References
- World Health Organization (WHO).
World report on ageing and health . Geneva; 2015. - Goodwin, N, Dixon, A, Anderson, G and Wodchis, WP. Providing integrated care for older people with complex needs. Lessons from seven international case studies; 2014. Available from:
https://pdfs.semanticscholar.org/7981/12c57a7ade2239037ea96ec32a4a8039a5a4.pdf . - Coleman, EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc, 2003; 51(4): 549–555. DOI: 10.1046/j.1532-5415.2003.51185.x
- Kripalani, S, Jackson, AT, Schnipper, JL and Coleman, EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med, 2007; 2(5): 314–323. DOI: 10.1002/jhm.228
- Stange, KC. The problem of fragmentation and the need for integrative solutions. Ann Fam Med, 2009; 7(2): 100–103. DOI: 10.1370/afm.971
- Brodsky, J, Habib, J, Hirschfeld, M and Siegel, B. Care of the frail elderly in developed and developing countries: the experience and the challenges. Aging clinical and experimental research, 2002; 14(4): 279–286. DOI: 10.1007/BF03324451
- World Health Organization (WHO). Integrated care for older people (ICOPE). Guidelines on community-level interventions to manage declines in intrinsic capacity; 2017. Available from:
http://www.who.int/ageing/WHO-ALC-ICOPE_brochure.pdf?ua=1 . DOI: 10.1093/geroni/igx004.2477 - Rechel, B, Doyle, Y, Grundy, E and McKee, M. How can health systems respond to population ageing? 2009. Available from:
http://www.euro.who.int/__data/assets/pdf_file/0004/64966/E92560.pdf . - Ham, C. Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England; 2018. Available from:
https://www.kingsfund.org.uk/publications/making-sense-integrated-care-systems . - Lewis, RQ, Rosen, R, Goodwin, N and Dixon, J.
Where Next for Integrated Care Organisations in the English NHS? London: The Nuffield Trust; 2010. - Tandon, A, Murray, CJL, Lauer, JA and Evans, DB. Measuring overall health system performance for 191 countries. GPE Discussion Paper Series: No. 30; 1998. Available from:
http://www.who.int/healthinfo/paper30.pdf . - Statens offentliga utredningar (SOU) Effektiv vård.
Efficient care. . Report SOU 2016:2. 2016. [In Swedish]. Available from:http://www.sou.gov.se/wp-content/uploads/2016/01/SOU-2016_2_Hela4.pdf . - Johansson, L and Schön, P.
Country Report Sweden . CEQUA Long Term Care Network, London School of Economics and Political Science. Brussels; 2017. - OECD.
Health at a Glance 2017: OECD Indicators . Paris; 2017. DOI: 10.1787/health_glance-2017-en - Fritzell, J, Salen, L, Nelson, K, Palme, J and Schön, P. European Social Policy Network (ESPN) Country Profile: Sweden. Chapter 2. Systems and policies affecting social outcomes, 2016; 29–43.
- Philbin, EF. Comprehensive multidisciplinary programs for the management of patients with congestive heart failure. J Gen Intern Med, 1999; 14(2): 130–135. DOI: 10.1046/j.1525-1497.1999.00291.x
- Rich, MW. Heart failure disease management: a critical review. J Card Fail, 1999; 5(1): 64–75. DOI: 10.1016/S1071-9164(99)90026-X
- Moser, DK. Heart failure management: optimal health care delivery programs. Annu Rev Nurs Res, 2000; 18: 91–126. DOI: 10.1891/0739-6686.18.1.91
- McAlister, FA, Lawson, FM, Teo, KK and Armstrong, PW. A systematic review of randomized trials of disease management programs in heart failure. Am J Med, 2001; 110(5): 378–384. DOI: 10.1016/S0002-9343(00)00743-9
- McAlister, FA, Lawson, FM, Teo, KK and Armstrong, PW. Randomised trials of secondary prevention programmes in coronary heart disease: systematic review. BMJ, 2001; 323(7319): 957–962. DOI: 10.1136/bmj.323.7319.957
- Johri, M, Beland, F and Bergman, H. International experiments in integrated care for the elderly: a synthesis of the evidence. International Journal of Geriatric Psychiatry, 2003; 18(3): 222–235. DOI: 10.1002/gps.819
