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. 2020 Oct 5;10(10):e039017.
doi: 10.1136/bmjopen-2020-039017.

Mixed-method evaluation of CARITAS: a hospital-to-community model of integrated care for dementia

Ngoc Huong Lien Ha  1   2 , Ivana Chan  1 , Philip Yap  1   2 , Milawaty Nurjono  3 , Hubertus J M Vrijhoef  4   5 , Sean Olivia Nicholas  1 , Shiou-Liang Wee  6   7
Affiliations

Mixed-method evaluation of CARITAS: a hospital-to-community model of integrated care for dementia

Ngoc Huong Lien Ha et al. BMJ Open. .

Abstract

Objectives: The capability and capacity of the primary and community care (PCC) sector for dementia in Singapore may be enhanced through better integration. Through a partnership involving a tertiary hospital and PCC providers, an integrated dementia care network (CARITAS: comprehensive, accessible, responsive, individualised, transdisciplinary, accountable and seamless) was implemented. The study evaluated the process and extent of integration within CARITAS.

Design: Triangulation mixed-methods design and analyses were employed to understand factors underpinning network mechanisms.

Setting: The study was conducted at a tertiary hospital in the northern region of Singapore.

Participants: We recruited participants who were involved in the conceptualisation, design, development and implementation of the CARITAS Programme from a tertiary hospital and PCC providers.

Intervention: We used the Rainbow Model of Integrated Care-Measurement Tool (RMIC-MT) to assess integration from managerial perspectives. RMIC-MT comprises eight dimensions that play interconnected roles on a macro-level, meso-level and micro-level. We administered RMIC-MT to healthcare providers and conducted in-depth interviews with key CARITAS stakeholders.

Primary and secondary outcome measures: We assessed integration scores across eight dimensions of the RMIC-MT and factors underpinning network mechanisms.

Results: Compared with other dimensions, functional integration (mechanisms by which information and management modalities are linked) achieved the lowest mean score of 55. Other dimensions (eg, clinical, professional and organisational integration) scored about 70. Presence of inspiring clinical leaders and tacit interdependencies among partners strengthened the network. However, the lack of structured documentation and a shared information-technology platform hindered functional integration.

Conclusion: CARITAS has reached maturity in micro-levels and meso-levels of integration, while macro-integration needs further development. Integration can be enhanced by assessing service gaps, increasing engagement with stakeholders and providing a shared communication system.

Keywords: geriatric medicine; health services administration & management; public health.

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Conflict of interest statement

Competing interests: PY is a key clinical leader of the CARITAS integrated dementia care network.

Figures

Figure 1
Figure 1
A logic model of CARITAS. CAMIE, care for the acute mentally infirm elders; CARITAS, comprehensive, accessible, responsive, individualised, transdisciplinary, accountable and seamless; CC, community care; ED, emergency department; KTPH, Khoo Teck Puat Hospital; MDD, multi-disciplinary discussion; PC, primary care; QOL, quality of life; SOC, specialist outpatient clinic.
Figure 2
Figure 2
Scores of RMIC’s eight dimensions of integration. RMIC, Rainbow Model of Integrated Care.
See this image and copyright information in PMC

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References

    1. Gröne O, Garcia-Barbero M, WHO European Office for Integrated Health Care Services . Integrated care: a position paper of the who European office for integrated health care services. Int J Integr Care 2001;1:e21. - PMC - PubMed
    1. Armitage GD, Suter E, Oelke ND, et al. . Health systems integration: state of the evidence. Int J Integr Care 2009;9:e82. 10.5334/ijic.316 - DOI - PMC - PubMed
    1. Kodner DL. All together now: a conceptual exploration of integrated care. Healthc Q 2009;13 Spec No:6–15. 10.12927/hcq.2009.21091 - DOI - PubMed
    1. Suter E, Oelke ND, Adair CE, et al. . Ten key principles for successful health systems integration. Healthc Q 2009;13 Spec No:16–23. 10.12927/hcq.2009.21092 - DOI - PMC - PubMed
    1. Starfield B. Is patient-centered care the same as person-focused care? Perm J 2011;15:63–9. 10.7812/TPP/10-148 - DOI - PMC - PubMed

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