Defining and measuring integrated patient care: promoting the next frontier in healthcare delivery.
Subject: Health care industry (Management)
Patients (Care and treatment)
Patients (Evaluation)
Authors: Singer, Sara J.
Burgers, Jako
Friedberg, Mark
Rosenthal, Meredith B.
Leape, Lucian
Schneider, Eric C.
Pub Date: 03/01/2011
Publication: Name: Journal of Healthcare Management Publisher: American College of Healthcare Executives Audience: Trade Format: Magazine/Journal Subject: Business; Health care industry Copyright: COPYRIGHT 2011 American College of Healthcare Executives ISSN: 1096-9012
Issue: Date: March-April, 2011 Source Volume: 56 Source Issue: 2
Topic: Event Code: 200 Management dynamics Computer Subject: Health care industry; Company business management
Geographic: Geographic Scope: Massachusetts Geographic Code: 1U1MA Massachusetts
Accession Number: 271594412
Full Text: GOAL. Achieving care integration is a central challenge of healthcare delivery, particularly for patients with multiple, complex chronic conditions. The objective of this paper was to clarify the concept of integrated patient care and to provide a definition and conceptual framework that would enhance measurement efforts.

METHODS. Based on literature review and expert interviews, we identified ways in which the concept of integrated patient care lacks clarity and concordance with current industry trends. We then developed a new definition of integrated patient care and proposed a framework that clarifies the concept. We also addressed issues related to constructing measures based on the framework and discussed implications for research and policy.

PRINCIPAL FINDINGS. We propose that "integrated patient care" is patient care that is coordinated across professionals, facilities, and support systems; continuous over time and between visits; tailored to the patients' needs and preferences; and based on shared responsibility between patient and caregivers for optimizing health. This definition distinguishes integration of healthcare systems (the means) from integrated patient care (the end) and recognizes the important role of patients and family members in integrated care delivery. Based on our definition, our conceptual framework includes seven dimensions: five related to coordination and two related to patient-centeredness. Together, these dimensions provide a robust description of integrated patient care that is agnostic to the organizational characteristics of delivery systems.

APPLICATIONS TO PRACTICE. Measures of integration that are based on the proposed framework would enable empirical assessment of the potential relationship between the integration of organizations, the integration of patient care, and patient outcomes. Using the proposed definition and framework as guides, we suggest developing valid and reliable patient survey-based measures of the degree to which care is integrated (from the patient's perspective). Combined with other modes of measurement (e.g., measures based on provider reports or chart review), these surveys could discriminate among settings delivering more and less integrated patient care, providing valuable guidance to health system reformers about how to achieve greater integration of care and improved patient health.

CONTACT. Sara Singer at ssinger@hsph.harvard.edu.

AUTHORS. Sara J. Singer, MBA, PhD, assistant professor, Department of Health Policy and Management, Harvard School of Public Health, Boston; Jako Burgers, MD, PhD, senior researcher, IQ healthcare, Radboud University Nijmegen Medical Centre, the Netherlands; Mark Friedberg, MD, MPP, associate natural scientist, RAND, Boston; Meredith B. Rosenthal, PhD, associate professor, Department of Health Policy and Management, Harvard School of Public Health, Boston; Lucian Leape, MD, adjunct professor, Department of Health Policy and Management, Harvard School of Public Health, Boston; Eric C. Schneider, MD, MSc, director, RAND, Boston.
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.