Béland François, Hollander Marcus J
Department of Health Administration, Faculty of Medicine, Université de Montréal, Montréal, Canada.
Gac Sanit. 2011 Dec;25 Suppl 2:138-46. doi: 10.1016/j.gaceta.2011.09.003. Epub 2011 Nov 15.
Interest is growing in integrated systems of care for the frail elderly. Few such systems have been both documented and evaluated in a rigorous manner. The present article provides an international review of such systems.
The literature on integrated care covered the period from 1997 to 2010, inclusive. Some 2,496 citations were identified from Age Line, PsycINFO, CINAHAL and MedLine and were reviewed. To be included in this paper, articles had to provide a good description of the care delivery system and good quality evaluations. Only nine articles were retained. Most of the articles reviewed described some form of coordinated care without evaluation.
There were essentially two types of models of integrated care delivery for the frail elderly. One was a smaller, community-based model that relied on cooperation across care providers, focused on home and community care, and played an active role in health and social care coordination. The second type of model was a large-scale model that could be applied at a national/provincial/state, or large regional health authority, level, had a single administrative authority and a single budget, and included both home/community and residential services.
Integrated care delivery can be achieved in various ways. Irrespective of which model is adopted, some of the key factors to be considered are how care can be coordinated effectively across different types of services, and how all the care provider organizations can be coordinated to ensure continuity of care for frail elderly persons.
针对体弱老年人的综合护理体系正日益受到关注。但鲜有此类体系得到严谨的记录和评估。本文对这类体系进行了国际综述。
有关综合护理的文献涵盖1997年至2010年（含）期间。从Age Line、PsycINFO、CINAHAL和MedLine数据库中识别出约2496条文献并进行了综述。要纳入本文，文章必须对护理提供体系有良好描述且具备高质量评估。仅保留了9篇文章。大多数被综述的文章描述了某种形式的协调护理但未进行评估。
体弱老年人的综合护理提供模式主要有两种类型。一种是规模较小的基于社区的模式，该模式依赖护理提供者之间的合作，专注于居家和社区护理，并在健康与社会护理协调中发挥积极作用。第二种模式是大规模模式，可应用于国家/省/州或大型地区卫生当局层面，有单一行政机构和单一预算，包括居家/社区和住宿服务。
综合护理提供可以通过多种方式实现。无论采用哪种模式，一些关键因素都需要考虑，比如如何在不同类型服务之间有效协调护理，以及如何协调所有护理提供者组织以确保体弱老年人护理的连续性。
