Organizing integrated health-care services to meet older people's needs.
Organizing integrated health-care services to meet older people's needs.
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DOI：
10.2471/blt.16.187617
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发表时间：
2017-11-01
影响因子：
11.1
通讯作者：
Beard JR
中科院分区：
文献类型：
--
作者：
Araujo de Carvalho I;Epping-Jordan J;Pot AM;Kelley E;Toro N;Thiyagarajan JA;Beard JR
在大多数国家，需要从根本上改变老年人临床护理的重点。不应试图以互不相关的方式管理众多疾病和症状，而应强调采取干预措施，优化老年人一生的身心能力，使他们能够做他们珍视的事情。这反过来又要求改变服务的组织方式：保健系统内部以及保健和社会服务之间应当更加一体化。现有的组织结构不必合并;相反，各种各样的服务提供者必须以更协调的方式共同努力。有证据表明，老年人的综合保健和社会护理有助于改善健康状况，其成本相当于通常的护理，从而比更熟悉的工作方式带来更好的投资回报。此外，老年人可以更长时间地参与社会并为社会作出贡献。临床护理一级的一体化尤为重要：老年人应接受全面评估，以优化功能能力，所有提供者应共享护理计划。在卫生系统一级，综合护理需要：㈠支持性政策、计划和监管框架; ㈡劳动力发展; ㈢投资于信息和通信技术; ㈣使用集合预算、捆绑支付和合同奖励。然而，可以在各级卫生保健部门采取行动，从一线提供者到高级领导人-每个人都可以发挥作用。
In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people’s physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services. Existing organizational structures do not have to merge; rather, a wide array of service providers must work together in a more coordinated fashion. The evidence suggests that integrated health and social care for older people contributes to better health outcomes at a cost equivalent to usual care, thereby giving a better return on investment than more familiar ways of working. Moreover, older people can participate in, and contribute to, society for longer. Integration at the level of clinical care is especially important: older people should undergo comprehensive assessments with the goal of optimizing functional ability and care plans should be shared among all providers. At the health system level, integrated care requires: (i) supportive policy, plans and regulatory frameworks; (ii) workforce development; (iii) investment in information and communication technologies; and (iv) the use of pooled budgets, bundled payments and contractual incentives. However, action can be taken at all levels of health care from front-line providers through to senior leaders – everyone has a role to play.