bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Teleton Integrated Care Approach to Deliver Rehabilitation Services and Promoting Inclusion for Children and Teenagers with Motor Disabilities in Chile - Implementation and lessons learned.
Authors: Saavedra Cristian 
Published: January 2024

People with disabilities face significant barriers in order to get proper access to health care. According to the World Health Organization, they are three times more likely to be denied health care, four times more likely to be treated badly in the healthcare system and 50% more likely to suffer catastrophic health expenditure.
In Chile, 5,8% of the children and teenagers have some form of disability. Motor disabilities are one of the most prevalent in this age group.
Teleton is a non-profit network of 14 healthcare institutes providing rehabilitation care to 93,5% of children and teenagers with motor disabilities in Chile.
Conditions treated by Teleton include Cerebral Palsy, amputations, central nervous system diseases, neuromuscular diseases and other congenital or acquired diseases leading to a motor impairment.
Established in 1979 and mostly financed through a yearly national fundraising campaign, over the last 10 years Teleton has faced difficulties to provide adequate coverage and continuity of care to their patients.
As a response to these challenges, in 2015 Teleton developed an integrated multidisciplinary model of care including interventions from several specialties such as: physiatry, orthopedics, nursing, physiotherapy, occupational therapy, psychology, education, social work, art therapy, phono audiology and adapted sports therapy. The model follows the principles of the McColl Chronic Model of care.
As a core element, the model establishes the creation of specialized multidisciplinary teams of professionals taking care of a specific population from a diagnostic group. This feature allows the workforce to gain expertise and enhance coordination, thus improving the quality of care.
Similarly, the model allow patients to be treated by the same professionals who know their clinic history facilitating the delivery of care and patient satisfaction.
The aim of this paper is to explain the key components of this model including clinical processes, organization of delivery of care, clinical metrics, team coordination practices, and to present main results in terms of health coverage, health quality, administrative performance, governance and impact on patient functionality.
Using Population Segmentation to Identify Opportunities for Integrated Care in Ontario, Canada.
Authors: Wodchis Walter , Hall Ruth , Mondor Luke , Bai Yu-Qing (Chris) 
Published: January 2024

Ontario, Canada has introduced Ontario Health Teams (OHTs) to advance integrated care and population health management. There are currently 54 OHTs covering a population of nearly 14 Million individuals. The teams are expected to plan and implement new care models that improve quadruple aim goals of patient and provider experience, health outcomes and cost efficiency. The Health System Performance Network (HSPN) is funded by the Ontario Ministry of Health to provide evaluation and research to support OHTs. The HSPN is using population segmentation alongside performance measurement to support OHTs to identify populations for improvement. OHTs are using the data provided by HSPN to target opportunities for improvement. This presentation summarizes the performance measures and population segmentation approach used in Ontario to advance integrated care and population health.
HSPN is using the British Columbia Health System Matrix (BCHSM), based on the Bridges to Health model to segment the population for each OHT. HSPN has identified 10 overall indicators of performance for OHTs ranging from premature mortality to continuity of physician care. There are also 5 measures respectively in several specific populations including older adults, mental health, and end of life. Indicators are also examined according to socioeconomic strata. This presentation will overview the population segmentation methodology, the ways that performance indicators vary according to population segments, and the ways that OHTs receive the data and are coached in the use of data to target and advance integrated care initiatives.
The BCHSM provides 14 different population segments ranging from non-users to low-users to frail older adults in the community to people at the end of life. Increasing frailty and clinical complexity is strongly related to the population segments/groups and premature mortality and total system costs correspond as well to increasing patient complexity. The BCHSM has high face-validity. Improvement indicators for mental health and health system priorities such as emergency presentations for mental health reasons and delayed discharge from acute hospital are also more common in specific population groups which helps to prioritize and target interventions. These data are supporting the development of specific integrated care programs to address health needs in underserved populations.
What knowledge and skills do community volunteers need to signpost palliative care needs to professionals? A qualitative study
Authors: Van Steenbergen Sabet , Vanderstichelen Steven , Statema Else Given , Deliens Luc , Dury Sarah , Chambaere Kenneth 
Published: January 2024

