bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the maturity of integrated care organizations
Authors: Majo Jocelyne , Peytremann-Bridevaux Isabelle , Carron Tania , Campisi David , Leroy Perrine , Castellani Pascale , Meylan Pascale , Périat Alain , Bosisio Francesca , Mathy Caryn 
Published: January 2024

Introduction: Given the difficulty of measuring and demonstrating the added value of integrated care organizations over traditional ones by using conventional evaluation methods, we used—and adapted—the SCIROCCO Maturity Model for Integrated Care to be considered as a steering tool for integrated care organizations to measure their maturity over time and enable improvements.
Methods: Three organizations located in Switzerland that have brought together the local hospital (with inpatient and outpatient care services), the nursing home, the day center for elderly people, the home care services and the primary care practice will be evaluated using the adapted SCIROCCO tool and approach (SCIROCCO-POL). The original SCIROCCO validated tool assesses the readiness and capacity of a healthcare system, at the level of a region or country, to adopt and scale-up integrated care solutions by capturing stakeholders’ perceptions of current progress towards integration.¹ Following the SCIROCCO methodology, healthcare stakeholders will be asked to assess (individually and then through consensus-building workshops) the maturity of their integrated care organization along 12 dimensions (e.g. governance, funding, digital infrastructure, process coordination, citizen empowerment). Since we aimed at obtaining a steering tool for integrated care organizations, a revision of the SCIROCCO tool is necessary, so that 1) the description of each dimension is adapted to the language used by local healthcare actors, including non-specialists, in the context of an organization, and 2) the 0-5 rating scales follow the same logic throughout the dimensions in terms of maturity progression. This tailoring and systematization will allow us to build a tool that healthcare organizations can easily use to monitor their level of maturity and make progress towards integrated care. The adapted version of the SCIROCCO tool will be used within three integrated care organizations, allowing for comparison and knowledge transfer.
Results and next steps: Currently, the evaluation process is ongoing. At the end of the full SCIROCCO evaluation process, management bodies of the three integrated care organizations, in conjunction with their stakeholders, will be invited to define SCIROCCO’s priority dimensions and action plans to address the identified maturity gaps; they will also prepare strategic roadmaps for the three identified priority dimensions.
We propose to present the adapted version of the SCIROCCO tool that allows the assessment of an organization’s level of maturity towards integrated care, and to discuss its advantages and more specifically its use as a steering and improvement tool that integrated care organizations can use on a regular basis.
¹ https://www.sciroccoexchange.com/
"The “Amfora conversation”: reflecting on life and death when the end is near. An innovative practice empowering patients".
Authors: Morel Michèle 
Published: January 2024

Death is part of life. Yet, few people are prepared for it. Many of those who are old or seriously ill, have the need to reflect on the past life, the nearing end and the things that matter. Talking about and sharing those deeper feelings and thoughts can be deeply liberating. It can create a closer connection between the ill or old person, the loved ones and the health care professionals. End-of-life conversations can stimulate the person to think about future care and, this way, contribute to advance care planning. And for loved ones it can have a preventive effect in the sense that it increases the chances of healthy grieving.
Who am I, where do I find strength, which meaning do I give to death? How do I look back on my life? What are my fears and my hopes? What do I wish to leave for those staying behind? Thinking and talking about these questions is not easy. The non-profit organization Amfora helps people to find language and create a tangible memory for loved ones, by means of an “Amfora conversation” resulting in a precious, carefully written end-of-life story. Amfora provides training to health care professionals and volunteers from various settings (hospitals, palliative care networks, facilities for people with disabilities and elderly care), so they can integrate the practice in their daily work.
Integrated care reflects the whole of a person’s health needs. It means we focus on the totality of the person and his full context, beyond the disease or chronic condition. This is particularly important in palliative care and end-of-life care, where consensus exists about the four pillars of care: physical, psychological, social and spiritual/existential. This last pillar – which goes far beyond religion – is the most intimate and hidden dimension of care, yet it’s crucial because of its close connection to each of the other dimensions.
However, it remains a challenge for many palliative care professionals how to implement this non-medical, existential pillar in practice. This is where the Amfora conversation comes in: it has proven to be an accessible and effective way to empower people in having their spiritual/existential needs fulfilled. The Amfora concept is innovative because it is based on the journalistic interview method. The interviewer captures the essence of the person and gives it back in another form, so it can be passed on. End-of-life conversations are a form of care and should therefore be fully integrated in palliative care.
MISSION IMPOSSIBLE? Integrated services for people with SMI and SUD - The importance of good leadership and management.
Authors: Poverud Lars 
Published: January 2024

