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Integrated Care

 

Across OECD countries, ageing populations and increasing numbers of people with chronic diseases shift the focus of health care services away from acute care addressing longer episodes of health care needs. Almost two in three people aged over 65 years live with chronic conditions. This has fuelled the debate on the need for integrated delivery systems capable of addressing continuous, coordinated, and high quality care delivery throughout people’s lifetime.

In recent decades, OECD countries have introduced integrated care initiatives aimed at ensuring individuals receive the right care, in the right place, at the right time, but existing organisational and financing structures appear to hamper their success.

Integrated-care

WHAT IS INTEGRATED CAre ?

The recent pandemic has only amplified the need for various parts of the health systems to work together to deliver seamless care. While the care of patients often focuses on acute care in hospitals, patients’ experiences and outcomes of care depend on how care is provided across a pathway of services. These begin before access to acute care, and extend well beyond a patient’s stay in hospital. As patterns of morbidity shift, the integration of hospital services with out-of-hospital care will be critical.

Ongoing OECD work in this area aims to:

  • develop quality and outcome indicators to support cross-country comparison in the effective delivery of integrated care across health care settings; and
  • identify policies to improve incentives, care models and governance arrangements aimed to tackle care coordination problems in health systems.

A new generation of indicators has been piloted and published in Health at a Glance 2021: OECD Indicators, see indicator on Integrated Care, to kick-start international benchmarking of quality measurement of integrated care. The pilot consisted of a set of three types of indicators providing insight into the quality of integration between hospital and community care one year after hospitalisation for people suffering from stroke and congestive heart failure:

  • All-cause and disease-specific hospital readmissions;
  • All-cause mortality after hospital discharge; and,
  • Prescription of appropriate medication for secondary care prevention after hospital discharge.

These indicators take a patient care pathway perspective by using “country-wide” electronic health records systems and data linkage at patient level across existing data sets to follow key events on a journey across the system for a person (as illustrated in the infographics below).

A technical report with detailed data analysis and next steps for future OECD work is forthcoming in the first quarter of 2022 (see Barrenho et al., forthcoming OECD Health Working Paper).

Example of a patient's journey: key events within the health system experienced by a first-time stroke patient

Integrated-care-patient-journey


Source: Authors, adapted from Sund and Hakkinen in (Cylus J, Papanicolas I and Smith PC, 2016).

KEY DATA

The graphs below show the mortality and readmissions outcomes across OECD countries in the year after discharge following ischaemic stroke or CHF in 2018. For patients who suffered an ischaemic stroke, on average, 64% survived and did not return to acute care, 22% survived and were readmitted to hospital (4% for stroke-related and 18% for other reasons) and 14% died in the following year. For CHF patients, on average, 45% who survived did not return to acute care, while 32% survived but were readmitted for CHF related or other causes and 23% died in the following year.

For patients who suffered a stroke and were discharged, 1-year mortality ranged from 2% in Japan to 25% in Estonia. For CHF patients, 1-year mortality varied from 8% in Japan to 33% in Slovenia. 1-year readmissions of stroke patients surviving one year or more ranged from 1% in Lithuania to 6% in Norway for stroke-related reasons, and from 0% in Costa Rica to 28% in the Czech Republic for non-stroke causes. For patients with CHF surviving one year or more, readmission rates varied from 1% in Italy to 17% in Israel for CHF-related causes and from 0% in Costa Rica to 29% in the Czech Republic for other causes.

Patient outcomes within one year of discharge after ischaemic stroke and congestive heart failure, 2018

Patient-outcomes-after-discharge-for-IS-and-CHF

Access the data behind the graphs.

Source: OECD HCQO Pilot Data Collection on Integrated Care 2021, in Health at a Glance 2021: OECD Indicators.
 

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