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Using the Project INTEGRATE Framework in Practice in Central Coast, Australia.

ABSTRACT: Introduction:Integrated care implies sustained change in complex systems and progress is not always linear or easy to assess. The Central Coast integrated Care Program (CCICP) was planned as a ten-year place-based system change. This paper reports the first formative evaluation to provide a detailed description of the implementation of the CCICP, after two years of activity, and the current progress towards integrated care. Theory and Methods:Progress towards integrated care achieved by the CCICP was evaluated using the Project INTEGRATE Framework data in a mixed methods approach included semi-structured interviews (n = 23) and Project INTEGRATE Framework based surveys (n = 27). All data collected involved key stakeholders, with close involvement in the program, self-reporting. Results:Progress has been mixed. Gains had most clearly been made in the areas of clinical and professional integration; specifically, relationship building and improved collaboration and cooperation between service providers. The areas of systemic and functional integration were least improved with funding uncertainty being an ongoing significant problem. The evaluation also showed that the Project INTEGRATE framework provided a consistent language for CCICP partners and for evaluators and consistent indicators of progress. The framework also helped to identify key facilitators and barriers. Discussion and Conclusion:The findings highlight the willingness and commitment of key staff but also the importance of leadership, good communication, relationship building, and cultural transformation.

SUBMITTER: Read DMY

PROVIDER: S-EPMC6588025 | biostudies-other | 2019 Jun

REPOSITORIES: biostudies-other

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Using the Project INTEGRATE Framework in Practice in Central Coast, Australia.

Read Donna M Y DMY Dalton Hazel H Booth Angela A Goodwin Nick N Hendry Anne A Perkins David D

International journal of integrated care 20190621 2

<h4>Introduction</h4>Integrated care implies sustained change in complex systems and progress is not always linear or easy to assess. The Central Coast integrated Care Program (CCICP) was planned as a ten-year place-based system change. This paper reports the first formative evaluation to provide a detailed description of the implementation of the CCICP, after two years of activity, and the current progress towards integrated care.<h4>Theory and methods</h4>Progress towards integrated care achie ...[more]

PMID: 31244564

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Project description:Traditional models for delirium based on the Diagnostic and Statistical Manual for Mental Disorders and its 1990 offspring, the Confusion Assessment Method (CAM), were not designed to distinguish behavioral and psychological symptoms of dementia from rapid cognitive decline. We examined a new diagnostic criterion for delirium plus exclusion of behavioral and psychological symptoms of dementia and recent inattention with a 25% decline in digit span forward (DSF).This was a prospective, randomized controlled trial comparing management of prevalent delirium in general medical with that in geriatric medical wards in a 370-bed hospital north of Sydney. Inclusion criteria were age ?65 years and prevalent delirium in the emergency department based on: CAM; proof that CAM elements were not better explained by behavioral and psychological symptoms of dementia; proof of recent inattention on DSF; evidence of cognitive decline not due to sedatives or antipsychotics in the emergency department. Measurements included the Instrumental Activities of Daily Living (IADL, 22-item), Selective IADL (8-item), Mini-Mental State Examination, DSF daily, Delirium Index daily, and Apathy Evaluation Scale. Pre-delirium scores from past cognitive tests and best scores were imputed after admission. Relative change (RC) was calculated as absolute change/test range and RC/MPC ratio was calculated as RC after admission/maximal possible change.A total of 130 subjects were recruited but 14 with subsyndromal delirium were excluded, leaving 116 subjects (mean age 83.6 years). Forty-eight percent had prior dementia. RC from pre-delirium to admission was 42% for the Mini-Mental State Examination, 41% for Selective IADL, 34% for 5-DSF, 54% for 6-DSF, and 37% for the Apathy Evaluation Scale. Improvements after admission (RC and RC/MPC ratios) were 32%/98% for 5-DSF, 54%/82% for 6-DSF, and 45%/80% for the Delirium Index. General medicine and geriatric medicine groups had similar outcomes.This delirium phenotype selects for a rapid high amplitude critical decline in attention, executive function, IADL, and apathy that recovers almost as rapidly.

Dataset Information

Using the Project INTEGRATE Framework in Practice in Central Coast, Australia.

Publications

Using the Project INTEGRATE Framework in Practice in Central Coast, Australia.

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