If measures for clinical outcomes, health literacy, patient satisfaction, benefits and many more present a challenge then a measure for integrated care falls into the category of a very steep peak.
It's a nebulous concept, we know what we mean, we recognize the principles and we even allow for variation in what integration and integrated care means for different people.
The January 2012 integrated care report by The King's Fund and Nuffield Trust (my post on this) had me thinking about some of the ingredients that might contribute to measures of integrated care and our efforts to record it. What instruments and formats do we need - what mix of microscope (individual), telescope (population), strobe (snapshot), time lapse (series), objective - subjective? Some elements then (in no particular order):
Breadth of the 'episode' (primary-secondary-tertiary-palliative)
The number of systems
information - e-records
commissioners
datasets: total, number of gatherers, submissions
The number of people - individuals involved
The number of 'responsible' organisations
Primary organisational efficiency - Lean Standing?
The number of teams
The number of policies (policy touches)
The number of interviews, assessments (paper, electronic, formal), care plans, reviews
Opportunities for communications
potential
actual
media forms
delivery forms (inc. technologies)
Number of handovers
weighted according to type
Patient experience - measure
(that is holistic across physical, mental health, social care?)
staff attitude
therapeutic relationship engagement (quality)
therapeutic modalities (quantity)
educational content, materials provided / information gains
number of patient (carer) choice points (potential - exercised)
Incidents of positive risk taking
Increase in health literacy
Co-ordination effectiveness
Self-care - autonomy, decision making
Patient (carer) as budget holder
Patient as record holder and direct data source (telecare - data entrant)
Carer involvement
Health : Social care (main dependency, ratio, index)
The number of disparate care philosophies encountered
Diagnoses
Diagnostic investigations complex (location, time)
Declarative success: agreed plan - success?
The geographic encounter footprint
Duration of engagement
Follow-up - care continuity care
Care Disintegration - safety
care interrupts# (falls, errors)
relapse, readmission
dependency (deferred discharge)
Influence of public engagement - involvement in local health services*
While many of the above might qualify as candidates for a measure of integrated care, you have to wonder whether in order to measure integration you must measure everything else. It appears here at least that integration and complexity are closely related. Several of the items above might individually represent - and no doubt do - indices of various kinds that also beg definition (e.g., co-ordination, success, philosophies, episode ...).
Although I've referred to 'numbers' you could no doubt refine the list by consulting the literature and considering the quantitative : qualitative mix.
Perhaps the key indicator of integrated care isolates the primary concepts for the person concerned and then fuses those within the INTERPERSONAL and POLITICAL care domains (policy touches would be one example)?
*How does a measure of integration incorporate those socially excluded?
#For want of a better word.
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