Integrated models of care delivery for the frail elderly: international perspectives
Bibliographic record
Abstract
Interest is growing in integrated systems of care for the frail elderly. Few such systems have been both documented and evaluated in a rigorous manner. The present article provides an international review of such systems. The literature on integrated care covered the period from 1997 to 2010, inclusive. Some 2,496 citations were identified from Age Line, PsycINFO, CINAHAL and MedLine and were reviewed. To be included in this paper, articles had to provide a good description of the care delivery system and good quality evaluations. Only nine articles were retained. Most of the articles reviewed described some form of coordinated care without evaluation. There were essentially two types of models of integrated care delivery for the frail elderly. One was a smaller, community-based model that relied on cooperation across care providers, focused on home and community care, and played an active role in health and social care coordination. The second type of model was a large-scale model that could be applied at a national/provincial/state, or large regional health authority, level, had a single administrative authority and a single budget, and included both home/community and residential services. Integrated care delivery can be achieved in various ways. Irrespective of which model is adopted, some of the key factors to be considered are how care can be coordinated effectively across different types of services, and how all the care provider organizations can be coordinated to ensure continuity of care for frail elderly persons. Los sistemas integrados de asistencia para los ancianos frágiles suscitan cada vez más interés. Hay pocos sistemas de este tipo que hayan sido documentados y evaluados de forma rigurosa. Este trabajo presenta un estudio internacional de estos sistemas. Correspondientes al periodo de 1997 a 2010, se identificaron y revisaron 2496 referencias bibliográficas de Age Line, PsycINFO, CINAHL y MedLine. Para ser incluidos en el estudio, los artículos debían ofrecer una buena descripción del sistema de asistencia sanitaria y unas buenas evaluaciones de calidad. Sólo se seleccionaron nueve artículos; la mayoría de ellos describían algún tipo de asistencia coordinada sin evaluación. Principalmente se han encontrado dos tipos de modelos de atención sanitaria integrada destinada a los ancianos frágiles. Uno era un modelo comunitario pequeño basado en la cooperación entre profesionales sanitarios, se centraba en la asistencia domiciliaria y comunitaria, y tenía un papel activo en la coordinación de la asistencia sanitaria y social. El segundo era un modelo a gran escala que podía ser aplicado por autoridades sanitarias nacionales/provinciales/estatales/regionales, que tenía una autoridad administrativa única, un solo presupuesto e incluía tanto servicios domiciliarios/comunitarios como residenciales. Hay varios modos de lograr una asistencia sanitaria integrada. Algunos de los factores clave a tener en cuenta, independientemente de cuál sea el modelo que se adopte, son cómo coordinar la asistencia entre los diferentes tipos de servicios de forma eficaz y cómo asegurarse de que todas las organizaciones asistenciales trabajan juntas para garantizar la continuidad de la asistencia para las personas mayores frágiles.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.006 | 0.012 |
| Science and technology studies | 0.001 | 0.006 |
| Scholarly communication | 0.012 | 0.017 |
| Open science | 0.003 | 0.006 |
| Research integrity | 0.005 | 0.007 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".