Introduction: Better services for people with mental illness and substance use disorder (SUD) can be looked at as a Mission Oriented Innovation (MOI). People with severe mental illness (SMI) and SUD are often in the need of a range of different services, and different service models for coordinating such services have been introduced through the years.
Aim: This study explores what inhibits and promotes integrated services for people with SMI and SUD in the service model FACT – Flexible Assertive Community Treatment.
Methods: This is a qualitative explorative multiple-case study with the use of focus group interviews and reflexive thematic analysis (RTA) of team members in three different FACT-teams in Norway.
Results: In team A the themes ‘Poor and lacking communication’, ‘Culture & Attitude’ and ‘Some resources are missing’ inhibits integrated services. And ‘A holistic and open work environment’, ‘Systemic assertive’ and ‘Focus on social recovery’ promotes. In team B ‘Lack of resources’, ‘Incorrect focus or problem focused practice’ inhibits, and ‘Function recovery advocacy & practice – Function FACT’ and ‘Good triple Management’ promotes. In team C ‘Administration & Management matters’, ‘Segregation & Prioritizing’ and ‘External interaction’ inhibits, and ‘Skilled, creative & dedicated team members’, ‘The FACT service model’ and ‘Internal & external cooperation’ promotes.
Conclusion: Will be presented at the conference.
The study also has PPI - Personal and Public Involvement with the engagement of three peer co-researchers contributing to the research project INNOFACT from start to end. The next step is to summarize and conclude regarding the importance of good leadership and management that will be presented at the conference. Later on the peer co-researchers will interview the patients about the same research questions.
There are to our knowledge no studies about what inhibits and promotes integrated services for people with dual (and multiple) diagnosis in the service model FACT.
Regional Strategic Planning of Care in Flanders based on population needs
Authors: Peuskens Geert 
Published: January 2024

Introduction: In 2014, Flanders started a process of re-designing the hospital care. This has led let to the recognition of 13 networks of hospitals in 2020.
Simultaneous we developed a framework for a Regional Strategic Care Plan (RSCP). The RSCP starts from demographic data and health indicators to determine future needs to which the future supply of the network must be tailored. The networks are asked to make such a RSCP for their network.
Target: The increase in ageing, multimorbidity, complex disorders, chronic care,… require a new relationship between hospitals and between hospitals and other healthcare providers. With the RSPC we want to match the hospital care to the needs of the population, in consultation with other healthcare providers. More attention will go to task differentiation and new partnerships.
The main principle has to be that basic care is organised close to the people, whereas more specialised care recruits from a wider environment. All healthcare providers will have to change from a supply-driven organisation of care towards person-centred care based on needs.
Design: Studies on future population needs, on an optimal spread of the care offer and to create a framework for RSPC, based on future needs, actual demografic figures, …., were executed by a consortium of Deloitte and the Leuven Institute for Healthcare Policy.
A computermodel was developed to visualise patient flows and to determine logical cooperation.
The main goal of RSPC:

Stimulate person-centred care
Stimulate cooperation and networking between hospitals and with other healthcare providers
Concentration of expertise and restricting the high-tech care supply
Expenditure should match the current financial context and achieve a health-economic justifiable offer.

Execution: At the moment the hospital networks are developing their RSPC based on the models that are provided to them. This is an intensive process in which the result must also be coordinated with other partners in the region. The RSPC will be evaluated by a committee consisting of representatives of hospitals, primary care and academics.
Results: Based on the first plans sumitted, we see that the hospital networks will tailor their offer to the needs of the population and that they consult with other care partners in the region. It encourages hospitals to think about their future role and how it is fulfilled. The doctors are also involved to develop a long-term vision.
On average, acute beds will be reduced by about 7%.
Lessons learned: It is important to provide hospitals with a framework on which to base themselves to tailor their future offerings to the needs of the population and to encourage them to think about this.
The division of powers between the federal government and the regions makes it difficult for hospitals to make choices.
Next steps: Evaluate the current framework to see if improvements can be made and the model can be updated. Certainly in terms of the involvement of other care partners, additional incentives must be given.
Chef-led taste centers provide an accurate and integrated transmural approach to chemotherapy-induced dysgeusia in adult cancer outpatients
Authors: Geurden Bart , Corremans Marleen , Van den Wijngaert Lobke , Goossens Edwig , Vlaemynck Geertrui 
Published: January 2024

