Managing Care for Frail Patients: The Role of Medicine and Technology in the Management of Integrated Care and the Implications for Innovation and Evaluation

Western developed countries have been facing a population-ageing trend that is projected to enlarge and deepen. The median age of the EU27 total population expected to increase from 40.4 to 47.9 years between 2008 and 2060. The elderly, currently absorbing 34-47% of healthcare expenditures in OECD countries, are going to grow among those vulnerable groups who experience difficulties accessing appropriate health and social services across care settings.In Europe and North America «integrated care» has become a relevant component of healthcare programs and reforms to cope with a changing epidemiology. Strategies aim to enhance coordination across care settings by means of a number of organizational models and techniques to foster prevention, rehabilitation and downward substitution of services for frail patients.However, although integration is assumed to improve both efficiency and effectiveness of care, the evaluation literature in this field shows inconsistent results. We argue that inconsistencies are mainly due to the inherent context-dependence of strategies and complementarities among the adopted operating means. In fact, any initiative aimed to provide integrated care faces implementation issues such as institutional fragmentation, cultural clashes (e.g., medicine vs. management, health vs. social care), providers’ competition over financial resources, barriers to information sharing. An aspect of the utmost interest concerns the new role of the medical profession within new patient-centric models of care: best practices suggest that soft variables, such as leadership, can challenge the “silos” of health systems (e.g., acute care, primary care, community care).The project focuses on frail elderly patients and aims to build on the extant literature and multiple case-studies (comparing advanced experiences in four countries) to define relevant typologies and a comprehensive explanatory framework aimed to orient further evaluation research, and provide decision makers with useful guidelines to manage the complexity belonging to caring for the needs of this target population.