Abstract Introduction: Both in literature and in practice there is debate about defining Integrated Care. The WHO for example, defines Integrated Care as a process, not covering the perspective of (cost-) effectiveness. From the perspective of research into evidence in Integrated Care this is rather awkward. Triple aim focusses on 1) quality of life of citizens; 2) quality and continuity of care and, 3) cost effective care. Integrated Care is aimed at well-organized, cost-effective processes of care delivery, provided by committed professionals which must be able to count on well-established evidence for the care interventions they provide in integrated trajectories to their patients. Research should support them both with evidence for effective interventions and evidence for effective application. A basis for thorough research in Integrated Care is narrowed by a lack of a comprehensive definition. Theory/Methods: Since Integrated Care is considered as sets of complex interventions targeting triple aim, we compared definitions of Integrated Care reported in literature with a definition of complex interventions and a model for evidence based developing, testing and implementing complex interventions. This definition and the accompanied model are issued by the British Medical Research Council (MRC) in 2008 and are nowadays worldwide established. During the session at the conference, after a short introduction, we will discuss our proposal with the participants for improving a new definition of evidence based integrated care.
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Binnen het projectonderwijs wordt nog vaak drooggezwommen. Enerzijds door de verstrekte projectopdrachten anderzijds door de suboptimalisatie van oplossingen. Deze zijn namelijk sterk afhankelijk van de verbonden modules en docenten. In de praktijk zijn de oplossingen echter altijd een afweging van tijd, geld en kwaliteit. Onze Human Engineers leren om daar op een goede manier mee om te gaan. Dit door de integratiemodule Integrated Product Development (IPD). IPD is een multidisciplinair project waarbij studenten van verschillende Fontys Instituten werken aan de commercikle en technische uitwerking van een bedrijfsopdracht. Marktonderzoek, doelgroep bepaling en productspecificatie zijn een vast onderdeel van een IPD project evenals het ontwerpen en bouwen van een prototype en het financieel onderbouwen van een Go/NO go advies aan de ondernemer. Het project vindt plaats in het laatste onderwijssemester, net vssr het afstuderen en is dus te zien als een open project met een bedrijf als opdrachtgever. De Human Engineering studenten zijn in deze projecten de verbindende schakel. De specialisten in de projectgroepen, de technische studenten, willen nogal eens zoeken naar mooie oplossingen vooral in technische zin. Daarbij gaan ze vaak volledig voorbij aan het belang van de ondernemer (winst maken) en het belang van de klant (kwaliteit en bedieningsgemak). Ook het projectwerk heeft een enorme sprong vooruit gemaakt door het team uit te breiden met Human Engineers. De Human Engineering studenten focussen vooral ook op het halen van targets (kosten) en deadlines (tijd), het maken en nakomen van afspraken en de communicatie binnen de groep en naar buiten toe (ondernemer en klant). Huidige studenten en alumni geven aan dat het project zeer realistisch is en dat het vergelijkbaar is met problemen die ze in hun werk tegen komen. Zeker blijven doen is hun advies. Organisatorisch vergt het wel een en ander omdat er bijvoorbeeld afstemming dient te komen tussen de verschillende instituten met betrekking tot: beoordeling van de studenten, afstemmen van lesroosters en vergoeding voor docenten. Ook het onderhouden van bedrijfsrelaties om bijvoorbeeld aan de opdrachten te komen blijft een moeilijke, tijdrovende zaak.
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Het betreft een opiniestuk met een modern model voor integrated care.
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Introduction The Integrated Recovery Scales (IRS) was developed by the Dutch National Expertise board for routine outcome monitoring with severe mental illnesses. This board aimed to develop a multidimensional recovery measure directed at 1. clinical recovery, 2. physical health, 3. social recovery (work, social contacts, independent living) and 4. existential, personal recovery. The measure had to be short, suited for routine outcome monitoring and present the perspective of both mental health professionals and service users with severe mental illnesses. All aspects are assessed over a period of the pas 6 months. Objectives The objective of this research is validation of the Integral Recovery Scales and to test the revelance for clinical practice and police evaluation. Methods The instrument was tested with 500 individuals with severe mental illnesses (80% individuals with a psychotic disorder), of whom 200 were followed up for 1 year. For the questions concerning clinical recovery, physical health and social recovery mental health care workers conducted semi structured interviews with people living with serious illnesses. The questions concerning personal health were self-rated. We analyzed interrater reliability, convergent and divergent validity and sensitivity to change. Results The instrument has a good validity and is easy to complete for service users and mental health care workers and appropriate for clinical and policy evaluation goals. Conclusions The Integrated Recovery Scales can be a useful instrument for a simple and meaningful routine outcome monitoring. Page: 121
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Integrated curricula seem promising for the increase of attention on science and technology in primary education. A clear picture of the advantages and disadvantages of integration efforts could help curriculum innovation. This review has focussed on integrated curricula in primary education from 1994 to 2011. The integrated curricula were categorized according to a taxonomy of integration types synthesized from the literature. The characteristics that we deemed important were related to learning outcomes and success/fail factors. A focus group was formed to facilitate the process of analysis and to test tentative conclusions. We concluded that the levels in our taxonomy were linked to (a) student knowledge and skills, the enthusiasm generated among students and teachers, and the teacher commitment that was generated; and (b) the teacher commitment needed, the duration of the innovation effort, the volume and comprehensiveness of required teacher professional development, the necessary teacher support, and the effort needed to overcome tensions with standard curricula. Almost all projects were effective in increasing the time spent on science at school. Our model resolves Czerniac’s definition problem of integrating curricula in a productive manner, and it forms a practical basis for decision-making by making clear what is needed and what output can be expected when plans are being formulated to implement integrated education.