Background: Volunteers often notice palliative care (PC) needs that healthcare professionals (HCP) and family caregivers miss, potentially playing an important signposting role. It is unknown what particular knowledge and skills are lacking and required to optimally fulfil this role in community homecare.
Aims: To explore the desired and required knowledge and skills for volunteers to recognize, describe and communicate PC needs to HCPs.
Methods: A qualitative study design with 7 focus groups (15 community volunteers, 20 HCP’s) and 10 in-depth interviews (6 community residents with PC needs, 4 informal caregivers).
Results: We identified 5 themes in our data: (1) the organization of community-based volunteer work, (2) the volunteer, (3) the resident with PC needs, (4) the volunteer – community resident relationship, and (5) communication/sharing of information with HCPs. Knowledge about types of PC needs and about community resources were considered important. Examples of required skills are: willingness to listen, being present, responding empathically, being able to relate to the person they visit, balancing personal distance and proximity, starting and maintaining non-threatening conversations, and building a relationship of trust with the resident. Insight into missing skills and knowledge was obtained by discussed experienced difficulties with regard to learning from other volunteers, finding the right information to help residents, exploring care signals with the resident and making their presence known and contributing to professionals.
Conclusion: In order to fulfill their signposting role, it is important that volunteers have knowledge about PC needs and community resources. Ideally, they have good relational skills, communication skills, observation skills and skills that enable them to provide practical help. Volunteers should make their presence and role known to professionals and find out what they can mean for each other.
Funding: Flemish Cancer Fund
Integrated care models for older adults with depression and physical multimorbidity: a scoping review
Authors: Tops Laura , Beerten Simon Gabriël , Vandenbulcke Mathieu , Vermandere Mieke , Deschodt Mieke 
Published: January 2024

Objective: Multimorbidity, the coexistence of multiple chronic conditions occurring in one person at the same time, where one is not a known complication of the other, is a growing challenge in the care for older people with mental illness. In order to address both physical and mental illnesses in older people, integrated care management is required. The purpose of this scoping review was to provide a comprehensive overview of integrated care models for older adults (60+) with depression and physical multimorbidity. We identified the core components of the examined integrated care models and mapped the reported outcomes and implementation strategies.
Methods and analysis: We followed the methodology of Arksey and O’Malley’s. MEDLINE, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers from inception to May 2022. Studies composed in English or Dutch concerning integrated care interventions for older adults with major depression and physical multimorbidity were included. We used the micro-level SELFIE framework to map the core concepts of integrated care models. Outcomes were divided in person-centered and service themes.
Results: After title and abstract and subsequent full-text screening, 38 studies were included describing 13 different care models. The majority (n=21) were randomized controlled trials, followed by observational studies (n=6), study protocols (n=5), qualitative studies (n=4), and feasibility studies (n=2). Studies were conducted in the North-America (n=28), Europe (n=6), Asia (n=3) and Australia (n=1). In all care models, a multidisciplinary team with a care coordinator was involved. Also treatment interaction, continuity of care, individualized care planning, tailored holistic assessment and self-management support were elements of all care models. Informal care giver involvement and shared decision making were less often described as core elements. Discrepancy was detected in the information systems and technology that different care models used. Only seven care models reported on financial aspects of the intervention, e.g. the reimbursement on participation or the provision of financial incentives.
A total of 32 different outcomes were evaluated in the primary studies. Patient outcomes, e.g. functional status and depression symptoms, are well described by all care models. In contrast, little attention is paid to service outcomes such as emergency department visits or therapy attendance. Only two studies briefly described the implementation strategies used in the study.
Conclusion: The core elements that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g. the cost of the intervention for the healthcare user, more transparently.
Key words: Collaborative care, integrated care, psychosomatic medicine, geriatric psychiatry, care models
Opportunities and Barriers to Embedding Community Development Approaches in Local Systems
Authors: Walters Elizabeth , Harden Angela , Findlay Gail , Curtis-Tyler Katherine 
Published: January 2024

