How will integrated care help the Irish healthcare system?

1. How will integrated care help the Irish
healthcare system?
Integrated Care & Quality Summit – Future Health Summit 2016
Dr Catherine Darker
Adelaide Assistant Professor in Health Services Research
27th May 2016

2. Trinity College Dublin, The University of Dublin
The Challenge
Political will and commitment
Power and advocacy
Confronting problems & failures
Complex changing environments
o Economic climate
o Changing policy arena
o Meeting the needs of a diverse & changing population; e.g. ageing
population, dementia, obesity-related ill-health, mental health.
o Rising expectations of population

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Evidence Base

4. Trinity College Dublin, The University of Dublin
A difficult start
Operational definition?
175 definitions of ‘Integrated Care’
WHO definition “The organization and management of health
services so that people get the care that they need, when they
need it, in ways that are user friendly, achieve the desired results
and provide value for money”

5. Trinity College Dublin, The University of Dublin
Who is integrated care for?
Necessary for any individual for whom a lack of care co-ordination
leads to an adverse event (care experiences or outcomes)
Best suited for e.g., :
– frail older people,
– children and adults with disabilities,
– people with addictions,
– people with multi-morbidities,
– people with chronic disease,
– people with mental health difficulties
Also urgent care – where fast and coordinated care response can
sig improve outcomes, e.g.,
– Strokes, TIA

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What is the end goal of Integration?

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Types of Integration
Levels of Integration:
– Clinical,
– Professional,
– Organisational
– Functional
Breadth of Integration:
– horizontal (e.g., multi-disciplinary teams) and vertical (e.g., primary
and secondary care)
Newer ideas:
– Integration between payers and providers (e.g., coordination of care
planning, commissioning and delivery)

8. Trinity College Dublin, The University of Dublin
3 degrees of Integration (Leutz, 1999)
Linkage (ad-hoc; e.g., referral of patients between services)
Coordination (structured response; e.g., PCT – mechanism
for sharing of information, and collaboration)
Full integration (transformative approach; e.g., typically
requires formation of a ‘new’ entity that consolidates
responsibilities, resources, finance etc)

9. Trinity College Dublin, The University of Dublin
How will integrated care help the Irish
healthcare system?
Future proofing – increasing demand for care
Bridging the gap between health and social care
Social integration of vulnerable groups
Mental health service users
Better system efficiency
Improvements in Quality, Safety and Continuity of Care

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11. Trinity College Dublin, The University of Dublin
Shared Care

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Treatment experience in last 6 months

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So what's the problem?

14. Trinity College Dublin, The University of Dublin
Challenges and Barriers – Policy Level
Competing policy agendas
Integrating social care and healthcare
– Healy report (2014) – calls for strengthening of integration between
primary and secondary care
Social care not funded under UHC
– NHS – separate
• NICE – recent recommendations
– Scottish Gov – moving towards integration of social and healthcare

15. Trinity College Dublin, The University of Dublin
Evidence based drivers of change?

16. Trinity College Dublin, The University of Dublin
Evidence – what works?
Integrated Care Pathways
Funding models
• MFTP
• Commissioning of services
Organization models
• Regionalization of hospital, community & primary care services
for geographic coverage
• Strengthening of Primary Care services
Human capacity models
• MDT
• Clinical leadership (i.e., clinical care programmes)
Aligning system incentives
Developing ICT

17. Trinity College Dublin, The University of Dublin
What tools will help – adoption & mainstreaming ‘at
scale’?

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Solution focused
2. Implementation Science
1. Plan, Do, Study, Act – Sir John Oldham –
NHS National Primary Care Development

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How can success be defined and measured?

20. Trinity College Dublin, The University of Dublin
Balance of perspectives
Balance scorecard (Kaplan & Norton; adapted by Devers) – used
to track progress towards integration
Clinical microsystem (Armitgae et al) – developed through
systematic analyses of 20 high preforming systems – allows
benchmarking
Scale of functional integration (Ahgren et al) – measures intra,
inter-org, horizontal & vertical

21. Thank You
Email: catherine.darker@tcd.ie
Phone: 01-896 8510
Twitter: @CatherineDarker