Introduction: Taste changes are common during chemotherapy. Currently, limited evidence-based guidelines exist for the effective management of chemotherapy induced dysgeusia in adult cancer outpatients. In this study, chefs gastro-engineering combine medical and para-medical assessments with innovative insights from gastrological sciences such as selective taste management to improve the taste of bread for cancer outpatients.
Method: The oncologists from the participating hospitals referred eligible patients to a chef-led taste center. The chef gastro-engineering carries out a taste assessment and combines these results with the food preferences of the patient as well as any advice of the dietician and/or the speech therapist to develop personalized recipes, in this case a recipe for personalized bread. The patients were asked to bake and consume this personalized bread at home, with the help of their family caregiver. The effects of this innovative self-care intervention were measured after 1 month follow-up.
Results: Included patients (N=112) are randomly divided in a bread-baking (intervention) group (N=54) and a control group (N=58). Over 80% of the bread baking patients perceived personalized bread as equally or more tasteful than usual bread despite their stressful chemotherapy-induced dysgeusia. After one month follow-up a significant loss of bodyweight (p .021) and Body Mass Index (p .025) is observed in the control group while in the bread-baking group this loss was not significant (p .968 and p .956 respectively). Only 17% of the bread baking group required some telephone or online assistance in order to correctly apply their personalized recipe. In-depth Interviews with the patients and their caregivers revealed the highly empowering effect of this innovative self-care intervention. In 60% of the cases, the bread was prepared by the family caregiver. Compliance was high and no side effects were reported.
Conclusion: A chef-led taste center appears to be able to accurately and safely address the chemotherapy-induced dysgeusia in adult cancer outpatients. Thanks to this integrated and hyper-personalized approach to a stressful side effect of chemotherapy, more than 80% of the participants were able to enjoy tasty bread again despite dysgeusia. Given the positive effect on patient empowerment and since baking personalized bread at home is safe and feasible, this approach should be extended to other meal components. A chef-led taste center should be structurally anchored in the transmural integrated care pathway for adult cancer pati
Drivers that influence the development of care and service pathways for mental health clients in health and social service organizations
Authors: Longpré Caroline , Jubinville Maripier , Tchouaket Nguemeleu Eric 
Published: January 2024

Background: Investigation, diagnosis, treatment, and follow-ups are the stages of care to be integrated into a care trajectory for clients requiring mental health care (MSSS, 2021). As a result of recent structural reforms, health care organizations are focusing on more integrated care and services in order to respond effectively to the complex needs of this clientele, which poses challenges for the institutionalization of clinical and management practices aimed at better integrating care and services.
Objective: To identify the drivers that influence the development of care and service pathways for mental health clients in health and social service organizations.
Method: Cross-sectional, descriptive, qualitative, single-case study (CISSS in Quebec) with nested levels of analysis covering the settings of a ""Mental Health Care"" trajectory. The settings include the first, second, and third levels of care. Guided by Longpré's (2017) framework (LO-DISS) linking governance, organizational, structural, and clinical processes with key organizational resources, an interview guide was developed. Clinical professionals, managers, and administrators (N = 10) participated in semi-structured interviews that were analyzed using a qualitative data processing tool (NVivo). Result: Drivers of integrated care and services for mental health care pathways have been identified for each component of the LO-DISS model (2017). These highlighted processes include interdisciplinary collaboration, the patient-partner approach, quality assessment mechanisms, the development of integrative roles (case manager), and the mobilization of environmental and technological resources (electronic records, an environment that supports confidentiality and collaboration). The findings support the notion that investments in resources, processes, also clinical and management practices are key to integrating care and services and providing quality of care.
Recommandations: Using the LO-DISS care and services integration model to support renewed clinical governance allows for the deployment of strategies aimed at formalizing clinical and management practices that link the various mental health care pathways experienced by the population.
Working towards inclusive integrated care: a possible lens
Authors: Berdai Chaouni Saloua 
Published: January 2024

According to the World Health Organisation (WHO), integrated care’s primary goal is meeting people's needs. Whichever integrative care model is used, the way to gauge the success of this goal is the healthcare user's satisfaction with the care provided, and the extent to which their needs have been met. In the super-diverse context of most Western-Europe cities and regions this is a challenge.
Ethno-cultural diversity as one of the visible aspects of diversity resulting from migration is increasing within our population. The question is therefore how we ensure that integrated care is inclusive for this growing ethnocultural diversity among care users. Our studies involving older labour migrants with dementia and their caregivers, both informal and formal, in Belgium indicated that these older adults do not receive care that meets their needs. The reason for this misfit in care is still too often and one-sidedly sought in these older people’s cultural background. Much less attention is paid to the exclusionary mechanisms within the care system.
To sharpen the picture, we developed a conceptual lens for inclusive care. This lens looks at the influencing factors for inclusive care at micro, meso, macro and chrono levels. It helps us to observe the complexity of these influencing factors and to avoid the essentialist framework shaping the current debate on provision of care for the 'culturally other'. We detected three building blocks for complexity-responsive integrated care: 1) awareness of the intersectional position of the ‘other’, 2) the need for inclusive care organizations and inclusive care landscapes in a globalized world, and 3) addressing societal exclusionary mechanisms. These building blocks can be a starting point to recognize the intersectional identity of each person involved in care, including the care provider’s, as a stepping stone to inclusive responsive care. This implies that the exclusionary mechanisms associated with social positions are recognized and addressed at micro, meso and macro level. To conclude, the proposed intersectional inclusiveness is a path worth exploring in attempts to achieve the ultimate goal of integrated care: meeting the needs of all care users.
#NavigatingHealth - Building a Global Movement Empowering Patients to Navigate Health Systems
Authors: Slade Siân , Ryan Kay 
Published: January 2024