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Steeds meer bedrijven publiceren naast hun financieel jaarverslag een integrated report, waarin naast financiële waarde ook over maatschappelijke waarden wordt gerapporteerd. Uit een rapport van KPMG (2017) blijkt dat 93% van de grootste bedrijven van de wereld een integrated report publiceert. Met de opkomst van integrated reporting is hier echter ook de nodige kritiek op ontstaan. Zo zouden bedrijven het integrated report vooral gebruiken om zich duurzamer voor te doen dan ze daadwerkelijk zijn (‘greenwashing’). In dit artikel wordt een analyse van de Triple Depreciation Line (TDL) beschreven. De TDL is een raamwerk, waarmee in potentie (voor een deel) tegemoet wordt gekomen aan de huidige kritiek op integrated reporting zoals bijvoorbeeld ‘greenwashing’. In dit artikel concluderen wij dat de TDL in zijn huidige opzet in de praktijk moeilijk toepasbaar is en doen wij aanbevelingen voor een meer praktische toepassing van dit raamwerk. Dit leidt tot een aangepast TDL-raamwerk, waarbij wij beargumenteren dat de toepassing van dit aangepaste raamwerk de potentie heeft om de transitie naar een duurzame economie aanzienlijk te versnellen.
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Introduction In 2016 a new form of integrated community treatment for patients with serious mental illnesses was implemented in two neighborhoods in the city of Utrecht (335000 inhabitants) in the Netherlands. Treatment is characterized by close collaboration of psychiatric care, somatic care (i.e. general practitioner, nurse practitioner), supported housing and other facilities, i.e. the police officer, and is provided in the direct neighborhood of the patients. This ‘neighborhood based integrated mental health care’ should not contribute solely to clinical recovery, but also specifically to social and personal recovery. Objectives The aim of this research was to investigate the experience of patients with serious mental illnesses themselves receiving this new form of neighborhood-based integrated mental health care. More specific the question is studied if and how neighborhood-based integrated mental health care supports personal and social recovery. Methods To assess the experience of patients in depth qualitative semi-structured interviews were conducted with 20 patients. Patients were asked to participate in interviews directly by the researchers, by their case managers and by experts by experience. Interview topics included personal and social recovery, resilience and self-efficacy related to the collective effort of caregivers. Qualitative data was analyzed by three independent researches with the qualitative computer program Tarzan. Strategies to enhance quality of data analysis (respondent validation) and validity (attention to negative cases) were used. Results The study will be finished in January 2019. Conclusions The results, a brief description of the collaborative care methodology offered and experiences of patients, and conclusions will be presented at the ENMESH conference.
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Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. Methods: The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. Results: The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. Discussion: The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.
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An investigation in the learning effects of integrated development projects. In two subsequent semesters the students were asked how they rated their competencies at the start of the project as well as at the end of it. The students voluntarily filled out a questionnaire. After the last questionnaire a number of students were also interviewed in order to learn more about their perceptions. It was a remarkable outcome of these interviews that a lot of students tended to give themselves lower ratings in the end if they met any difficulties in for instance communication or co-operation during the project. Then the questionnaire showed a decrease in the student's ratings, while anyone else would say the student did learn something after recognizing these difficulties. It required a different interpretation of the outcomes of the questionnaires. The investigation showed that co-operating in general and in multidisciplinary teams in particular, co-operating with companies and also working according to plans are the four objectives that are recognized mostly by the students. The factors that actually contribute to, or block, the learning effects remained unknown yet.
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De projecten op gebied van "Integrated Product Development" (IPD) bij Fontys worden beschreven. Aan de orde komen de verschillende vormen, waarin deze projecten in de loop der jaren zijn uitgevoerd en de samenwerkingsverbanden die hieruit zijn ontstaan. Er wordt aandacht besteed aan de onderwijsvormen, die hierbij worden toegepast. Tenslotte worden de belangrijkste leereffecten van deze projecten vastgesteld en wordt stilgestaan bij het belang van participatie in deze projecten door informaticastudenten.
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