Journal of Multidisciplinary Healthcare (Jun 2024)
Implementation of a New Integrated Healthcare Model; Quality Aspects to Support the Complex Home Care of Older Adults with Multiple Needs
Abstract
Lena-Karin Gustafsson,1 Els-Marie Anbacken,2 Gunnel Östlund,2 Anna Bondesson,1 Tina Pettersson,1 Viktoria Zander3 1Division of Caring Science, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden; 2Division of Social Work, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden; 3Division of Health and Welfare Technology, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, SwedenCorrespondence: Lena-Karin Gustafsson, Division of Caring Science, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden, Tel +46 70 7874420, Email [email protected]: This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people’s homes.Materials and Method: Open-ended group interviews with personnel were carried out, three of the group interviews pre-implementations of the model, and three of the group interviews post-implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis.Results: The quality of the integrated care model was based on care-chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person-centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants’ experiences of the post-implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting.Conclusion: Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question.Plain language summary: The intention of the present study was to follow the process of working with a new model of providing care at home, thus preventing increased numbers of hospital readmissions, based on the professionals´ point of view of what quality care is for older adults with complex care needs due to multimorbidity, living in their own home. The professionals were interviewed in group settings on several occasions during the implementation.The result showed hopeful expectations expressed by the professionals before the new model was implemented, such as a hope for getting more time for high-quality care for the older adults with multimorbidity. During the teamwork, the conversation within the team members was praised as a key factor that included shared professionalism from professionals with different levels of education and focus on their work. According to the staff, unnecessary hospital stays were reduced, while the interprofessional care-chain cooperation was improved through the work of the integrated care team. For many team members, the positive difference in both work and care satisfaction was highlighted in comparison to regular home care as they were able to use their multi-disciplinary skills and support.Keywords: integrated-care model, multi-morbidity, interprofessional care, home-based care, person-centred integrated care
