Literature Collection

This scoping review explores the concepts of integrated healthcare, interprofessional collaboration, and healthcare funding within the context of primary and allied healthcare. A systematic database, internet, and manual search of included article reference lists sought published and gray literature. From an initial 8,122 papers, a total of 63 met the inclusion criteria and were assessed using a three-stage narrative synthesis that sought to meaningfully account for the complexity and heterogeneity of the included papers: (1) Preliminary analysis involved data extraction and mapping of key themes, including article, integration, collaboration, and funding characteristics; (2) Robustness evaluation involved critically appraising the methodological quality of the literature using the Crowe Critical Appraisal Tool, and the Johns Hopkins Nursing Evidence-based Practice Research Evidence Appraisal Tool, and Non-Research Evidence Appraisal Tool; and (3) Relationship exploration found that most primary and allied healthcare services still operate under fee-for-service funding arrangements that discourage the delivery of integrated collaborative, coordinated, and complex care, instead encouraging traditional siloed and hierarchical approaches that are linked to workload, remuneration, and job satisfaction inequalities between primary and allied healthcare professions. Future research exploring sustainable blended funding models that encourage greater collaboration and integration among primary and allied healthcare is needed.

BACKGROUND: We analyzed early outcomes regarding the impact of our integrated alcohol-associated liver disease (ALD) clinic on patients with ALD and alcohol use. METHODS: We conducted a retrospective study of patients with ALD who were evaluated in our integrated clinic from May 1, 2022, to December 31, 2023. Primary outcomes included differences in baseline clinical/demographic data between patients who accepted versus declined an appointment and changes in the severity of ALD, alcohol consumption, functional status, hospital utilization, and remission in alcohol use disorder for evaluated patients. RESULTS: Patients who declined appointments (n=66) had higher median no-show rates (15.0 [8.0,30.0] vs. 8.5 [3.25,15.0], p<0.001), social vulnerability index (0.53 [0.26,0.79] vs. 0.38 [0.17,0.63], p=0.033), and proportions of cirrhosis (78.8% vs. 59.8%, p=0.017) versus evaluated patients. Comparison of baseline to first follow-up visit for evaluated patients (n=102) demonstrated significant reductions in median AST (59.5 [41.75, 89] vs. 44.5 [33.5, 56.25], p<0.001), alanine-aminotransferase (33.5 [20,45.25] vs. 26.5 [18.75,33.0], p=0.017), total bilirubin (1.6 [0.7,3.3] vs. 1 [0.5,1.9], p=0.001), phosphatidylethanol (263 [35, 784] vs. 0 [0, 163], p<0.001), MELD-3.0 and Sodium scores for patients with alcohol-associated hepatitis and cirrhosis (16 [11, 18.75] vs. 12 [9, 14], p<0.001), 14 [9.25, 17.75] vs. 11 [8.5, 14], p<0.001), and Child-Turcotte-Pugh scores for patients with cirrhosis (9 [6, 10.5] vs. 7 [6, 9], p<0.001). The proportion of patients with active-severe alcohol use disorder significantly decreased (85.2% vs. 51.9%, p<0.001). Additionally, patients had significant reductions in emergency department utilization (incidence rate ratio of 0.64 emergency department visits/month (p=0.002) and 0.71 hospital admissions/month (p=0.025). However, after considering the false discovery rate, the reduction in hospitalization admissions/month was not statistically significant (False Discovery Rate adjusted p=0.056). CONCLUSIONS: Our integrated approach led to reductions in liver injury, degree of liver decompensation, alcohol use, and ED utilization, and remission in AUD in a population of both non-transplant ALD and post-transplant patients.