Background: Community development is a multi-faceted process which generates individual and community empowerment and can contribute towards reducing health inequalities, particularly in marginalised communities. Community development approaches refer to interventions, frameworks and programmes which work with communities to help them to identify their collective needs and challenges, and mobilises them to utilise available assets to generate long term change within the community. Funding for community development is typically provided on a short term ‘one off’ basis which limits its potential benefits. Continued investment, so that community development becomes normalised, is needed. Embedding community development within local systems, such as primary health care, local authorities and housing associations, is one way to achieve continued investment and to maximise benefits. However, there is little research on how to embed community development approaches within such systems. The research presented is part of a PhD project which aims to address this research gap.
Methods: Semi-structured interviews with Key Informants, who have experience embedding community development approaches within systems, are currently being conducted and shall be completed in December 2022. Participants are being recruited through purposive sampling. The interview topic guides were reviewed by a Public and Patient Involvement (PPI) panel in June 2021 and were developed around the Consolidated Framework for Implementation Research (CFIR). Data analysis is being undertaken also using the five domains of the CFIR (intervention characteristics, outer setting, inner setting, individual characteristics and intervention processes) in NVivo.
Results: Preliminary results have shown that all five domains of the CFIR impact the embedding process. Funding is frequently described as a barrier to implementation, but some participants believe that funding is incorrectly identified as a barrier, with only limited funds needed to embed this way of working. It is frequently mentioned that a strong belief in the purpose of the project and key individuals driving systemic change within the organisation are key to long term implementation. Other current emerging themes include the significance of the political setting at both a local and national level, as well as a multidisciplinary and inter-sectoral approach being adopted being a facilitator to change.
Future Implications: The results of this research will be collated with other parts of the PhD research project on embedding community development approaches in systems to improve health and reduce inequalities, to generate guidelines on how systems can embed community development approaches into their way of working. A panel of community members will contribute towards the generation of these guidelines, which will be made available to any local system considering adopting a community development approach.
Still struggling with the governance of interprofessional elderly care in mandated collaboratives: a qualitative study
Authors: Chrifou Rabab , Braspenning Jozé , Grit Kor , Stalenhoef Hanna 
Published: January 2024

Background: Governing interprofessional elderly care requires the commitment of many different organisations connected in mandated collaboratives. Research over a decade ago showed that the governance relied on clan-based mechanisms, while lacking formal rules and incentives for collaborations. Awareness and reflection were seen as first steps towards progression. We aim to re-identify critical governance features of contemporary mandated collaboratives by discussing cases introduced by the healthcare professionals and managers themselves.
Methods: Qualitative research took place from November 2019 to November 2020 in the Netherlands. First, the general setting of integrated elderly care was explored by interviewing healthcare managers and professionals (n=6). Second, in-depth interviews (n=24) were conducted with two different regional mandated collaboratives to learn more about critical governance features. The interviews were thematically analysed by the project team (authors) to synthesise the results and then were validated during a focus group.
Results: Little progress has been made in the governance of mandated collaboratives. The degree of formalization is kept low and the guiding principles of governance are trust and leadership. This approach meant that little attention is paid to the negotiation of interests, which makes it more difficult to implement the innovations in a sustainable manner. Moreover, the necessary resources are often lacking for the desired innovations. The fact that the mandated collaboratives are to a limited extent linked to the political or system level makes longer-term decisions and structural financing more difficult.
Conclusions: Although the reported cases are Dutch, the international scientific discussion is in line with our empirical results and is probably not limited to elderly care. Mandated collaboratives emerge to govern interprofessional elderly care, but after more than 10 years of international experience the mandated collaboratives still struggle to strike the right balance between formalization, trust and leadership. This makes it difficult to find available resources and to realize three-fold connectivity (care, organisation and system level). A more fundamental debate about our governance expectations of mandated collaboratives is needed to make focused progress.
Elderly Abuse: the importance of a scientific and a participatory approach
Authors: Messelis Els , Vanoutrive Dieter 
Published: January 2024

