Monday, November 29, 2010

[EQ] Clinical and service integration: the route to improved outcomes

Clinical and service integration:
the route to improved outcomes

Natasha Curry and Chris Ham
The King's Fund 2010 - ISBN 978 1 85717 605 6

Available online PDF [64p.] at: http://t.co/gdQZgQm

 “…..Does integration of care act as a barrier to choice and competition?
This question has long been debated and highlights the complexities and nuances of the issue.
The debate should be informed by evidence on the performance of integrated systems – and by greater clarity on the terminology used.

 

Clinical and system integration makes a significant contribution to that debate by:

- describing integrated care and identifying the different forms it takes

- exploring the different levels within the system at which it operates

- setting out the evidence for the different systems.

 

Integration can take a variety of forms, involving either providers, or providers and commissioners, who work together to deliver better outcomes at a number of levels within the system.

 

This report summarises relevant evidence about high-profile integrated systems in the United States, such as Kaiser Permanente and Geisinger Health System and outlines examples of integrated care in North America and Europe for particular groups, such as older people or patients with long-term conditions – for example, the integrated health and social care teams in Torbay. It also explores the range of approaches to improving co-ordination for individual patients and carers – for example, the Care Programme Approach in mental health.

 

The report focuses on examples that are most relevant to the NHS in England in the context of the coalition government's programme. ......”

Content:

Executive summary

Introduction

Definitions and forms of integration

Macro-level integration

Meso-level integration

Micro-level integration

Implications for the NHS

References

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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[EQ] Cross border care EU: How to choose the best hospital?

Cross border care EU: How to choose the best hospital?

- A study of hospital information portals in five EU countries

Helena Cordasev, M.A., Arne Björnberg, Ph.D. and Oscar Hjertqvist

Health Consumer Powerhouse - Report - November 2010

Available online PDF [88p.] at: http://bit.ly/e8CJSw

“………a research on hospital information portals in five European countries: the Netherlands, Denmark, Germany, the United Kingdom and Sweden.
These IT portals were analysed on aspects such as user-friendliness and quality of care information (QCI). Furthermore, a questionnaire about the use and effectiveness of such hospital information portals from the patients’ point of view was distributed in 32 European countries and evaluated afterwards. The survey indicates huge patient interest in issues of information and choice in healthcare.

The main conclusions that we draw together in this report reflect today’s picture of QCI in all major European countries. The Internet as an information source, which is available 24 hours and 7 days a week, plays a leading role in all thinkable areas of a consumer’s life. In healthcare however, it is still in its baby shoes and QCI has a long way to go before it can become a serious alternative to other information sources.

 

Throughout our survey we've come to see that the impact of hospital IT-portals as a source of information for patients remains low. In healthcare, people still tend to make their choices based on other grounds, such as the traditional family GP or the hospital around the corner.

One possible explanation for this might be that the consumer is generally in doubt about the reliability and credibility of Internet information in healthcare. Also the question remains unanswered, on what ground patients are ready to make active decisions about an often complicated question such as hospital treatments: independently or in close dialogue with healthcare professionals, peers and relatives. Emotional barriers from a lay-person's perspective, as fear and a general feeling of powerlessness, seem to be one of the reasons why patients tend to stick to their traditional choices.

The type of information presented on hospital information portals should evolve around at least four pillars: quality of treatment, waiting times, patient experience and patient satisfaction…..”

 

Contents

1. Summary

2. Why bother to make a choice?

3. Study aim and design

4. Hospital benchmarking websites

5. Comparison of existing hospital information portals

5.1 The Netherlands – top of Europe

5.2 Denmark – “small is beautiful”

5.3 Germany – a web revolution

5.4 United Kingdom – where it all started

5.5 Sweden – trailing behind

6. How user-friendly and reliable are the portals?

7. Can I find the best GP on the web?

8. Patient opinions about quality outcomes portals

9. Conclusions and visions

10. References

Appendix 1. Questionnaire used in the survey commissioned from Patient View

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]
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“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Medical education for the 21st century - Health professionals for a new century

