Suchergebnisse

Time spent on family care of frail older people is difficult to substantiate because of its complex nature. The aim of this study is to check the content validity of existing questionnaires measuring the time spent on caring. Comparing the activities mentioned in the questionnaires with those from other data sources (three validated scales measuring the functional limitations in day-to-day activities and a qualitative study) enabled identification of important drawbacks in the questionnaires reviewed. A comprehensive list of activities was built in order to help future researchers to conduct effective data collection and thereby enable an in-depth analysis of family care supply.

Background / Objective: In the international literature, case management is often found to be a valuable way of organizing home care services and providing continuity of care. However, not many studies have provided evidence that case management can be effective in delaying institutionalization of older persons. The Belgian federal government is interested in funding home care projects that attain this goal. Twenty two case management projects will be analyzed during a 4-year period to reach a policy decision. Methods: Professional caregivers are asked to fill out the comprehensive geriatric assessment interRAI Home Care (HC) and an ad-hoc economic questionnaire describing the social services use and the time of informal care Informal caregivers also fill out the Zarit Burden scale 12 items and older persons fill out the WHOQOL-8. After descriptive statistics, the study population is stratified according to impairment levels (ADL, depression and cognition). Multivariate analyses are performed to identify significant associations and the effect of case management on the delay of institutionalization. Results: The study population consists of frail older persons in 21 case management projects (n=8534, average age: 79.7 median age 81.0, 67.6% women. The total of older persons in case management projects is 5004. This population shows moderate to high ADL impairment (47% CI(0.45 - 0.48)), moderate to high cognitive problems (27% CI(0.25 - 0.27)) and daily depression symptoms (27% CI(.25 - .28). These clients will be compared to a population not receiving any case management. International Journal of Integrated Care – Volume 14, 01 October – URN:NBN:NL:UI:10-1-116159– http://www.ijic.org/ Conclusion: This research will show the effect of case management combined with home care interventions in order to delay institutionalization of older persons. This information can help home care providers to adapt their services into a more integrated form of care model where case management will bring different types of services together. The results will also help policy makers to decide whether case management should be funded or not.

Background / Objective: In the international literature, case management is often found to be a valuable way of organizing home care services and providing continuity of care. However, not many studies have provided evidence that case management can be effective in delaying institutionalization of older persons. The Belgian federal government is interested in funding home care projects that attain this goal. Twenty two case management projects will be analyzed during a 4-year period to reach a policy decision. Methods: Professional caregivers are asked to fill out the comprehensive geriatric assessment interRAI Home Care (HC) and an ad-hoc economic questionnaire describing the social services use and the time of informal care Informal caregivers also fill out the Zarit Burden scale 12 items and older persons fill out the WHOQOL-8. After descriptive statistics, the study population is stratified according to impairment levels (ADL, depression and cognition). Multivariate analyses are performed to identify significant associations and the effect of case management on the delay of institutionalization. Results: The study population consists of frail older persons in 21 case management projects (n=8534, average age: 79.7 median age 81.0, 67.6% women. The total of older persons in case management projects is 5004. This population shows moderate to high ADL impairment (47% CI(0.45 - 0.48)), moderate to high cognitive problems (27% CI(0.25 - 0.27)) and daily depression symptoms (27% CI(.25 - .28). These clients will be compared to a population not receiving any case management. International Journal of Integrated Care – Volume 14, 01 October – URN:NBN:NL:UI:10-1-116159– http://www.ijic.org/ Conclusion: This research will show the effect of case management combined with home care interventions in order to delay institutionalization of older persons. This information can help home care providers to adapt their services into a more integrated form of care model where case management will bring different types of services together. The results will also help policy makers to decide whether case management should be funded or not.

