Cara Brown is a Ph.D. student in the Department of Community Health Sciences in the Rady College of Health Sciences at the University of Manitoba. She is interested in improving health care services for older adults, particularly in regards to transitions of care. She is also a licensed occupational therapist and an instructor in the Department of Occupational Therapy in the Rady College of Health Sciences at the University of Manitoba.
A Conceptual Framework for Patient-Level Integrated Care Indicator Development
Linda Fieldstone, M.Ed., former Supervisor of Family Court Services for the 11th Judicial Circuit, Florida, Miami-Dade County, Florida. Leadership roles include past President of the Association of Family and Conciliation Courts (AFCC); past President of its Florida Chapter (FLAFCC); Secretary of the AFCC Task Force on Parenting Coordination 2005 and on Task Force to update standards; Florida Supreme Court Rules and Policies Committee. She is involved in research, training, and consultation internationally and has written articles on high conflict families, family court services, empirically based parenting plans and parenting/eldercaring coordination. Ms. Fieldstone is currently Co-Chair of the ACR and FLAFCC Elder Justice Initiatives on Eldercaring Coordination and servicing the community through Family Resolutions, LLC, to provide conflict resolution opportunities directly to families of all ages before, during or after court actions.
Background: Integrated care aims to provide high quality care to older adults with chronic disease or disability. It does this by addressing and coordinating the complex health, social and functional needs of this population. Integrated care programs are most successful when implemented comprehensively at both the macro level, such as with policy and administrative integration, and the micro level, such as with clinical integration. The development of integrated care evaluation tools is in its infancy. Most tools measure clinical delivery of integrated care from the provider perspective, rather than from objective patient data.
Objective: To address this gap, we aimed to determine the feasibility of developing individual-level integrated care indicators for older adults with complex care needs that could be derived from medical charts.
Method: Using literature on integrated care, we developed four themes that address the integrated care needs of older adults transitioning between hospital and home: Community-Hospital Coordination and Continuity, Care Coordination and Multidisciplinary Care for Individualized Care, Within Hospital Coordination and Continuity, and Patient and Family Involvement. These themes guided the extraction of data from 214 hospital medical records of older adults who had been hospitalized under the general medicine service and discharged with continuing care services. Specific integrated indicators were developed based on: the completeness of the chart data, the time required for converting the chart data into an indicator, and the relevance of the indicator to one or more of the four integrated care themes.
Results: There was high variation in the ease of extraction and analysis of the indicators. For example, whether or not the patient had a primary care provider prior to admission was an efficiently extracted indicator since it is documented in a standardized fashion by the study setting. On the other hand, extracting data on communication between the hospital and community care providers was more challenging, due to a lack of standardization in chart documentation. However, without the inclusion of indicators gathering non-standardized information, there is inadequate breadth in the indicators to address the complex concept of integrated care over other similar but narrower concepts, such as continuity of care.
Conclusion: Individual-level integrated care indicators collected via patient charts need to be tailored to the documentation procedures of the study setting. This poster presents a conceptually grounded framework for the development of clinical-level integrated care indicators that can be adapted for different settings to determine within-program integrated care practices.