Thomas Round, Mark Ashworth, Tessa Crilly, Ewan Ferlie and Charles Wolfe
A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and…
Abstract
Purpose
A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment.
Design/methodology/approach
Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes.
Findings
The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of “successes”, “challenges” and “lessons learnt”.
Research limitations/implications
Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit.
Practical implications
Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation.
Originality/value
Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.
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Standard Mortality Ratios (SMR) for certain diseases from which death is considered avoidable can be used as outcome indicators, measuring the effectiveness of health service…
Abstract
Standard Mortality Ratios (SMR) for certain diseases from which death is considered avoidable can be used as outcome indicators, measuring the effectiveness of health service intervention. The interpretation of SMRs for diseases such as stroke, asthma and cancer of the bladder will be discussed. The responsibility of health service managers and clinicians in the investigation of avoidable deaths is outlined in order that district health authorities (DHAs) can begin to reduce the number of unnecessary deaths from these diseases.
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Christopher McKevitt and Charles Wolfe
Although ‘quality of life’ is thought to be an important concept in healthcare, there is a lack of agreement about what this term means. This paper arises from a study which made…
Abstract
Although ‘quality of life’ is thought to be an important concept in healthcare, there is a lack of agreement about what this term means. This paper arises from a study which made the idea of quality of life itself the object of enquiry. We report findings from qualitative interviews with 47 healthcare professionals working with stroke and elderly care patients, which sought their views of the meaning and uses of quality of life. Most defined quality of life in terms of happiness/life satisfaction. Poor health and disability were assumed to reduce quality of life; interviewees represented their work as aiming to improve patient quality of life through improving health. Most regarded formal quality of life measurement as a research tool but not feasible or appropriate in routine care. However, conversations and observations of patients and carers were represented as informal ways of judging patient quality of life, and were generally regarded as a useful or essential part of the therapeutic relationship. Such assessments were said to take place routinely and to provide opportunities for patients/carers to express their wishes, and for ‘real’ patient needs to be identified. This runs counter to evidence of low levels of patient/carer participation in decision‐making and discharge. The real value of the quality of life concept remains unproven but we suggest that in the context of our interviews it was used by professionals to reflect on the nature of the therapeutic encounter and to articulate ideas about healthcare practice.
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Blues music is in the midst of its second revival in popularity in roughly thirty years. The year 1960 can be identified, with some qualification, as a reference point for the…
Abstract
Blues music is in the midst of its second revival in popularity in roughly thirty years. The year 1960 can be identified, with some qualification, as a reference point for the first rise in international awareness and appreciation of the blues. This first period of wide‐spread white interest in the blues continued until the early seventies, while the current revival began in the middle 1980s. During both periods a sizeable literature on the blues has appeared. This article provides a thumbnail sketch of the popularity of the blues, followed by a description of scholarly and critical literature devoted to the music. Documentary and instructional materials in audio and video formats are also discussed. Recommendations are made for library collections and a list of selected sources is included at the end of the article.
An autoethnographic account is given in order to depict the building of the author's musical subjectivity through the specific modes of cross-generational and peer-to-peer…
Abstract
An autoethnographic account is given in order to depict the building of the author's musical subjectivity through the specific modes of cross-generational and peer-to-peer interaction involving material and emotional investments, discursive constraints, and transgressions. The event of discovering the “sound of silence” is brought in contrast to the more encoded experiences of classical music, especially operatic. Emotionally charged musical events and rituals are revisited (narrated) together with accounts of transgressing the boundaries of inherited musical environments and learned patterns of musical appreciation.
Penny Irwin, Zoe Rutledge and Anthony G. Rudd
Reports on an audit of service organizations, clinical care and casemix. The sample included up to 40 consecutive cases of acute stroke (1CD10 161‐164) from each trust, admitted…
Abstract
Reports on an audit of service organizations, clinical care and casemix. The sample included up to 40 consecutive cases of acute stroke (1CD10 161‐164) from each trust, admitted from 1 January to 31 March 1998 and 1 August to 31 October 1999. Feedback consisted of individualized reports showing participants’ own results compared to the national data, and regional multidisciplinary workshops between audit rounds. A total of 197 (81 per cent) trusts (6,894 cases) in England, Wales and Northern Ireland participated in the first round, and 175 (72 per cent) (5,823 cases) in the second. Of the 38 organisational standards, 29 improved between 1998 and 1999 (range 1‐20 per cent, median 5 per cent); 64 of the 71 process standards improved (range 1‐20 per cent, median 8 per cent). Inter‐rater reliability was good with kappa scores of 0.49 to 0.87. National multidisciplinary, cross sector audit is feasible and can promote service improvements. Comparison of participants’ results to national data is a useful way of identifying areas needing change at local level.
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Turgut Var, William W. Swart and Charles E. Gearing
Although this is a survey of research techniques, it has become increasingly apparent, as the study has progressed, that our investigation of research methods for use in tourism…
Abstract
Although this is a survey of research techniques, it has become increasingly apparent, as the study has progressed, that our investigation of research methods for use in tourism and travel studies, without prior consideration of the nature and scopes of tourism and travel themselves, would he inadequate. At the outset it would be imperative to distinguish three interrelated terms. These are recreation, tourism, and travel.
This chapter documents how eugenics, scientific racism, and hereditarianism survived at Harvard well into the interwar years. In the late 1920s and early 1930s, Thomas Nixon…
Abstract
This chapter documents how eugenics, scientific racism, and hereditarianism survived at Harvard well into the interwar years. In the late 1920s and early 1930s, Thomas Nixon Carver and Frank W. Taussig published works in which they established a close nexus between an individual’s economic position and his biological fitness. Carver, writing in 1929, argued that social class rigidities are attributable to the inheritance of superior and inferior abilities on the respective social class levels and proposed an “economic test of fitness” as a eugenic criterion to distinguish worthy from unworthy individuals. In 1932, Taussig, together with Carl Smith Joslyn, published American Business Leaders – a study that showed how groups with superior social status are proportionately much more productive of professional and business leaders than are the groups with inferior social status. Like Carver, Taussig and Joslyn attributed this circumstance primarily to hereditary rather than environmental factors. Taussig, Joslyn, and Carver are not the only protagonists of our story. The Russian-born sociologists Pitirim Alexandrovich Sorokin, who joined the newly established Department of Sociology at Harvard in 1930, also played a crucial role. His book Social Mobility (1927) exercised a major influence on both Taussig and Carver and contributed decisively to the survival of eugenic and hereditarian ideas at Harvard in the 1930s.