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Improving Person-Centredness in Integrated Care for Older People: Experiences from Thirteen Integrated Care Sites in Europe.

ABSTRACT: Introduction:Although person-centredness is a key principle of integrated care, successfully embedding and improving person-centred care for older people remains a challenge. In the context of a cross-European project on integrated care for older people living at home, the objective of this paper is to provide insight at an overarching level, into activities aimed at improving person-centredness within the participating integrated care sites. The paper describes experiences with these activities from the service providers' and service users' perspectives. Methods:A multiple embedded case study design was conducted that included thirteen integrated care sites for older people living at home. Results:Service providers were positive about the activities that aimed to promote person-centred care and thought that most activities (e.g. comprehensive needs assessment) positively influenced person-centredness. Experiences of service users were mixed. For some activities (e.g. enablement services), discrepancies were identified between the views of service providers and those of service users. Discussion and conclusion:Evaluating activities aimed at promoting person-centredness from both the service providers' and service users' perspectives showed that not all efforts were successful or had the intended consequences for older people. Involvement of older people in designing improvement activities could ensure that care and support reflect their needs and preferences, and build positive experiences of care and support.

SUBMITTER: Stoop A

PROVIDER: S-EPMC7319083 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Improving Person-Centredness in Integrated Care for Older People: Experiences from Thirteen Integrated Care Sites in Europe.

Stoop Annerieke A Lette Manon M Ambugo Eliva A EA Gadsby Erica Wirrmann EW Goodwin Nick N MacInnes Julie J Minkman Mirella M Wistow Gerald G Zonneveld Nick N Nijpels Giel G Baan Caroline A CA de Bruin Simone R SR

International journal of integrated care 20200626 2

<h4>Introduction</h4>Although person-centredness is a key principle of integrated care, successfully embedding and improving person-centred care for older people remains a challenge. In the context of a cross-European project on integrated care for older people living at home, the objective of this paper is to provide insight at an overarching level, into activities aimed at improving person-centredness within the participating integrated care sites. The paper describes experiences with these ac ...[more]

PMID: 32607103

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Project description:IntroductionThe concept of personhood is particularly important in person-centred dementia care because its overall aim is to maintain the personhood of people living with dementia despite disease progression. In a previous review on autonomy for people with dementia, two different underlying concepts of personhood were identified: a rationalistic and a social constructionist concept of personhood. The present integrative review aims to (1) identify existing theoretical approaches in person-centred dementia care, (2) describe the constitutive components for these theoretical approaches, (3) report the goals and/or outcomes to be achieved by person-centred care for people living with dementia and (4) identify the underlying concepts of personhood.Methods and analysisFor our integrative review the search terms were derived from the research questions and clustered according to the 'PICo' (Population, Interest, Context) framework. A systematic literature search for theoretical approaches of 'person-centred dementia care' will be performed on MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). The title/abstract and full-text screening will be performed independently by two researchers according to the inclusion criteria. The data analysis procedure will have two steps: (1) identification and extraction of general information (e.g., type of publication and name of theoretical approaches described) and (2) a qualitative content analysis to analyse the components, goals, outcomes and understanding of the respective underlying conceptions of personhood within the theoretical approaches. The extraction of general information (e.g., authors) will be performed by one researcher and qualitative content analysis will be performed independently by two researchers using MAXQDA software. Any disagreements will be resolved through discussion between the two researchers or, if no consensus can be reached, with all coauthors.Ethics and disseminationDue to the nature of a review, ethical approval is not required. We will disseminate our results in peer-reviewed journals and at (inter)national conferences.

Project description:BackgroundThere is worldwide recognition that the future provision of health care requires a reorganization of provision of care, with increased empowerment and engagement of patients, along with skilled health professionals delivering services that are coordinated across sectors and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports the intentions of the World Health Organization (WHO) to have integrated people-centered care.ObjectiveTo design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care, and embraces the use of digital technology.MethodsThe overall research method was inspired by action research and used an agile, iterative approach. In 2012, a living lab was established in a Danish municipality which allowed for the freedom of redesigning health care processes. As the first step, a wide group of stakeholders was gathered to create a layout for the reorganization of services and development of technology, based on established principles for innovative management of people with chronic conditions. The next three steps were (1) a proof of concept in 2012, (2) a pilot study, and (3) a feasibility study from 2013 to 2015, in which a total of 93 chronic obstructive pulmonary disease (COPD) patients were enrolled. Citizens were provided a tablet-based solution for remote follow-up and communication purposes, and access to a 24/7 response and coordination center that coordinated both virtual and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed function.ResultsBased on the findings from the iterative process, and evolving technology and workflow solutions, we propose a robust and feasible model that can provide a framework for developing solutions to support an active life with one or more LTCs. The resulting Epital Care Model (ECM) consists of six stages, and serves as a template for how a digitally-enhanced health service can be provided based on patients' medical needs. The model is designed to be a proactive, preventive, and monitoring health care system that involves individuals in the management of their own health conditions.ConclusionsThe ECM is in accordance with WHO's framework for integrated people-centered health services, and may serve as a framework for the development of new technologies and provide a template for future reorganization.

Dataset Information

Improving Person-Centredness in Integrated Care for Older People: Experiences from Thirteen Integrated Care Sites in Europe.

Publications

Improving Person-Centredness in Integrated Care for Older People: Experiences from Thirteen Integrated Care Sites in Europe.

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