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JAMA: Integrated Care Improves Patient Outcomes & Reduces Costs

A worldwide trend in healthcare reforms and new organizational arrangements, integrated care (also known as comprehensive care, transmural care, co-ordinated care or seamless care) focuses on more integrated and co-ordinated forms of care provision.  According to the WHO, “Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion.  Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency.” Covering a complex and comprehensive field, integrated care can be seen as a response to the fragmented delivery of social service and health that is an acknowledged problem in many health systems around the world.

According to a study published in the Journal of the American Medical Association, integrated care delivery in a primary care setting leads to better patient outcomes and reduces costs.

The 10 year study, which focused on 113,452 patients between 2003 and 2013, including 27 team-based and 75 traditional practices, showed that patients who received team-based primary care were screened at a much higher rate for depression than those in traditional practices, which has allowed for earlier interventions.  In team-based practices, 46.1 percent of patients were diagnosed with depression, compared to only 24.1 percent in traditional care settings.

As compared to patients cared under traditional practices, team-based care patients showed higher rates of engagement and meaningful chronic disease management.  According to the study, compared to only 19.5 percent of traditional care patients, 24.6 percent of patients receiving team-based care followed diabetes protocols.  There was a significant discrepancy between team-based and traditional practices when it came to patient self-care plans.  As compared to just 8.6 in traditional settings; a self-care plan was implemented 48.4 percent of the time in team-based primary care settings.  The study also revealed that patients not only used fewer healthcare providers but also saw a reduction in their total cost of care in a team-based setting.

As per the study, on the basis of per 100 person years, emergency room visits was lower in team-based settings (18.1%), as compared to traditional settings (23.5%).  Similarly, hospital readmission rates were also lower in team-based care settings (9.5%), compared to traditional care settings (10.6%).  The number of visits to a physician by team-based patients was 232.8 as compared to 250.4 for traditional care patients.

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