1) Introduction Moving from existing segmented care to integrated care is complex and disruptive. It is complex in the sense that the type of changes and the timeframe of these changes are not completely predictable. It is disruptive in the sense that the process of change modifies but also is influenced by the nature of interactions at the individual and organisational level. As a consequence, building competences to govern the necessary changes towards integrated care should include capacity to adapt to unexpected situations. Therefore, the tacit knowledge of the stakeholders ("knowledge-in-practice developed from direct experience; subconsciously understood and applied"1) should be at the centre. However, the usual research and training practices using such a knowledge (i.e. action research or case studies), are highly time-consuming. New approaches are therefore needed to elicit tacit knowledge. One of them is agent based modelling (ABM)2 through computer simulation. The aim of this paper is to make a "showcase" of an agent-based model that uses the emergence of tacit knowledge and enhances loco-regional adaptive governance for improving integrated chronic care. 2) Theory/Methods We used a complex adaptive system's lens to study the health systems integration process. We applied key components of ABM to assess how health systems adapts through the dynamics of heterogeneous and interconnected agents (agents are characterised by their level of autonomy, heterogeneity, and interactions with other agents). The agent-based model was developed through a process where concept maps, causal loop diagrams, object-oriented unified modelling language diagrams and computer simulation (using Netlogo©) were iteratively used. 3) Results The agent-based model was presented to health professionals with variable experience in healthcare to elicit their perceptions and tacit knowledge. It consisted of agents with certain characteristics and transition rules. Agents included providers, patients, networks' or health systems' managers. Agents can adopt or influence the adoption of integrated care through learning and because of being aware, motivated and capable of decision making. The environment includes institutional arrangements (e.g., financing, training, information systems and legislation) and leadership. Different scenarios were created and discussed. Key rules to strengthen adaptive governance were reflected on. 4) Discussion and conclusion This study is an initial step of an exercise to use ABM as a means to elicit of and enhance tacit knowledge to strengthen governance for integrated care. It is expected that the study will foster dialogue between actors of loco-regional projects to integrate health and social care for chronic diseases in Belgium (a new program initiated by federal authorities). 5) Suggestions for future research Future research is expected to continue developing methods that combine ABM with participative exploration approaches to make better use of tacit knowledge in strengthening loco-regional governance for the development of integrated care. 1. Kothari, A. et al. The use of tacit and explicit knowledge in public health: a qualitative study. Implement. Sci. 7, 20 (2012). 2. Anderson, J., Chaturvedi, A. & Cibulskis, M. Simulation tools for developing policies for complex systems: modeling the health and safety of refugee communities. Health Care Manag. Sci. 10, 331–339 (2007).

1) Introduction Moving from existing segmented care to integrated care is complex and disruptive. It is complex in the sense that the type of changes and the timeframe of these changes are not completely predictable. It is disruptive in the sense that the process of change modifies but also is influenced by the nature of interactions at the individual and organisational level. As a consequence, building competences to govern the necessary changes towards integrated care should include capacity to adapt to unexpected situations. Therefore, the tacit knowledge of the stakeholders ("knowledge-in-practice developed from direct experience; subconsciously understood and applied"1) should be at the centre. However, the usual research and training practices using such a knowledge (i.e. action research or case studies), are highly time-consuming. New approaches are therefore needed to elicit tacit knowledge. One of them is agent based modelling (ABM)2 through computer simulation. The aim of this paper is to make a "showcase" of an agent-based model that uses the emergence of tacit knowledge and enhances loco-regional adaptive governance for improving integrated chronic care. 2) Theory/Methods We used a complex adaptive system's lens to study the health systems integration process. We applied key components of ABM to assess how health systems adapts through the dynamics of heterogeneous and interconnected agents (agents are characterised by their level of autonomy, heterogeneity, and interactions with other agents). The agent-based model was developed through a process where concept maps, causal loop diagrams, object-oriented unified modelling language diagrams and computer simulation (using Netlogo©) were iteratively used. 3) Results The agent-based model was presented to health professionals with variable experience in healthcare to elicit their perceptions and tacit knowledge. It consisted of agents with certain characteristics and transition rules. Agents included providers, patients, networks' or health systems' managers. Agents can adopt or influence the adoption of integrated care through learning and because of being aware, motivated and capable of decision making. The environment includes institutional arrangements (e.g., financing, training, information systems and legislation) and leadership. Different scenarios were created and discussed. Key rules to strengthen adaptive governance were reflected on. 4) Discussion and conclusion This study is an initial step of an exercise to use ABM as a means to elicit of and enhance tacit knowledge to strengthen governance for integrated care. It is expected that the study will foster dialogue between actors of loco-regional projects to integrate health and social care for chronic diseases in Belgium (a new program initiated by federal authorities). 5) Suggestions for future research Future research is expected to continue developing methods that combine ABM with participative exploration approaches to make better use of tacit knowledge in strengthening loco-regional governance for the development of integrated care. 1. Kothari, A. et al. The use of tacit and explicit knowledge in public health: a qualitative study. Implement. Sci. 7, 20 (2012). 2. Anderson, J., Chaturvedi, A. & Cibulskis, M. Simulation tools for developing policies for complex systems: modeling the health and safety of refugee communities. Health Care Manag. Sci. 10, 331–339 (2007).