Explaining Integrated Care Innovation: Highest to Lowest Hospital Readmission Rates among Older Persons by Professional Agency and Awareness-Farness-Fairness in Collaborative Capacity Building

• Continuity and coordination of care leading to quality are global priorities for reorienting cooperation between health and care providers to meet the needs of people, especially for older persons with chronic or complex conditions. Sweden is particularly interesting from this perspective, with its decentralized non-hierarchical system based on collaboration between service providers operating at the same level, carried out by coordination body representatives sharing the responsibility for local eldercare by 290 municipality councils and regional health care by 21 county councils. This horizontal model–implemented after the Community Care Reform (Ädelreformen), when the governance of eldercare was decentralized from regional to local government level in the early 1990s—is during the last decades increasingly challenged by centralization through vertical network, market, and hierarchy coordination. However, a significant reduction of quality in ageing has occurred during the last decade in all regions–with the unexpected exception of Region Jämtland Härjedalen RJH—clearly indicated by increasing proportions of unplanned hospital readmissions among older persons, followed by the failure to assess and improve integrated care for frail older persons during the COVID19 pandemic. The purpose is to explain how a coordination body like the extreme, unique case of RJH can change and succeed by collaborative capacity building—using readmission rates as a quality in ageing effect indicator. We rely on The Swedish National Board of Health and Welfare's data on the proportion of unplanned hospital readmissions within 30 days among frail older persons living with multimorbidity 2010-11 and 2018-19, enabling the search for systematic patterns of explanation across 52 coordination bodies repeatedly surveyed across 17 regions for the 2011-14, 2015-18, and the 2019-22 terms of office. Interviews were made with five long-lasting local and regional key leaders—administrative, political, professional—representing the only case (collaborating research partner) of improvement—from “worst to best” 2010-2019. They unfold how its public administration’s collaborative capacity building first grew from professional agency awareness to innovation of integrated care, by coping with the region’s geographical-administrative farness and political-economic fairness stemming from civic traditions, and how it is related to the effect of going from unusually high, to unusually low hospital readmission rates among its older frail citizens.

Ämnesord

SAMHÄLLSVETENSKAP  -- Statsvetenskap -- Statsvetenskap (hsv//swe)

SOCIAL SCIENCES  -- Political Science -- Political Science (hsv//eng)

Nyckelord

Integrated Care Innovation

Collaborative Capacity Building

Unplanned Hospital Readmissions

Quality in Ageing

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