Examining the influence of integrated home and community care on Quadruple Aim and Health Equity outcomes across the health system
Notice bibliographique
Résumé
Introduction: Many countries with publicly funded health systems, such as Canada, are looking to transform how people receive long-term care and services by shifting more care into the community and strengthening community-based options . Despite the potential of integrated home and community care to address the needs of an aging population in their desired location, the influence of these programs on the broader health system is not well understood. Methods: We conducted a scoping review following Levac et al.’s 2010 methodology. A comprehensive literature search was undertaken in three databases (Ageline, CINAHL, MEDLINE) to identify literature published in the last decade that examined the outcomes of integrated home and community care programs related to the health system (acute care, emergency services, primary care, informal care, and facility-based long-term care) through the lens of the Quadruple Aim (client/caregiver experience, provider well-being, population health, costs care) and Health Equity. Major integrated care journals and citations of included articles were also hand searched. Consultation meetings were held with leadership of a local integrated care team and operations and strategy leaders of a Canadian health social enterprise to support interpretation of results and the development of meaningful messaging applicable to program development, evaluation planning and policy work. Results: 5,656 titles and abstracts underwent screening, with 569 full-text articles assessed for eligibility and 50 articles moving the extraction phase. Due to unclear descriptions of interventions, including what care was provided by whom, or how the care model facilitated integrated care delivery in home and community settings, many identified articles were excluded. Preliminary findings indicate an evidentiary focus on hospital or emergency medical service utilization outcomes of integrated home and community care programs (i.e., readmission rates, length of stay, and emergency department visits), along with population health outcomes. Few articles investigated economic impacts of patient and/or provider experiences or health equity related to programs. There is a predominance of articles focusing on integrated community palliative care programs. Local and international programs which were identified as important examples of integrated home and community care in practice, were not represented in the peer-reviewed literature. More detailed findings and results from consultations will be available at ICIC24. Learnings and next steps: Synthesis and application of evidence on integrated home and community care models requires researchers to ensure clear description of model components and study settings in study reporting. To support development and use of evidence on the outcomes of integrated home and community care programs for transformative system change, more collaboration between health services researchers and health and social care organizations in a learning health system model is needed. Ensuring future research focuses on outcomes beyond hospital-based service utilization is needed to build rationale across the continuum of care for broader uptake, scale and spread. Consensus on meaningful short and long-term metrics within each component of the Quadruple Aim and Health Equity framework could support more robust and consistent evaluation of integrated home and community care programs and comparison of outcomes to support political, operational, clinical and financial decision-making.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,031 | 0,114 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,004 |
| Bibliométrie | 0,015 | 0,019 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,006 | 0,003 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».