Integrated care

Integrated Care – also known as case management, shared care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated Care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems.

Integrated Care covers a complex and comprehensive field and there are many different approaches to and definitions of the concept. WHO gives the following definition: ''Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency''.

Central concepts
The Integrated Care literature distinguishes between different ways and degrees of working together and three central terms in this respect are autonomy, co-ordination and integration. While autonomy refers to the one end of a continuum with least co-operation, integration (the combination of parts into a working whole by overlapping services) refers to the end with most co-operation and co-ordination (the relation of parts) to a point in between.

Distinction is also made between horisontal integration (linking similar levels of care, e.g. multiprofessional teams) and vertical integration (linking different levels of care, e.g. primary, secondary and tertiary care).

Closely related to Integrated Care is also the concept of continuity of care emphasizing the patient’s perspective through the system of health and social services and hence providing valuable lessons for the integration of systems. Continuity of care is often subdivided in 3 components: 1. Continuity of information (though shared records), 2. Continuity across the secondary-primary care interface (discharge planning from specialist to generalist care), 3. Provider continuity (seeing the same professional each time with value added if there is a therapeutic, trusting relationship).

The concept of Integrated Care seems particularly important to service provision to the elderly, as elderly patients often are chronically ill and subjects to co-morbidities and thus in special need of continuous care.

Example
The FP7 Homecare project is an example of an integrated care pathway addressing the continuity in discharge planning using the home of the patient to bridge transition from health to social services.