The effects of integrated care on quality of work in nursing homes: a quasi-experiment.
BACKGROUND
In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved.


OBJECTIVE
The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes).


METHODS
A non-equivalent pre-test/post-test control group design was used in this study.


METHODS
Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards.


METHODS
Data were selected by means of written questionnaires.


RESULTS
The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction.


CONCLUSIONS
The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric).
Boumans
Nicolle P G
NP
Department of Health Organisation, Policy and Economics, Maastricht University, P.O. Box 616, 6200 Maastricht MD, The Netherlands. n.boumans@beoz.unimaas.nl
Berkhout
Afke J M B
AJ
Vijgen
Sylvia M C
SM
Nijhuis
Frans J N
FJ
Vasse
Rineke M
RM
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003299:Cooperative Behavior; D005260:Female; D006272:Health Facility Environment; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008297:Male; D016294:Models, Nursing; D020380:Needs Assessment; D009426:Netherlands; D015403:Nursing Evaluation Research; D009735:Nursing Homes / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D025341:Principal Component Analysis; D011787:Quality of Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D011795:Surveys and Questionnaires