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As mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs. This study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID.

Background Organising integrated health services beyond domains in interorganizational networks, can be supported by conceptual models to overview the complexity. The Development Model for Integrated Care (DMIC) is a systematically developed generic model that has been applied to innovate and implement integrated care services in a large range of (international) healthcare settings. After a decade, it is important to incorporate new available literature in the model. Therefore, our aim was to update and further develop the DMIC by incorporating the current body of knowledge. Methods A systematic literature review and subsequent stepwise systematic update of the DMIC. Results The review of the literature resulted in 179 included studies and eventually 20 new elements for the development model, which could be positioned in the nine clusters. New elements address the importance of the social system and community of the client, proactive care during the life span, digital (care) services and ethical and value driven collaboration in interorganizational networks that cross domains. The added elements for integrated care build further on the nine thematic clusters and the model as a whole, expanded with new accents. Conclusion The renewed model emphasizes the connectedness of care within a larger eco-system approach and inter-organizational networks. The model captures current knowledge which can be supportive as a generic conceptual model to develop, implement or innovate integrated services towards health value in societies. Further, it can serve for healthcare services research purposes to reflect on an monitor developments in integrated care settings over time on multiple levels.

This study focusses on the implementation of an integrated care pathway for women with SGA in their obstetric history that pursues value-based healthcare. This study aims to 1) Determine whether the integrated care pathway led to a reduction in the number of antenatal secondary care consultations, as an indicator of care efficacy, and 2) compare clinical outcomes for women with a history of SGA before and after implementation of the integrated care pathway. Retrospective cohort study including data from pregnant women with a history of SGA within integrated maternity care organisation Annature, 2017-2020. Intervention was an integrated care pathway (2018). Pre- and post-intervention periods were compared assessing prenatal secondary care consultations, place and mode of delivery, and perinatal outcomes. The implementation of the care pathway for pregnant women with a history of SGA led to a reduction in mean number of prenatal secondary care consultations per pregnancy from 11 in 2017-5 in 2020, and fewer inductions of labour (78 (34.2%) vs 127 (26.8%), p = 0.045). Additionally, the number of births in primary care increased (35 (15.4%) vs 136 (28.8%), p < 0.001) with no significant adverse impact on neonatal outcomes in the post-intervention period compared to the pre-intervention period. The implementation of the care pathway for pregnant women with a history of SGA resulted in a reduction in prenatal secondary care consultations and fewer inductions of labour. Additionally, the number of births in primary care increased, with no significant adverse impact on neonatal outcomes in the post-intervention period compared to the pre-intervention period.

Background To help ensure that children and families get the right support and services at the right time, strong and stable relationships between various child service organizations are vital. Moreover, strong and stable relationships and a key network position for gatekeepers are important preconditions for interprofessional collaboration, the timely and appropriate referral of clients, and improved health outcomes. Gatekeepers are organizations that have specific legal authorizations regarding client referral. However, it is largely unclear how strong relations in child service networks are structured, whether the gatekeepers have strong and stable relationships, and what the critical relations in the overall structure are. The aim of this study is to explore these preconditions for integrated care by examining the internal structure and dynamics of strong relations. Methods A comparative case study approach and social network analysis of three inter-organizational networks consisting of 65 to 135 organizations within the Dutch child service system. Multiple network measures (number of active organizations, isolates, relations, average degree centrality, Lambda sets) were used to examine the strong relation structure and dynamics of the networks. Ucinet was used to analyze the data, with use of the statistical test: Quadratic Assignment Procedure. Visone was used to visualize the graphs of the networks. Results This study shows that more than 80% of the organizations in the networks have strong relations. A striking finding is the extremely high number of strong relations that gatekeepers need to maintain. Moreover, the results show that the most important gatekeepers have key positions, and their strong relations are relatively stable. By contrast, considering the whole network, we also found a considerable measure of instability in strong relationships, which means that child service networks must cope with major internal dynamics. Conclusions Our study addressed crucial preconditions for integrated care. The extremely high number of strong relations that particularly gatekeepers need to build and maintain, in combination with the considerable instability of strong relations considering the whole network, is a serious point of concern that need to be managed, in order to enable child service networks to improve internal coordination and integration of service delivery.

Background As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers). Methods Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery. Results Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery. Conclusions We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.

Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden's three step approach for thematic synthesis. Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.

Background In order to organize person-centered health services for a growing number of people with multiple complex health and social care needs, a shift from fragmented to integrated health services delivery has to take place. For the organization of governance in integrated health services, it is important to better understand the underlying factors that drive collaboration, decision-making and behavior between individuals and organizations. Therefore, this article focuses on these underlying normative aspects of integrated health services. This study investigates the values that underpin integrated health services delivery as a concept, by examining the extent to which an initial literature based set of underlying values underpins integrated care and the relevance of these values on the different levels of integration. Methods An international Delphi study with 33 experts from 13 different countries was carried out to examine the initial set of underlying values of integrated health services. In addition, the relevance of the values was assessed on the different levels of integration: personal level, professional level, management level and system level. Results The study resulted in a refined set of 18 values of integrated health services developed in three Delphi study rounds. In addition, the results provided insight into the relevance of these values on the personal level (e.g. ‘trustful’), professional level (e.g. ‘collaborative’), management level (e.g. ‘efficient’) and system level (e.g. ‘comprehensive’) of integration. Some of the values score consistent across the different levels of integration while other values score inconsistent across these levels. Conclusions The Delphi study resulted in an international normative basis for integrated health services delivery as a concept. The values can be used as ingredients for a values framework and provide a better understanding of the normative aspects of integrated health services delivery. Future research could focus on associated behaviors in practice, the relationship between normative integration and governance, and differences between the value priorities of stakeholder groups.

Background Although coordination of care and integrated care models aim to enhance patient satisfaction and perceived care quality, evidence regarding their practical implementation remains scarce. Understanding the nuances of collaboration across care providers to achieve effective coordination of care is imperative for seamless care integration. The aim of this study was to construct a grounded theory of how inter-organizational collaboration is performed to support coordination of care for patients with complex care needs. Methods A qualitative design with a constructivist grounded theory approach was applied. In total, 86 participants with diverse backgrounds were recruited across multiple care settings, including hospitals, ambulance services, primary care centers, municipal home healthcare and home care services. The grounded theory was developed iteratively, based on a combination of observations and interviews, and using constant comparative analysis. Results Coordination of care, a complex process that occurs across interconnected healthcare organizations, is manifested as “Negotiating care in organizational borderlands.” Care coordination evolves through a spectrum of inter-organizational collaboration, ranging from “Dividing care by disease-specific expertise” to “Establishing paths for collaboration” and ultimately “Co-constructing a comprehensive whole.” These categories highlight the challenges of coordinating care across both professional and organizational boundaries. In the multifaceted healthcare landscape, effective care coordination occurs when healthcare professionals actively bridge the divides, leveraging their collective expertise. Importantly, organizational boundaries may serve a purpose and should not be dissolved to facilitate effective care coordination. Conclusions The key to effective care coordination lies in robust inter-organizational collaboration. Even when patients receive integrated care, healthcare professionals may have fragmented roles. This research emphasizes the importance of clearly defined lines of accountability, reinforcing mutual responsibility and facilitating bridging of professional and organizational boundaries. Healthcare professionals and policymakers can use these insights to effectively utilize inter-organizational collaboration in supporting care coordination for patients with complex care needs.