RATIONALE, AIMS AND OBJECTIVES: Integrated health management represents a pivotal strategy for enhancing both operational efficiency and the quality of care in hospital environments. This study undertakes a systematic literature review to examine the influence of integrated health management on hospital administration. The principal aim is to synthesise a structured body of knowledge capable of informing strategic clinical decision-making and shaping future research trajectories. METHODS: This investigation employed the Constructivist Knowledge Development Process (ProKnow-C), a methodological framework implemented in four sequential stages: (i) the selection of pertinent peer-reviewed literature to construct a representative portfolio; (ii) bibliometric analysis to evaluate the impact and consistency of sources; (iii) systemic analysis to categorise thematic dimensions; and (iv) the identification of research gaps and prospective avenues for investigation. A total of 20 scholarly articles were scrutinised using both quantitative and qualitative criteria. RESULTS: Three principal approaches to integrated hospital management were identified: (1) the utilisation of management tools-such as the Balanced Scorecard and performance indicators-to improve service delivery efficiency; (2) strategies for performance enhancement, underpinned by strategic planning, detailed operational analysis, and robust internal controls; and (3) financial management approaches, grounded in hospital information systems and evidence-based decision-making. Bibliometric findings confirmed the internal coherence of the selected portfolio, while the systemic analysis demonstrated the presence of shared conceptual frameworks throughout the literature. CONCLUSIONS: This systematic review contributed to the consolidation of a structured knowledge base concerning integrated hospital management and highlighted critical areas for future research. Further enquiry is warranted into models for clinical risk mitigation, the optimisation of resource allocation, and the development of financially viable management practices. The ProKnow-C methodology proved robust and suitable for guiding research within the domains of clinical evaluation and healthcare management.

The current study explored the use and preliminary outcomes of physical health treatment elements integrated into a traditional brief cognitive behavioral therapy (bCBT) approach for medically ill veterans with depression and/or anxiety. Data were collected as part of a pragmatic randomized trial examining patient outcomes of bCBT versus an enhanced usual care condition. bCBT was delivered to participants by Veterans Health Administration (VA) mental health providers in the primary care setting. Using a skill-based approach, providers and participants selected modules from a list of intervention strategies. Modules included Taking Control of Your Physical Health, Using Thoughts to Improve Wellness, Increasing Pleasant Activities, and Learning How to Relax. Skill module use and impact on treatment completion and clinical outcomes were explored for participants randomized to bCBT who received at least one skill module (n = 127). Utilization data showed that participants and providers most commonly selected the physical health module for the first skill session. Receiving the "physical health" and "thoughts" modules earlier in treatment were associated with a higher likelihood of treatment completion (defined as four or more sessions). Preliminary outcome data suggest that the physical health skill module was equally effective or superior to other bCBT skill modules. Results suggest that incorporating physical health elements with a bCBT approach hold the potential to positively impact treatment engagement/completion and may result in improved outcomes for medically ill patient populations.

Recent years have seen an emergence of collaborative primary care models in the English National Health Service and other international health systems. Primary Care Networks (PCNs) were introduced in England in July 2019, marking the first time collaboration between general practices was incentivised through a nationwide policy. While participation was not mandatory, nearly all general practices joined a PCN, largely due to strong financial incentives. Our study aim was to estimate the impact of PCNs on emergency hospitalisations using an interrupted time series design. Quarterly data between October 2016 and March 2023 from the North West London Whole Systems Integrated Care dataset was used to construct two primary outcomes: all-cause and ambulatory care sensitive conditions (ACSC) emergency hospitalisations, as well as Accident and Emergency attendances, considered as a secondary outcome. Furthermore, we analysed whether the impact of PCNs varied based on practice characteristics. A reduction in all-cause and ACSC hospitalisations was observed following the PCNs' introduction, until the start of the COVID-19 pandemic. The analysis also revealed a smaller reduction in ACSC hospitalisations among practices with more deprived patient populations and larger populations of patients with long-term conditions. While PCNs' implementation appears to have led to a reduction in emergency hospitalisations in North West London, this effect was only observed in the very short term as it stopped with the COVID-19 pandemic. Future studies should examine the effect across England and evaluate their continued impact.