- Sin, DD, McAlister, FA, Man, SF and Anthonisen, NR. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA, 2003; 290(17): 2301–2312. DOI: 10.1001/jama.290.17.2301
- Ouwens, M, Wollersheim, H, Hermens, R, Hulscher, M and Grol, R. Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care, 2005; 17(2): 141–146. DOI: 10.1093/intqhc/mzi016
- Eklund, K and Wilhelmson, K. Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trials. Health & social care in the community, 2009; 17(5): 447–458. DOI: 10.1111/j.1365-2524.2009.00844.x
- Rosenberg, T. Acute hospital use, nursing home placement, and mortality in a frail community-dwelling cohort managed with Primary Integrated Interdisciplinary Elder Care at Home. Journal of the American Geriatrics Society, 2012; 60(7): 1340–1346. DOI: 10.1111/j.1532-5415.2012.03965.x
- Stewart, MJ, Georgiou, A and Westbrook, JI. Successfully integrating aged care services: a review of the evidence and tools emerging from a long-term care program. International Journal of Integrated Care, 2013; 13:
e003 . DOI: 10.5334/ijic.963 - Damery, S, Flanagan, S and Combes, G. Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews. BMJ Open, 2016; 6(11):
e011952 . DOI: 10.1136/bmjopen-2016-011952 - Balaban, RB, Zhang, F, Vialle-Valentin, CE, Galbraith, AA, Burns, ME, Larochelle, MR, et al. Impact of a Patient Navigator Program on Hospital-Based and Outpatient Utilization Over 180 Days in a Safety-Net Health System. J Gen Intern Med, 2017; 32(9): 981–989. DOI: 10.1007/s11606-017-4074-2
- Di Pollina, L, Guessous, I, Petoud, V, Combescure, C, Buchs, B, Schaller, P, et al. Integrated care at home reduces unnecessary hospitalizations of community-dwelling frail older adults: a prospective controlled trial. BMC Geriatr, 2017; 17(1): 53. DOI: 10.1186/s12877-017-0449-9
- Pini, A, Sarafis, P, Malliarou, M, Tsounis, A, Igoumenidis, M, Bamidis, P, et al. Assessment of Patient Satisfaction of the Quality of Health Care Provided by Outpatient Services of an Oncology Hospital. Glob J Health Sci, 2014; 6(5): 196–203. DOI: 10.5539/gjhs.v6n5p196
- Costa-de Lima, K, Peixoto-Veras, R, Pereira-Caldas, C, Motta, LB, Bonfada, D, Marques-Dos Santos, M, et al. Effectiveness of intervention programs in primary care for the robust elderly. Salud Publica Mex, 2015; 57(3): 265–274. DOI: 10.21149/spm.v57i3.7566
- Blom, J, den Elzen, W, van Houwelingen, AH, Heijmans, M, Stijnen, T, Van den Hout, W, et al. Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People—the ISCOPE study. Age Ageing, 2016; 45(1): 30–41. DOI: 10.1093/ageing/afv174
- Ouwens, M, Hulscher, M, Hermens, R, Faber, M, Marres, H, Wollersheim, H, et al. Implementation of integrated care for patients with cancer: a systematic review of interventions and effects. Int J Qual Health Care, 2009; 21(2): 137–144. DOI: 10.1093/intqhc/mzn061
- Ellis, G, Whitehead, MA, O’Neill, D, Langhorne, P and Robinson, D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev, 2011; (7):
CD006211 . DOI: 10.1002/14651858.CD006211.pub2 - Baxter, S, Johnson, M, Chambers, D, Sutton, A, Goyder, E and Booth, A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res, 2018; 18(1): 350. DOI: 10.1186/s12913-018-3161-3
- Garin, N, Koyanagi, A, Chatterji, S, Tyrovolas, S, Olaya, B, Leonardi, M, et al. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. The Journals of Gerontology: Series A, 2015; 71(2): 205–214. DOI: 10.1093/gerona/glv128
- Kodner, DL. All together now: a conceptual exploration of integrated care. Healthc Q, 2009; 13 Spec No: 6–15. DOI: 10.12927/hcq.2009.21091
- Looman, WM, Fabbricotti, IN and Huijsman, R. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care. International Journal of Integrated Care, 2014; 14:
