Just how integrated are integrated delivery systems? Results from a national survey

This article examines three emergent processes in physician-hospital integrated delivery systems (IDSs). We find these processes are underdeveloped based on data gathered from a national sample of hospitals drawn from nine health care systems. These processes are also loosely coupled with the structures used to integrate physicians and hospitals, as well as with the environmental context in which they occur. Such loose coupling entails both advantages and disadvantages for IDSs.     

Care management in mental health services in England and Northern Ireland: do integrated organizations promote integrated practice?

OBJECTIVE: To explore whether integrated structures are associated with more integrated and differentiated forms of care management in mental health services. METHOD: Cross-sectional postal survey of care management arrangements in local authority social services departments in England (n=101) and health and social services Trusts in Northern Ireland (NI) (n=11). RESULTS: Some, but not all, indicators showed more evidence of integrated practice in NI mental health and social services. This included: greater involvement of health care staff in care management; greater multidisciplinary working and a more integrated approach to assessment and care planning processes; a more differentiated approach to care management, including greater targeting of care management resources; a closer link between care management and specialist provision; and overall more integrated practice. CONCLUSIONS: This study concurs with previous research showing that structurally integrated health and social services in NI are more conducive towards, although insufficient to secure, integrated working. As the nature, type of services and ways of working appear to be broadly similar in England and NI, this may imply that greater structural integration per se may not lead to better service outcomes.     

How are Scottish integrated primary care organisations managed?

In the absence of central guidance on the development of integrated primary care organisations, a diversity of models is emerging. This paper examines the management arrangements of Scottish local health care co-operatives (LHCCs). A postal questionnaire survey of all 79 LHCCs was conducted. The response rate was 35 per cent. LHCCs set up management bodies and created workgroups. Stakeholder representation was not socially inclusive: attempts to engage patients and local communities were limited and need to be stepped up to increase responsiveness and accountability to local health care users. LHCCs were also vehicles for local ownership and control of health care provision. To facilitate co-operation among participating practices, LHCCs need to focus on issues of leadership, organisation, and involvement in decision making. Finally, management expenditure per capita was comparable with that of other types of integrated primary care organisations.     

Teachers’ perceptions of integrated kindergarten programs in Hong Kong

This article reports findings from a qualitative interview study that examined the provision of integrated kindergarten education for children with disabilities from the perspectives of general education teachers implementing integrated kindergarten programs. Analysis of interviews with eight informants led to the identification of two broad generalizations: the interviewed teachers emphasized teaching academics to children without disabilities, but they focused on social development at the exclusion of academic instruction for children with disabilities; and, according to the teachers, instruction was academic and skill‐oriented in the integrated kindergarten programs. Research procedures are described and data supporting the findings are presented. Ways to improve program quality are discussed in terms of three major components: the Hong Kong government should include early childhood education within the compulsory education system, and enforce the formally recommended approach of developmental appropriateness; teacher education institutions should prepare prospective teachers to work in school settings where program goals may be contradictory with the ideology of inclusion; and educational researchers should monitor program quality in integrated childcare centers by conducting further research.     

Obesity and eating disorder prevention: an integrated approach?

This article provides a rationale for interventions aimed at the prevention of eating disorders and obesity, an overview of some of the questions and controversies currently facing the fields of eating disorder and obesity prevention, and a discussion of the potential for integrated prevention approaches that address the broad spectrum of weight-related disorders. A rationale for utilizing an integrated approach, the challenges inherent to developing such an approach, and suggestions for working toward integrated approaches aimed at preventing the broad spectrum of weight-related disorders are discussed.     

Does integrated care improve treatment for depression? A systematic review

Care management-based interventions promoting integrated care by combining primary care with mental health services in a coordinated and colocated manner are increasingly popular; yet, the benefits of specific approaches are not well established. We conducted a systematic review of integrated care trials in US primary care settings to assess whether the level of integration of provider roles or care process affects clinical outcomes. Although most trials showed positive effects, the degree of integration was not significantly related to depression outcomes. Integrated care appears to improve depression management in primary care patients, but questions remain about its specific form and implementation.     

Model for the integrated network? Rehabilitation makes a good candidate

Rehabilitation is a good model for an integrated delivery network (IDN). Because it is an integral part of the treatment plans of a diverse group of medical specialties, rehab often plays a pivotal role in patients' recovery. Since its focus is on functional outcomes, rehab is compatible with a capitated payment system. In addition, rehab entered the managed care arena before other "product lines," so rehab providers have experience with diverse reimbursement conditions. And although rehab encompasses all levels of care, it is not too large to function as a model for a full-scale IDN. There are four key stages in the development of a rehab IDN: A strong leader with a clear vision organizes a working committee composed of the key leaders of each entity involved in rehab: hospitals, nursing homes, home health, and others. The committee begins to design the proposed network. Though the committee may study other IDNs, its focus is on its own organization's needs and objectives. A master plan addressing systems gaps and opportunities throughout the IDN is drawn up. Integral to the plan is a schedule according to which each of the network's components will be integrated. The master plan is implemented. The working committee determines the IDN's final structure and names the members of the management team.     

How do integrated delivery systems adopt and implement clinical information systems?

We examined how five integrated delivery systems make decisions about and implement clinical information systems. Using case study methods, we identified general themes and explored how organizational context factors and information technology characteristics affect adoption and implementation processes.