Integrated Care Program: An Evaluation Study

Background

Integrated care programs began operating worldwide in the 1970s as one of the solutions for the growing need to coordinate various care systems and provide an integrated response to the needs of older adults living in the community. In 2014/15, an integrated care program was launched in Israel as a pilot project in Ashkelon and from 2016 to 2019, the pilot was expanded to four local authorities. In early 2020, it was decided to implement an integrated care program for older adults living in the community in 33 local authorities (hereinafter: the program).

The core of the program is the coordination between two service systems – one providing health services and the other providing welfare services. Each system is represented by a service professional: the health system by a nurse and the welfare system by a social worker (hereafter: the coordinators). Their role is to assess the needs of the participants in the program, propose a treatment plan, and coordinate the treatment plan between the two systems.

The program operates according to three models: the integrated model, in which a social worker from the social services department and a nurse from the health maintenance organization (HMO) work together in the social services department; the intra-HMO model, in which a social worker and a nurse from the HMO work together within the HMO; and the integrated model with the assistance of an administrator, in which the team operates within the social services department. The program is operated by JDC-Eshel.

Study Goals

The main goals of the study were to examine the impact of the program on the participants, to assess the systemic effects of the program’s activities, and to estimate the program’s cost and the savings it generates due to the more efficient use of services.

Methods

The evaluation was a quantitative-comparative study. The data were collected using various methods: telephone interviews with the program’s professional staff, program participants (hereinafter: the experimental group), and a control group; online questionnaires for the program coordinators, program staff and other professionals from the community working with the program; and an analysis of administrative data from two HMOs (Clalit Health Services and Maccabi Health Services) regarding the utilization of health services by the program participants.

Main Findings

Participants in the experimental group reported having more trust in the welfare system relative to participants in the control group. They also felt that the welfare services were doing everything necessary to provide them with the best care. The experimental group received more home health care treatments from the HMOs and more geriatric assessments than the control group. Additionally, the control group reported more visits to clubhouses and day centers for older adults relative to the experimental group. For most of the other services examined, no differences were found between the groups.

The professionals expressed a high level of satisfaction with the program, and many of the program staff and other professionals from the community noted that the program had become a useful part of their “toolkit” and that it contributed to systemic cooperation among care providers. Despite the organizational challenges of integrating elements from the welfare and health systems, the program managed to create internal and external cooperation. However, a number of areas were identified for improvement in order to enhance and strengthen the program such as: the availability of care coordinators and the ability to contact them, involvement of the patient and his/her family in decision-making and familiarizing the coordinators’ work colleagues with the program and the role of the care coordinators.

The analysis of administrative data on the utilization of health services by the program participants indicates a decrease in the average number of visits to hospital emergency rooms and an increase in the average number of visits to community urgent care centers. This decrease translates into a cost saving equal to approximately 9% of the average program cost per participant.

 Conclusion

The research findings indicate that the program has had a degree of success in improving the condition of its participants and in providing them with individualized care. It was also found to be particularly effective in identifying and addressing problems quickly and providing medical and welfare services to those in need.

According to the program staff and other professionals from the community, the added value from the professional collaboration between a nurse and a social worker within the program surpasses the usual benefit of collaboration between organizations.

The program faces organizational challenges in integrating the two systems. While it appears that the program is successfully addressing these challenges, with care coordinators and professionals reporting high satisfaction according to various parameters, there are areas that need improvement in order to enhance and strengthen the program.

The program succeeded in reducing the number of visits to emergency departments (thereby reducing the average program cost per participant by approximately 9%) by directing patients to the appropriate medical services and providing medical and welfare services to those in need of services. Thus, the program contributes to the efficient use of health and welfare services.