Literature Collection

Perinatal mental illness is an important public health issue, with one in five birthing persons experiencing clinically significant symptoms of anxiety and/or depression during pregnancy or the postpartum period. The purpose of this study was to develop a consensus-based model of integrated perinatal mental health care to enhance service delivery and improve parent and family outcomes. We conducted a three-round Delphi study using online surveys to reach consensus (≥75% agreement) on key domains and indicators of integrated perinatal mental health care. We invited modifications to indicators and domains during each round and shared a summary of results with participants following rounds one and two. Descriptive statistics were generated for quantitative data and a thematic analysis of qualitative data was undertaken. Study participants included professional experts in perinatal mental health (e.g., clinicians, researchers) (n = 36) and people with lived experience of perinatal mental illness within the past 5 years from across Canada (e.g., patients, family members) (n = 11). Consensus was reached and all nine domains of the proposed model for integrated perinatal mental health care were retained. Qualitative results informed the modification of indicators and development of an additional domain and indicators capturing the need for antiracist, culturally safe care. The development of an integrated model of perinatal mental health benefitted from diverse expertise to guide the focus of included domains and indicators. Engaging in a consensus-building process helps to create the conditions for change within health services.

Patient-generated health data (PGHD) encompass health-related information created, recorded, and gathered by patients in their daily lives, and are distinct from data collected in clinical settings. PGHD can offer insight into patients' everyday health behaviors and conditions, supporting health management and clinical decision-making. The Veterans Health Administration (VHA) has developed a robust infrastructure to collect PGHD, including automatically collected data from digital sensors and patient-entered data. This effort is guided by comprehensive policy and strategy documents to ensure the secure storage and effective use of PGHD. This paper describes the development and implementation of an infrastructure to support PGHD within the VHA and highlights envisioned clinical and research uses of PGHD to advance health care for US veterans. The PGHD database was built to Fast Healthcare Interoperability Resources standards, facilitating secure data storage and exchange of PGHD. Clinical tools, such as the provider-facing dashboards, make PGHD accessible from the electronic health records. Research and evaluation efforts focus on evaluating PGHD's impact on patient engagement, clinical outcomes, and health care equity. The VHA's comprehensive PGHD infrastructure represents a significant advancement in personalized health care and patient engagement. The integration of PGHD into clinical practice can enhance shared decision-making and self-management, while research and evaluation efforts can address how to maximize the benefits of PGHD for veterans. The VHA's approach sets a benchmark for other US health care systems in leveraging PGHD to achieve the broad aims of enhancing stakeholder health care experiences, improving population health and health equity, and reducing costs.

Integrated healthcare models show great promise for addressing health disparities affecting Indigenous people, which are often rooted in the enduring effects of colonisation. These models align with Indigenous holistic views of health, recognizing the importance of community, cultural knowledge, and connection to land. To understand how these models are being developed and implemented, we conducted a systematic scoping review. Guided by Indigenous methodologies and community needs, we searched four databases (Web of Science, PubMed, Scopus and ProQuest) for peer-reviewed literature on integrated healthcare for Indigenous communities in Australia, Canada, the United States, and New Zealand. Included articles were appraised using the Indigenous quality appraisal tool and analysed from a relational perspective supported by the Joanna Briggs Institute's convergent integrated method. Nineteen publications met the inclusion criteria. Most studies were from Australia (53%) and Canada (26%), and most (74%) were published in the last five years, indicating a recent surge in interest. The review identified several key factors critical to the effective implementation of these models. These included strong community leadership and ownership, culturally and contextually relevant approaches, meaningful partnerships with stakeholders, and flexible service delivery. The review further highlights the importance of having motivated and well-trained health providers, as well as adequate funding. The wide variety of methods found in the studies reflects the complexity of integrated care and the influence of distinct cultural, disciplinary and contextual factors. The findings suggest that to improve healthcare and well-being for Indigenous populations, it is crucial to strategically address these key elements.

