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What do we mean by ‘integration’ of care?
Integrated care pathways have been used over the last 20 years to deliver health services for many different conditions.1 ,2 There is growing evidence that integrated care can positively impact on the quality of care;3 ,4 policy makers and commissioners are increasing the funding available for integrated approaches.5 Integration may take many different forms: vertical integration brings together elements of healthcare such as primary and secondary care services; horizontal integration brings together different agencies, for example, health and education and social care. It might also link services for physical and mental health. Children's healthcare additionally benefits from longitudinal integration, which aims to smooth transition across the life course.6 Much recent debate has considered whether such connections need to be absolute, such as through the formation of joint ventures or takeovers; or whether they can be achieved virtually, through cooperative partnerships. On the whole, emphasis tends to remain on well-defined condition-specific pathways of integrated care and there are few initiatives concentrating on whole system integrative approaches.7–10 Wolfe et al's recent review gives a good analysis of these wider debates11 and there is a strong argument in favour of integrated care for children and young people to move beyond pathways and take a whole population ‘segmentation’ approach.
Using segmentation to move beyond pathways
There are a number of initiatives in the USA that have begun to use segmentation models to deliver high-quality, cost-effective care to populations of patients. The ‘Bridges to Health’ model12 was devised around 10 years ago to enable a rational customisation of healthcare around important and coherent segments of the population. It advocates an approach to stratifying risk in segments of the population and aims to go beyond the usual focus on diagnoses or provider types. The authors argue that ‘in a healthcare system designed around the …
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