Integrated care

Integrated care – also known as integrated health, coordinated care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems.

Integrated care covers a complex and comprehensive field and there are many different approaches to and definitions of the concept. WHO gives the following definition: ''Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency''.

Central concepts
The integrated care literature distinguishes between different ways and degrees of working together and three central terms in this respect are autonomy, co-ordination and integration. While autonomy refers to the one end of a continuum with least co-operation, integration (the combination of parts into a working whole by overlapping services) refers to the end with most co-operation and co-ordination (the relation of parts) to a point in between.

Distinction is also made between horizontal integration (linking similar levels of care, e.g. multiprofessional teams) and vertical integration (linking different levels of care, e.g. primary, secondary and tertiary care).

The concept of continuity of care is closely related to integrated care; it emphasizes the patient’s perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided in 3 components: 1. Continuity of information (though shared records), 2. Continuity across the secondary-primary care interface (discharge planning from specialist to generalist care), 3. Provider continuity (seeing the same professional each time with value added if there is a therapeutic, trusting relationship).

The concept of integrated care seems particularly important to service provision to the elderly, as elderly patients often are chronically ill and subjects to co-morbidities and thus in special need of continuous care.

Contradiction to any attempt of merging roles
In contrast to the moves of managers and comptrollers with headcount cutting, the proper integrating of care does not mean the merging of roles. It will steadily remain uneconomical to make a physician serve as a nurse. And the opposite approach is strictly prohibited by accreditation and certification schemes anyhow. Hence the mix of staff for the various roles shall be maintained to enable a profitable integration in caring.

Examples

 * The United States Department of Veterans Affairs is the largest integrated care delivery system in the U.S.
 * Kaiser Permanente and the Mayo Clinic are the two largest private U.S. systems