e034 . DOI: 10.5334/ijic.1010 - Struckmann, V, Leijten, FRM, van Ginneken, E, Kraus, M, Reiss, M, Spranger, A, et al. Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review. Health Policy, 2018; 122(1): 23–35. DOI: 10.1016/j.healthpol.2017.08.008
- Creditor, MC. Hazards of hospitalization of the elderly. Ann Intern Med, 1993; 118(3): 219–223. DOI: 10.7326/0003-4819-118-3-199302010-00011
- Ahrens, B. Reduced mortality, the ultimate indicator of treatment efficacy. Review and perspectives. Pharmacopsychiatry, 1994; 27(Suppl 1): 37–40. DOI: 10.1055/s-2007-1014326
- Armitage, GD, Suter, E, Oelke, ND and Adair, CE. Health systems integration: state of the evidence. International Journal of Integrated Care, 2009; 9:
e82 . DOI: 10.5334/ijic.316 - Kodner, DL and Spreeuwenberg, C. Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care, 2002; 2:
e12 . DOI: 10.5334/ijic.67 - Donabedian, A. Evaluating the Quality of Medical Care. Milbank Quarterly, 2005; 83(4): 691–729. DOI: 10.1111/j.1468-0009.2005.00397.x
- de Carvalho, IA, Epping-Jordan, J, Pot, AM, Kelley, E, Toro, N, Thiyagarajan, JA, et al. Organizing integrated health-care services to meet older people’s needs. Bulletin of the World Health Organization, 2017; 95(11): 756–763. DOI: 10.2471/BLT.16.187617
- The Swedish Agency for Health Technology Assessment.
Utvärdering av metoder i hälso- och sjukvården och insatser i socialtjänsten. Mall för kvalitetsgranskning av randomiserade studier. [Assessment of Social Services Evaluation – Methods in Health and Social Care. Template for quality assessment of randomised trials.] 2014 [in Swedish] Available from:https://www.sbu.se/globalassets/ebm/metodbok/mall_randomiserade_studier.pdf . - The Swedish Agency for Health Technology Assessment.
Utvärdering av metoder i hälso- och sjukvården och insatser i socialtjänsten. Mall för kvalitetsgranskning av observationsstudier. [Assessment of Social Services Evaluation methods in health and social care. Template for quality assessment of observational studies.] 2014 [in Swedish] Available from:https://www.sbu.se/globalassets/ebm/metodbok/mall_observationsstudier.pdf . - The Swedish Agency for Health Technology Assessment.
Utvärdering av metoder i hälso- och sjukvården och insatser i socialtjänsten. Mall för kvalitetsgranskning av studier med kvalitativ forskningsmetodik – patientupplevelser. [Assessment of Social Services Evaluation methods in health and social care. Template for quality assessment of qualitative research – patients’ perceptions.] 2014 [in Swedish] Available from:http://www.sbu.se/globalassets/ebm/metodbok/mall_kvalitativ_forskningsmetodik.pdf . - Hebert, R, Raiche, M, Dubois, M-F, Gueye, NDR, Dubuc, N, Tousignant, M, et al. Impact of PRISMA, a coordination-type integrated service delivery system for frail older people in Quebec (Canada): A quasi-experimental study. The journals of gerontology. Series B, Psychological sciences and social sciences, 2010; 65B(1): 107–118. DOI: 10.1093/geronb/gbp027
- Atherly, A, Kane, RL and Smith, MA. Older adults’ satisfaction with integrated capitated health and long-term care. The Gerontologist, 2004; 44(3): 348–357. DOI: 10.1093/geront/44.3.348
- Brown, L, Tucker, C and Domokos, T. Evaluating the impact of integrated health and social care teams on older people living in the community. Health & social care in the community, 2003; 11(2): 85–94. DOI: 10.1046/j.1365-2524.2003.00409.x
- Beland, F, Bergman, H, Lebel, P, Clarfield, AM, Tousignant, P, Contandriopoulos, A-P, et al. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. The journals of gerontology. Series A, Biological sciences and medical sciences, 2006; 61(4): 367–373. DOI: 10.1093/gerona/61.4.367
