mellitus and foot ulcers after infra-popliteal bypass surgery - attacking the problem by an integrated case management model. Vasa 42 (1) 56-67.
Sluis, V.D., Corry K., Datema, L., Saan, I., Stant, D. & Dijkstra, P.U. (2009). Effects of a nurse practitioner on a multidisciplinary consultation team. Journal of Advanced Nursing 65 (3) 625–633.
Vrijhoef, H., Diederiks, J., Spreeuwenberg, C., Wolffenbuttel, B. & Wilderen, L.V. (2002). The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting: effects on patient outcomes. International Journal of Nursing Studies 39, 441-451.
Watts, S.A., Gee, J., O’Day, M.E., Schaub, K., Lawrence, R., Aron, D. & Kirsh, S. (2008). Nurse practitioner-led multidisciplinary teams to improve chronic illness care: The unique strengths of nurse practitioners applied to shared medical appointments/group visits. Journal of the American Academy of Nurse Practitioners 21, 167-172.
Laurant, M., Reeves, D., Hermens, R., Braspenning, J., Grol, R., Sibbald, B., (2005). Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews (2), CD001271.
Dennis, S., May, J., Perkins, D., Zwar, N., Sibbald, B. & Hasan, I. (2009). What evidence is there to support skill mix changes between GPs, pharmacists and practice nurses in the care of elderly people living in the community? Australia and New Zealand Health Policy 6, 23-23.
Sibbald, B., Shen, J. & McBride, A. (2004). Changing the skill-mix of the health care workforce. Journal of Health Services Research & Policy 9 (Supplement 1) 28-38.
Mattke, S., Seid, M. & Mat, S. (2007). Evidence for the Effect of Disease Management: Is $1 Billion a Year a Good Investment? American Journal of Managed Care 13, 670-676.
W.K. Kellogg Foundation. (2004). Logic Model Development Guide: Using Logic Models to Bring Together Planning, Evaluation, and Action. Michigan, USA: W.K. Kellogg Foundation.
Skills for Care. (2013). Evidence review - integrated health and social care. London: King's Fund.
Shenton, A.K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information 22, 63-75.
Fossey, E., Harvey, C., McDermott, F. & Davidson, L. (2002). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry 36, 717-732.
Boeije, H. (2012). Analyseren in kwalitatief onderzoek: Denken en doen. Den Haag: Boom Lemma uitgevers.
Nancarrow, S.A., Roots, A., Grace, S., Moran, A.M. & Vanniekerk-Lyons, K. (2013). Implementing large-scale workforce change: learning from 55 pilot sites of allied health workforce redesign in Queensland, Australia. Human Resources for Health 11, 66-66.
DOI: http://dx.doi.org/10.5750/ejpch.v5i1.1197
Refbacks
- There are currently no refbacks.