Examining the influence of integrated home and community care on Quadruple Aim and Health Equity outcomes across the health system
Bibliographic record
Abstract
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.
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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 | 0.031 | 0.114 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.015 | 0.019 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.006 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
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".