- Landi, F, Gambassi, G, Pola, R, Tabaccanti, S, Cavinato, T, Carbonin, PU, et al. Impact of integrated home care services on hospital use. Journal of the American Geriatrics Society, 1999; 47(12): 1430–1434. DOI: 10.1111/j.1532-5415.1999.tb01562.x
- Landi, F, Onder, G, Russo, A, Tabaccanti, S, Rollo, R, Federici, S, et al. A new model of integrated home care for the elderly: impact on hospital use. J Clin Epidemiol, 2001; 54(9): 968–970. DOI: 10.1016/S0895-4356(01)00366-3
- de Stampa, M, Vedel, I, Buyck, J-F, Lapointe, L, Bergman, H, Beland, F, et al. Impact on hospital admissions of an integrated primary care model for very frail elderly patients. Archives of gerontology and geriatrics, 2014; 58(3): 350–355. DOI: 10.1016/j.archger.2014.01.005
- Schiotz, M, Price, M, Frolich, A, Sogaard, J, Kristensen, JK, Krasnik, A, et al. Something is amiss in Denmark: a comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente. BMC Health Serv Res, 2011; 11: 347. DOI: 10.1186/1472-6963-11-347
- Ham, C, York, N, Sutch, S and Shaw, R. Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. BMJ, 2003; 327(7426): 1257. DOI: 10.1136/bmj.327.7426.1257
- Tourigny, A, Durand, P, Bonin, L, Hebert, R and Rochette, L. Quasi-experimental study of the effectiveness of an integrated service delivery network for the frail elderly. Canadian Journal on Aging, 2004; 23(3): 231–246. DOI: 10.1353/cja.2004.0038
- Bernabei, R, Landi, F, Gambassi, G, Sgadari, A, Zuccala, G, Mor, V, et al. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ, 1998; 316(7141): 1348–1351. DOI: 10.1136/bmj.316.7141.1348
- Smit, LC, Schuurmans, MJ, Blom, JW, Fabbricotti, IN, Jansen, APD, Kempen, G, et al. Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview. J Clin Epidemiol, 2018; 96: 110–119. DOI: 10.1016/j.jclinepi.2017.12.013
- Toh, HJ, Lim, ZY, Yap, P and Tang, T. Factors associated with prolonged length of stay in older patients. Singapore medical journal, 2017; 58(3): 134–138. DOI: 10.11622/smedj.2016158
- Kohn, L, Corrigan, J and Donaldson, M.
To err is human: building a safer health system . Washington DC: National Academy Press; 2000. - Heggestad, T. Do Hospital Length of Stay and Staffing Ratio Affect Elderly Patients’ Risk of Readmission? A Nation-wide Study of Norwegian Hospitals. Health services research, 2002; 37(3): 647–665. DOI: 10.1111/1475-6773.00042
- Uittenbroek, RJ, Kremer, HPH, Spoorenberg, SLW, Reijneveld, SA and Wynia, K. Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace. J Gen Intern Med, 2017; 32(5): 516–523. DOI: 10.1007/s11606-016-3742-y
- Kasper, JD and Riley, G. Satisfaction with medical care among elderly people in fee-for-service care and an HMO. J Aging Health, 1992; 4(2): 282–302. DOI: 10.1177/089826439200400207
- Spoorenberg, SL, Wynia, K, Fokkens, AS, Slotman, K, Kremer, HP and Reijneveld, SA. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study. PLoS One, 2015; 10(10):
e0137803 . DOI: 10.1371/journal.pone.0137803 - Burström, B, Burström, K, Nilsson, G, Tomson, G, Whitehead, M and Winblad, U. Equity aspects of the Primary Health Care Choice Reform in Sweden – a scoping review. International Journal for Equity in Health, 2017; 16(29). DOI: 10.1186/s12939-017-0524-z
- Andersson Bäck, M and Calltorp, J. The Norrtaelje model: a unique model for integrated health and social care in Sweden. International Journal of Integrated Care, 2015; 15:
e016 . DOI: 10.5334/ijic.2244 - Ström, M.
Kan Borgholm-modellen bli lösningen för framtidens sjukvård? [Could the Borgholm model become the model of future healthcare?] . Läkartidningen [Journal of the Swedish Medical Association]. [in Swedish] 2018; 03(115:EX47). - Klinga, C.
The only constant is change. Exploring the evolvement of health and social care integration . Stockholm; 2018.