Integrated Care Pathways

Fears plans block pathway to full integration

In the debate over the government’s health reforms. But while almost everyone in the NHS believes it is, as 1066 and All That would have put it, “a good thing”, people mean many different things by it.

To some it is the vertical integration of care between organisations. So an NHS foundation trust might run not just itself, but community services and family doctors too, providing seamless care for patients from a single budget. In essence, this is what Kaiser Permanente and some of the best care providers do in the US.

Cameron on integrated care « QIPP Right Care – Blog

David Cameron’s speech yesterday on the NHS makes much use of words such as “integrated” care and “accountable” care – but what is understood by these concepts? From the forthcoming Right Care glossary, we have captured the following useages in medical literature:

1.    “Integrated health care systems capable of meeting certain quality standards and improving the coordination of care.” 2010;363:2579.

3.    “ACOs consist of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth. Our definition emphasizes that these cost and quality improvements must achieve overall, per capita improvements in quality and cost, and that ACOs should have at least limited accountability for achieving these improvements while caring for a defined population of patients.” 2010;29(5):982.

4.    “The ACO model is based on 3 design principles: accountability of the ACO for the entire continuum of care for a defined population of patients: payment reforms that reward quality improvement and slow spending increases while avoiding excessive financial risk for the ACOs; and reliable performance measurement to support improvement and provide public confidence that lower cost can be achieved with better care.” 5.    “ACOs could take various forms, but they have generally been conceived of as groups of primary care physicians, specialists, and sometimes hospitals, joined together in either vertically integrated systems or networks that are accountable for improving the quality and affordability of care for a defined patient population and that are eligible for financial bonuses if performance goals are met.” Source : Sinaiko AD, Rosenthal MB. (2010) Patients’ Role in Accountable Care Organizations. N Engl J Med 363(27):2583-2585.

6.    “ACOs being not with insurance but with a collection of providers (physicians and faciilties) who come together and accept internal payment arrangements that facilitate the provision of efficient, high-quality care.” ‘An ICP is a multidisciplinary outline of anticipated care, placed in an appropriate time frame, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes.   variation from the pathway may occur as clinical freedom is exercised to meet the needs of the individual patient/client.’ A term that can mean more than one thing often ends up meaning nothing – how can we differentiate?