Mixed-method evaluation of CARITAS: a hospital-to-community model of integrated care for dementia.
BMJ Open
; 10(10): e039017, 2020 10 05.
Article
de En
| MEDLINE
| ID: mdl-33020104
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 OUTCOMEMEASURES:
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.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Prestation intégrée de soins de santé
/
Démence
Type d'étude:
Prognostic_studies
/
Qualitative_research
Limites:
Humans
Pays/Région comme sujet:
Asia
Langue:
En
Journal:
BMJ Open
Année:
2020
Type de document:
Article
Pays d'affiliation:
Singapour
Pays de publication:
ENGLAND
/
ESCOCIA
/
GB
/
GREAT BRITAIN
/
INGLATERRA
/
REINO UNIDO
/
SCOTLAND
/
UK
/
UNITED KINGDOM