Chambers Rachel L, Pask Sophie, Higginson Irene J, Barclay Stephen, Murtagh Fliss E M, Sleeman Katherine E
Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, SE5 9PJ, UK.
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
AMRC Open Res. 2023 Jan 10;4:19. doi: 10.12688/amrcopenres.13079.2.
In England, Integrated Care Systems have been established to improve integration of care, as part of the NHS Long Term Plan. For people near the end of life, palliative care can improve integration of care. We aimed to understand whether and how palliative and end of life care was included in Integrated Care System strategies, and to consider priorities for strengthening this.
Documentary analysis of Integrated Care System (ICS) strategies, using summative content analysis, was performed. Google searches were used to identify NHS Trust, Clinical Commissioning Group or ICS websites. We searched these websites to identify strategies. Key terms were used to identify relevant content. Themes were mapped onto an adapted logic model for integrated care.
23 Integrated Care System strategy documents were identified. Of these, two did not mention any of the key terms, and six highlighted palliative and end of life care as either a priority, area of focus, or an ambition. While most (19/23) strategies included elements that could be mapped onto the adapted logic model for integrated care, the thread from enablers and components, to structures, processes, outcomes, and impact was incomplete.
Greater prioritisation of palliative and end of life care within recently established Integrated Care Systems could improve outcomes for people near the end of life, as well as reduce reliance on acute hospital care. Integrated Care Systems should consider involving patients, the public and palliative care stakeholders in the ongoing development of strategies. For strategies to be effective, our adapted logic model can be used to outline how different components of care fit together to achieve defined outcomes and impact.
在英格兰，作为国民保健服务长期计划的一部分，已建立综合医疗系统以改善医疗服务的整合。对于临终患者而言，姑息治疗可改善医疗服务的整合。我们旨在了解姑息治疗和临终关怀是否以及如何纳入综合医疗系统战略，并考虑加强这方面工作的优先事项。
采用总结性内容分析法对综合医疗系统（ICS）战略进行文献分析。通过谷歌搜索来确定国民保健服务信托基金、临床委托小组或综合医疗系统的网站。我们在这些网站上搜索以确定战略。使用关键词来识别相关内容。将主题映射到一个适用于综合医疗的逻辑模型上。
共识别出23份综合医疗系统战略文件。其中，两份未提及任何关键词，六份将姑息治疗和临终关怀列为优先事项、重点领域或目标。虽然大多数（19/23）战略包含可映射到适用于综合医疗的逻辑模型上的要素，但从促成因素和组成部分到结构、流程、结果和影响的脉络并不完整。
在最近建立的综合医疗系统中，更高程度地优先考虑姑息治疗和临终关怀，可能会改善临终患者的治疗效果，并减少对急性医院护理的依赖。综合医疗系统应考虑让患者、公众和姑息治疗利益相关者参与战略的持续制定。为使战略有效，我们改编的逻辑模型可用于勾勒不同护理组成部分如何协同工作以实现既定结果和影响。
