OPEN ARCH: integrated care at the primary–secondary interface for the community-dwelling older person with complex needs
Jennifer Mann A B D , Rachel Quigley A B , Desley Harvey A C , Megan Tait A , Gillian Williams A and Edward Strivens A BA Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
B College of Public Health, Medicine and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia.
C College of Healthcare Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia.
D Corresponding author. Email: jennifer.mann3@health.qld.gov.au
Australian Journal of Primary Health 26(2) 104-108 https://doi.org/10.1071/PY19184
Submitted: 24 September 2019 Accepted: 19 February 2020 Published: 15 April 2020
Abstract
Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary–secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population.
Additional keywords: case management, delivery of health care: integrated, organisation: models, primary health care.
References
Agency for Clinical Innovation (2014) Building partnerships: a framework for integrating care for older people with complex health needs. New South Wales Department of Health: Sydney, NSW, Australia.Australian Digital Health Agency (2018) What is My Health Record? Available at https://www.myhealthrecord.gov.au/for-you-your-family/what-is-my-health-record [Verified 10 September 2019]
Australian Government Department of Health (2019a) Health care homes. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-care-homes [Verified 10 September 2019]
Australian Government Department of Health (2019b) Short-term restorative care programme. Available at https://agedcare.health.gov.au/programs-services/flexible-care/short-term-restorative-care-programme [Verified 10 September 2019]
Australian Institute of Health and Welfare (AIHW) (2014) Australia’s health 2014. Cat. no. AUS 178, Australia’s health series no. 14. AIHW, Canberra, ACT, Australia.
Beswick AD, Rees K, Dieppe P, Avis S, Gooberman-Hill R, Horwood J, Ebrahim S (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 371, 725–735.
| Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 18313501PubMed |
Bird SR, Kurowski W, Dickman K, Kronborg I (2007) Integrated care facilitation for older patients with complex health care needs reduces hospital demand. Australian Health Review 31, 351–361.
| Integrated care facilitation for older patients with complex health care needs reduces hospital demand.Crossref | GoogleScholarGoogle Scholar |
Curry N, Ham C (2010) ‘Clinical and service integration: the route to improved outcomes.’ (The Kings Fund: London, UK)
Davy C, Kite E, Aitken G, Dodd G, Rigney J, Hayes J, Van Emden J (2016) What keeps you strong? A systematic review identifying how primary health-care and aged care services can support the well-being of older Indigenous peoples. Australasian Journal on Ageing 35, 90–97.
| What keeps you strong? A systematic review identifying how primary health-care and aged care services can support the well-being of older Indigenous peoples.Crossref | GoogleScholarGoogle Scholar | 27324863PubMed |
De Carvalho IA, Epping-Jordan J, Pot AM, Kelley E, Toro N, Thiyagarajan JA, Beard JR (2017) Organizing integrated health-care services to meet older people’s needs. Bulletin of the World Health Organization 95, 756–763.
| Organizing integrated health-care services to meet older people’s needs.Crossref | GoogleScholarGoogle Scholar |
Goodwin N (2013) Understanding integrated care; a complex process, a fundamental principle. International Journal of Integrated Care 13, e011–e012.
| Understanding integrated care; a complex process, a fundamental principle.Crossref | GoogleScholarGoogle Scholar | 23687483PubMed |
Harvey D, Foster M, Strivens E, Quigley R (2017) Improving care coordination for community dwelling older Australians; a longitudinal qualitative study. Australian Health Review 41, 144–150.
| Improving care coordination for community dwelling older Australians; a longitudinal qualitative study.Crossref | GoogleScholarGoogle Scholar | 27333204PubMed |
Katterl R, Anikeeva O, Butler C, Brown L, Smith B, Bywood P (2012) Potentially avoidable hospitalisations in Australia: causes for hospitalisations and primary health care interventions. PHCRIS policy issue review. Primary Health Care Research & Information Service, Adelaide, SA, Australia.
Leutz WN (1999) Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. The Milbank Quarterly 77, 77–110.
| Five laws for integrating medical and social services: lessons from the United States and the United Kingdom.Crossref | GoogleScholarGoogle Scholar | 10197028PubMed |
McPake B, Mahal A (2017) Addressing the needs of an ageing population in the health system: the Australian case. Health Systems and Reform 3, 236–247.
| Addressing the needs of an ageing population in the health system: the Australian case.Crossref | GoogleScholarGoogle Scholar | 31514669PubMed |
Mitchell GK, Burridge L, Zhang J, Donald M, Scott IA, Dart J, Jackson CL (2015) Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness? Australian Journal of Primary Health 21, 391–408.
| Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?Crossref | GoogleScholarGoogle Scholar | 26329878PubMed |
Productivity Commission (2017) Integrated care, shifting the dial: 5 year productivity review, Supporting Paper Number 4. Productivity Commission, Canberra, ACT, Australia.
Queensland Government (2018) Cairns and Hinterland Hospital and Health Service Clinical Service Plan 2018–2022. State of Queensland, Cairns and Hinterland Hospital and Health Service, Cairns, Qld, Australia.
Smith K, Flicker L, Shadforth G, Carroll E, Ralph N, Atkinson D, Lindeman M, Schaper F, Lautenschlager NT, LoGiudice D (2011) ‘Gotta be sit down and worked out together’: views of Aboriginal caregivers and service providers on ways to improve dementia care for Aboriginal Australians. Rural and Remote Health Journal 11, 1650
State of Queensland (2019) Integrated care innovation fund. Available at https://www.health.qld.gov.au/improvement/make-it-happen/integrated-care-innovation-fund [Verified 10 September 2019]
Swierssen H, Duckett S (2016) Chronic failure in primary medical care. Grattan Institute report no. 2016–2. Grattan Institute, Melbourne, Vic., Australia.
Tieman J, Mitchell G, Shelby-James T, Currow D, Fazekas B, O’Doherty L, Hegarty M, Eriksson L, Brown R, Reid-Orr D (2007) Integration, coordination and multidisciplinary care: what can these approaches offer to Australian primary health care? Australian Journal of Primary Health 13, 56–65.
| Integration, coordination and multidisciplinary care: what can these approaches offer to Australian primary health care?Crossref | GoogleScholarGoogle Scholar |
Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA (2013) Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care 13, e010
| Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.Crossref | GoogleScholarGoogle Scholar | 23687482PubMed |
Wodchis WP, Dixon A, Anderson GM, Goodwin N (2015) Integrating care for older people with complex needs; key insights and lessons from a seven-country cross-case analysis. International Journal of Integrated Care 15, e021
World Health Organization (2016) Integrated care models: an overview. Health Systems Delivery. Programme Division of Health Systems and Public Health, World Health Organization Regional Officer for Europe, Copenhagen, Denmark.
