Abstract
Background: As the world population is ageing, the growing complexity of healthcare and health needs, together with the associated financial challenges, the value of integrated services to deliver optimum experiences of care and outcomes across settings is being recognized. Integration allows people, to access timely, individualized, culturally appropriate and flexible care working within quality and supportive systems. As primary care is usually the first point of access to the care system, integrated care is a key priority. In the Australian primary care context, Primary Health Networks (PHNs) assess the health care needs of their community and commission health services to meet those needs, supporting integration, by facilitating health services to connect with each other to improve people’s care and strengthen the system. Evidence has been collated to support strategies and interventions to improve integration in primary care including shared decision making. However, systematic ways of measuring the impact of primary care commissioned services on integration requires further investigation.
Approach: Desktop review of international models and measurement approaches to integration, an Integrated Care Framework (ICF) designed detailing: 1. Types of Integration (Administrative, Service, Professional, Clinical); 2. Mechanisms of Integration (the how); 3. Intensity of Integration (how much); and 4. Level of Integration (the where), and a process to inform the consideration of integration across the Commissioning cycle.
It was identified that indicators would be required to consistently measure integration of care across Commissioned Service Providers (CSPs) and for ongoing evaluation. Integration indicators were developed by a working group consisting of: Capacity Building Coordinators (manage CSP contracts), Integration Coordinators (good understanding of sector differences), Planning and Design Officers (develop/ design programs based on need), Palliative Care Coordinator (national priority area of Aged care identified as key focus). Integrated care was defined as person-centred, therefore the guiding principle was the measurement of integrated care must be focused on how person-centred care is, with Service integration the overarching concept. Integration indicators needed to be applicable at the local, sector and systems level.
Results: Indicators were aligned with the dimension of quality: Appropriateness, Access, Safety, Effectiveness, Continuity of Care, Efficiency and Sustainability. Twenty-three Key Performance indicators and 26 integrated care indicators were developed. The working group then considered the types of Service Contracts which included: a/ Direct service delivery activities, b/ Capacity Building Providers, and c/ Capacity Building Consumers. The indicators were trialed across contracts and refined.
Implications: The benefits of developing integration indicators embedded across primary health care commissioned activities included increased efficiencies for the Integrated Care Capacity Building Coordinators from a monitoring perspective and the PHN now has the capacity to capture consistent indicators related to integrated care across programs. Embedding measures of integrated care across primary care initiatives will facilitate the achievement of their ultimate intent of promoting integration, to optimize the experiences of care, outcomes, and increase efficiencies across health care settings. The indicators will also be applied to system focused research including the co-designing and evaluation of an integrated care model for people with chronic conditions in vulnerable populations.