Health professionals for a new century:
transforming education to strengthen health systems in an interdependent world

Prof Julio Frenk a, Dr Lincoln Chen b ‡  , Prof Zulfiqar A Bhutta c, Prof Jordan Cohen d, Nigel Crisp e, Prof Timothy Evans f, Harvey Fineberg g, Prof Patricia Garcia h, Prof Yang Ke i, Patrick Kelley g, Barry Kistnasamy j, Prof Afaf Meleis k, Prof David Naylor l, Ariel Pablos-Mendez m, Prof Srinath Reddy n, Susan Scrimshaw o, Jaime Sepulveda p, Prof David Serwadda q, Prof Huda Zurayk r

Available online at: http://bit.ly/edUAoJ

"…..A Lancet Commission highlights a call from 20 professional and academic leaders for major reform in the training of doctors and other healthcare professionals for the 21st century. Changes are needed because of fragmented, outdated, and static curricula that produce ill-equipped graduates. The Commission argues for major reform across the entire medical education system, in order to produce competency-led curricula for the future…"

 

"…..100 years ago, a series of studies about the education of health professionals, led by the 1910 Flexner report, sparked groundbreaking reforms. Through integration of modern science into the curricula at university-based schools, the reforms equipped health professionals with the knowledge that contributed to the doubling of life span during the 20th century.

By the beginning of the 21st century, however, all is not well. Glaring gaps and inequities in health persist both within and between countries, underscoring our collective failure to share the dramatic health advances equitably. At the same time, fresh health challenges loom. New infectious, environmental, and behavioural risks, at a time of rapid demographic and epidemiological transitions, threaten health security of all. Health systems worldwide are struggling to keep up, as they become more complex and costly, placing additional demands on health workers.

Professional education has not kept pace with these challenges, largely because of fragmented, outdated, and static curricula that produce ill-equipped graduates. The problems are systemic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health-system performance. Laudable efforts to address these deficiencies have mostly floundered, partly because of the so-called tribalism of the professions—ie, the tendency of the various professions to act in isolation from or even in competition with each other.

Redesign of professional health education is necessary and timely, in view of the opportunities for mutual learning and joint solutions offered by global interdependence due to acceleration of flows of knowledge, technologies, and financing across borders, and the migration of both professionals and patients. What is clearly needed is a thorough and authoritative re-examination of health professional education, matching the ambitious work of a century ago.

That is why this Commission, consisting of 20 professional and academic leaders from diverse countries, came together to develop a shared vision and a common strategy for postsecondary education in medicine, nursing, and public health that reaches beyond the confines of national borders and the silos of individual professions.

 

The Commission adopted a global outlook, a multiprofessional perspective, and a systems approach. This comprehensive framework considers the connections between education and health systems. It is centred on people as co-producers and as drivers of needs and demands in both systems. By interaction through the labour market, the provision of educational services generates the supply of an educated workforce to meet the demand for professionals to work in the health system. To have a positive effect on health outcomes, the professional education subsystem must design new instructional and institutional strategies….."

 

 

a Harvard School of Public Health, Boston, MA, USA

b China Medical Board, Cambridge, MA, USA

c Aga Khan University, Karachi, Pakistan

d George Washington University Medical Center, Washington, DC, USA

e Independent member of House of Lords, London, UK

f James P Grant School of Public Health, Dhaka, Bangladesh

g US Institute of Medicine, Washington, DC, USA

h School of Public Health Universidad Peruana Cayetano, Heredia, Lima, Peru

i Peking University Health Science Centre, Beijing, China

j National Health Laboratory Service, Johannesburg, South Africa

k School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

l University of Toronto, Toronto, ON, Canada

m The Rockefeller Foundation, New York, NY, USA

n Public Health Foundation of India, New Delhi, India

o The Sage Colleges, Troy, MI, USA

p Bill & Melinda Gates Foundation, Seattle, WA, USA

q Makarere University School of Public Health, Kampala, Uganda

r Centre for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]
Washington DC USA

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
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