Primary health care teams are a key strategy in providing integrated care, particularly for patients with multiple chronic conditions. Despite a strong commitment to improving primary health care through team-based care globally, challenges to its implementation remain. A comparative policy analysis was conducted in four Canadian provinces (British Columbia, Alberta, Ontario, and Quebec) to examine the policies and structures supporting service integration for patients with two or more chronic conditions through primary health care teams. Results are reported on Phase 3 of the project, including a national knowledge translation event to refine recommendations and develop actions for implementing recommendations related to team-based primary health care in policy and practice. Our virtual knowledge translation event took place in June 2022; with 25 participants including policymakers, decision-makers, providers, patients and researchers. Eight key recommendations were discussed and revised with feedback and strategies for implementation developed. Five themes were identified from the discussions: 1) composition of the team and access; 2) communication and electronic health records; 3) remuneration; 4) patient engagement; and performance measurement. Recommendations for policy and practice are outlined and compared to existing Canadian and international literature.

The persistent challenge of implementing meaningful and sustainable change in healthcare is well-documented. Barriers include resource limitations, technical insufficiencies, and resistance from entrenched processes and systems within hospitals, clinics, and health systems. Traditional quality improvement (QI) frameworks, while valuable, often fall short in addressing the variability and unpredictability of human behavior and decision-making that reflects the uniqueness of individual experiences and backgrounds working together in a complex organization. In response, Hackensack Meridian Health (HMH), a large integrated health system, established the Agile Institute to promote and diffuse methodologies from Agile Science (sprints, feedback loops, techniques from behavioral psychology to encourage certain behaviors, etc.) as a means to accelerate and sustain quality improvement efforts in care and patient outcomes. This narrative case study describes the conception, structure, and impact of the Agile Institute at HMH. The Institute was designed around three core pillars: training and education, consultation, and organizational identity development. Bootcamps and certification programs equipped staff across the health system with the knowledge and mindset needed to apply Agile. Consultative groups facilitated co-design sessions and iterative sprints, fostering collaboration and interdisciplinary development and implementation of innovative solutions. Intentional brand development helped to build engagement and credibility in both internal and external audiences. Over its first year, the Agile Institute achieved significant milestones: training over 130 staff, launching collaborative physician networks, and supporting system-wide initiatives that improved standardization and patient outcomes. The Institute's approach-grounded in psychological safety, stakeholder co-design, and iterative feedback-demonstrated the value of embedding Agile principles not only in QI projects but also in organizational culture. Lessons learned highlight the importance of a minimally viable, adaptable structure and the necessity of aligning Agile strategies with both system and individual priorities. The HMH Agile Institute offers a replicable model for other healthcare organizations seeking to drive sustainable, system-wide transformation through Agile.

BACKGROUND: Veterans Health Administration (VHA) has been at the forefront of offering integrated and patient-centered care to address the complex needs of more than 30,000 Veterans with HIV in the United States of America. These Veterans present with diverse cultural identities, personal values, and goals pertinent to their care, and they are often managing multiple comorbid chronic conditions, mental health diagnoses, and psychosocial stressors alongside HIV. The quality of their care has often been affected by stigma, minority stress, and the quality of the patient-provider relationship and associated collaborations over treatment approaches and goals, which has a direct effect on outcomes. OBJECTIVE: At San Francisco VA Health Care System, the Infectious Disease Care and Resilience (IDCaRe) team was established to improve outcomes for Veterans with acute needs or persistent difficulties in care delivery and efficacy. METHOD: A five-step model to address complex needs in HIV care was adapted from existing literature and evidence base, combined with a culturally-aligned, interdisciplinary care orientation. This model was implemented with patients determined to be at high-risk for poor health engagement. A representative composite case study demonstrates the process. RESULTS: Three Veterans underwent the intervention with results presented. Lessons learned and future discussions are also discussed. CONCLUSION: The IDCaRe model has promise as an integrated, patient-centered, behaviorally-grounded intervention for improving HIV-related care outcomes for Veterans with complex needs.