Background: Whilst health reports talk about health systems shifts from reactive “one size fits all” to proactive personalised health care, the current reality is that health systems are challenging for patients and carers to navigate. Patients frequently experience gaps and barriers in healthcare. We talk about patient-centred care, but we do not have patient centred systems. The challenges are not new and patient navigation was extensively research by Professor Harold Freeman in the US over 30 years ago.
Audience: This presentation is for a multidisciplinary audience of patients, health professionals, policy managers and politicians focused on enabling patient-centred at a systems level.
Who did you involve and engage with? What was the approach and process undertaken?
Patients, professionals and policy makers in Australia and globally have been involved in what started as a national Community of Practice in Australia “Mind the Gap: #NavigatingHealth”.
The approach was tested for audience interest with a series of two webinars in September 2021 to set the scene of navigating health across a life journey of patient and provider experiences with a solutions focused approach on how to tackle the many challenges.
Following the success and interest of the webinars and as part of a focused advocacy and change management approach we developed a bimonthly Community of Practice. This is open to all those in Australia. Our focus in the first year was to make visible the many solutions being developed to support patients and to develop an engaged participatory community and build connection.
Further to the success in the first year, we have now expanded the approach at a global level running our first global webinar in November 2022 with speakers from Australia, the United States of America, Canada and the United Kingdom providing a connected approach across a life journey. This included lived experience of patients as well as presentations from non-governmental, medical and government organisations interweaving micro, meso and macro approaches (for example included American Cancer Society, NHS England).
What is the learning for the international audience? Problems that patients face navigating health systems in countries are common and consistent. Collaborating across disease and functional areas both within and across countries allows the opportunity to take a “big-picture” view to take a systems focused approach. This allows the solutions being developed to be coalesced at a systems level, remove duplication and leverage resources to benefit both patients, providers and policy makers to focus on a person-centred value-based healthcare approach across a life journey.
What are the next steps? Our next steps are to consolidate the learnings and scale. Whilst our initial focus has been high income countries we will be expanding the approach in 2023 to low and middle income countries using the same methodology.
Introducing a conceptual framework for reflective team dialogue to foster interdisciplinary collaboration in community health centers in Flanders &amp; Brussels
Authors: Vyncke Veerle , Meeus Tom , Depoot Peter 
Published: January 2024

Short intro: By facilitating a reflective team dialogue on key elements of interdisciplinary care, the framework “Complementary Care” supports primary care teams in shifting from multidisciplinary to interdisciplinary collaboration.
Abstract: The Association of Community Health Centers (CHC) overarches a diverse set of 37 interdisciplinary primary care practices in Flanders and Brussels. The centers are funded via a needs based capitation model. Although team collaboration is facilitated by practical and financial factors, there was a need for strengthening interdisciplinary collaboration.
A reflective framework was developed by an interdisciplinary group of primary care professionals. It was described that the CHCs wanted to evolve from task shifting towards task sharing. In task shifting, care tasks are delegated from one team member to another team member. Task sharing however is a the uptake of integrated care by the whole team in shared responsibility and based on a shared vision of care, via the acknowledgment, recognition and optimal usage of the qualities in the interdisciplinary team. A participative trajectory, including 47 primary care professionals from 11 different disciplines, led to the identification of six essential buildings stones to work towards task sharing: (1) the acknowledgment of other team members in their expert role, (2) the composition of the team, (3) self care, (4) shared ownership, (5) speaking a common language and (6) a sense of equality within the team. The developed framework has been tested as a discussion tool in 5 interprofessional teams. Preliminary evaluation shows that it has led to the implementation of quick wins and more profound transitions towards integrated care. A further dissemination of the framework is planned trough in-site visits of CHCs.