Introduction: The world population of older adults, aged 60 and older, will double from 542 million in 1995 to 1.2 billion in 2025. Despite the fact that many of them are in good health, more and more people will face dementia, multiple problems and elder abuse (WHO, 2021).
In this abstract, we will concentrate on elder abuse, which is a complex and multifactorial problem but moreover a taboo subject which needs more community awareness.
Purpose: Human rights and people’s health of older adults are being violated and this needs to be addressed on a massive scale. Efforts have already been done in developing scientific insights concerning early diagnosis, risk and protective factors as well as evidence-based interventions.
The problem is that professionals and organizations in our country often work above, under or next to each other on the subject. Moreover, the voices of older adults are neglected. Therefore we are making a call to cooperate in a participatory way. Integrated care will be the future to prevent elder abuse and to cope with it. We can’t do it alone.
Methods: In 2022 we could raise awareness through public involvement as both were invited in two programs on the Belgian Television:
Canvas TV Documentary ‘Als je eens wist’ – series 3 – Canvas (made by Hilde Van Mieghem) – May 10th 2022: Rating: 189.158.
Canvas Contact Webinar ‘Hoe doorbreek je het taboe van ouderenmis(be)handeling’ (Interviewer Joris Hessels) - May 16th 2022: Rating: >100.
Results: In both programs we raised the importance of breaking the taboo, the need for professional cooperation and the importance to listen to the voices of older adults through storytelling. In the Webinar we also could come in discussion with the audience. So we could address the health demands.
Afterwards, co-design approach was set up by Odisee Advanced Education in cooperation with Vlaams Ondersteuningscentrum Ouderenmis(be)handeling (VLOCO), organizing an event called ‘Elderly Care is Safe Hands – The Power of Multidisciplinary Cooperation’ – 01st December 2022 – Brussels. Messelis e.a. will present an ‘Intervention Piramide on Elder Abuse’ to involve all kinds of professional organizations on different levels. Also a panel debate will be set up with different organizations and professionals.
Conclusions: Our insights teach us that a very long way has already been made in terms of attention to elder abuse. Despite the many new insights and impact analyses, the topic of elder abuse remains a taboo and underappreciated problem. Only the tip of the iceberg is ever revealed.
If we want to tackle the problem, we have to break the taboo and cooperate in a participatory way. Therefore we want to discuss with the international audience to learn other Evidence Based Practices. We also have a wake -up call for the legislator in order to create a clear legal framework. Governments can also do more to prevent and address elder abuse but also to support professional equipment’s and ‘antennas’. We never stand alone.
In what context does goal-oriented care thrive? A qualitative study investigating how contextual factors influence implementation efforts for goal-oriented care.
Authors: Anthierens Sibyl , Raeymaeckers Peter , Declercq Anja , Verté Emily 
Published: January 2024

This study aims to explore how the concept of goal-oriented care is being picked up and adopted in Flanders, Belgium. Looking at the meso- and macro-level context: what drives the implementation process of goal-oriented care forward and what might hinder its uptake? This research helps individuals and organizations who want to introduce an innovation such as goal-oriented care inside their organization or in the broader primary care landscape by offering insights into an implementation process, in particular on how contextual elements influence implementation efforts.
We conducted qualitative research, performing in-depth interviews with n=23 respondents who are involved with the implementation of goal-oriented care within their professional function, either on project level or strategic/policy level. This way, we learned about the perspectives and lived experiences of a wide range of actors working for governmental institutions, non profit organizations, provider organizations, patient organizations, health or social care organizations and care councils. Data were collected using a semi-structured interview guide, audio recorded, and analyzed first inductively and then deductively using a categorization of constructs into structural, organizational, provider, patient, and innovation level factors, as described by Chaudoir et al. (2013).
Our preliminary findings suggest that facilitators for the implementation of goal-oriented care are mainly found on an organizational, provider and innovation level. Active commitment, overall recognition of goal-oriented care as quality of care and setting up a form of coordination are key. Most prominent barriers are found on a structural level, which shows that for goal-oriented care to be actually embedded in primary care the meso- and macro context structures and preconditions should be further shaped.
Our findings can contribute to further translate the concept of goal-oriented care into a practice-based intervention. It gives insight in how to perform a context scan for a primary care intervention and highlights the dynamics between contextual factors and implementation efforts. The next step is to define implementation strategies for goal-oriented care that come forward out of the identified barriers and facilitators.