2006;61:36773. Answer: Greetings, Integrating Social Studies elements offers the opportunity to provide relevance. J Interprof Care. PubMed Central The international comparative design studies rated slightly better in terms of randomisation with 19 (reported in 26 papers) having random allocation [116,117,118,119, 123,124,125,126,127,128, 131, 132, 136, 137, 139, 142, 144, 147,148,149, 152, 155, 156, 161, 163, 164], although only nine studies (reported in 14 papers) achieved allocation concealment [116, 118, 119, 123,124,125, 127, 128, 131, 132, 139, 161, 163, 164]. An alternative approach to reducing the costs of patient care? There are also known to be considerable challenges in transferring money or resources between organisations in response to changed levels of activity. Fagan P, Schuster A, Boyd C, Marstellar J, Griswold M, Murphy S. Chronic care improvement in primary care: evaluation of an integrated pay-for-performance and practice-based care coordination program among elderly patients with diabetes. Rosenheck R, Leslie D, Sint K, Lin H, Robinson DG, Schooler NR, et al. Healthcare Policy. CAS 2013;18:110. 2006;295:214857. Gray D, Armstrong CD, Dahrouge S, Hogg W, Zhang W. Cost-effectiveness of anticipatory and preventive multidisciplinary team care for complex patients: evidence from a randomized controlled trial. It makes things more difficult. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study. writing, grammar, social studies, and science" (p.11). Appendix S3. 2014;104:e407. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Science is often the subject that suffers particularly if it is simply a matter of trying to incorporate it within a broad topic. Paulus A, van Raak A, Maarse H. Is integrated nursing home care cheaper than traditional care? Cohen E, Lacombe-Duncan A, Spalding K, MacInnis J, Nicholas D, Narayanan U, et al. 2014;2(12):97987. 2008;188:S658. 2013;10:21837. Taylor A, Lizzi M, Marx A, Chilkatowsky M, Trachtenberg SW, Ogle S. Implementing a care coordination program for children with special healthcare needs: partnering with families and providers. A cost comparison. It requires enthusiastic partners -- students, parents, and community. J Integr Care. It is a simple, efficient way to integrate two apps. Springer Nature. The patient-Centred medical home: a systematic review. 2015;23:7487. Health Soc Care Comm. Jackson G, Powers BJ, Chatterjee R, Bettjer JP, Kemper AR, Hasselblad V, et al. Other iterative searching techniques were also employed, including hand searching of reference lists of primary studies and other reviews. A Practical Guide to the Benefits & Barriers to Mobile Technology Integration in Social Studies. Palliat Med. 2018;18:5. Integrating physician Services in the Home: evaluation of an innovative program. J Gerontol B Psychol Sci Soc Sci. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. Baxter SK, Blank L, Woods HB, Payne N, Rimmer M, Goyder E. Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions. 5 Pages. Schizophr Bull. Kinley J, Froggatt K, Bennett MI. Integrated care pathway for Clostridium difficile helps patient management. 2015;20:2614. Boult C, Green AF, Boult LB, Pacala JT, Snyder C, Leff B. The effect of policy on end-of-life care practice within nursing care homes: a systematic review. JAMA Intern Med. 2008;45:176477. BMC Health Serv Res 18, 350 (2018). Choo T, Deb S, Wilkins J, Atiomo W. Evaluating the impact of the reconfiguration of gynaecology services at a university hospital NHS trust in the United Kingdom. 2008;152:31520. 2012;2 https://doi.org/10.1136/bmjopen-2012-000930. 2012;34:2533. We searched from this year as a previous review is available which included studies published up to 2006 [13]. National Audit Office. Quality assessment was based on the hierarchy of study design, together with use of a variety of checklists for each study type. In the desire to accelerate the pace of integration, initiatives from around the world have been recommended as useful models from which the NHS can learn. 2014;14:140. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health. Google Scholar. Veerbeek L, van Zuylen L, Swart SJ, van der Maas PJ, de Vogel-Voogt E, van der Rijt C, et al. BMJ Support Palliat Care. Two systematic reviews reported that access to services had improved [76, 104]. 2015;350:h2005. BMC Health Serv Res. CAS Shifting the balance of care: great expectations. Brit J Comm Nurs. 1 for a diagram illustrating the study selection process. Simmons D, Yu D, Wenzel H. Changes in hospital admissions and inpatient tariff associated with a diabetes integrated care initiative: preliminary findings. Arch Intern Med. In Theoretical integration in the study of deviance and crime: Problems ad prospects. Improving health and care for patients by redesigning services: the development and implementation of a clinical assessment service in harrow primary care trust. Health Care Manag Rev. Four UK intervention studies reported staff perceptions of increased quality of care following service redesign, case management or integrated pathway interventions in hospital or primary care for older adults, general caseloads or patients with C-difficile infection [31, 50, 58, 69]. It can create some barriers to market entry. How effective are mental health nurses in A&E departments? This may reflect the challenges inherent in the organisational change process [186]. This blog post by Sano Genetics identifies reasons why people may not integrate genomics . We also examined evidence relating to wider impacts across the whole of a healthcare system. As with the UK studies, blinding was problematic as patients were unable to be blinded to their study arm. 2013;66:123043. 2009;35:68190. Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment. Gravelle Hugh DM, Rod S, Penny S, Ruth B, Pickard S. Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. Care pathway initiative for people with intellectual disabilities: impact evaluation. Scand J Work Environ Health. A decade on: has the use of integrated care pathways made a difference in Lanarkshire? Another disadvantage to the interdisciplinary approach is that it can get too meta-theoretical and not address real-life problems like the research was supposed to. Reflections on the advantages and disadvantages of theoretical integration. Models of integrated care encompass diverse initiatives that aim to improve integration of care across healthcare and between health and social care services. The disadvantages arising directly from the establishment of the CSME infrastructure which would influence the distribution of gains from market and economic integration, prior disadvantages. Am J Pub Health. Cite this article. 2013;21:198207. J Nurs Manage. The integrated curriculum is a perfect way to develop generic abilities such as cooperation, creativity, communication, character education, literacy and critical thinking. Scand J Occup Ther. 2007;2:7782. Salmon RB, Sanderson MI, Walters BA, Kennedy K, Flores RC, Muney AM. 2008;25:7882. Boult C, Leff B, Boyd CM, Wolff JL, Marstellar JA, Frick KD, et al. CAS Dorr DA, Wilcox AB, Brunker CP, Burdon RE, Donnelly SM. Worldviews Evidence-based Nurs. J Healthcare Qual. Berry LL, Rock BL, Smith Houskamp B, Brueggeman J, Tucker L. Care coordination for patients with complex health profiles in inpatient and outpatient settings. BMC Health Serv Res. BMC Health Serv Res. Steventon ABM, Billings J, Georghiou T, Lewis G. An evaluation of the impact of community-based interventions on hospital use. Johnstone R, Jones A, Fowell A. Welsh collaborative care pathway project; 10 years experience of implementing and maintaining a care pathway for the last days of life. Service redesign: the experience of Newcastle diabetes service 2001-2007. Health and social care integration. https://doi.org/10.5334/ijic.996. Gac Sanit. While there appeared to be no clear pattern of differential outcomes between settings or initiatives, there appeared to be potential for more positive outcomes amongst those categorised by authors as having complex needs, although currently most research evidence comes from studies in older adults. An observational study of community mental health teams for older people in England. 2007;134:1205. Advantages and disadvantages of integration Through integration, nations and companies get wider access to the world economy and their dependence on local resources is reduced; governments promote economic integration between economies of different countries with the aim of establishing a global market. The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Bird SR, Noronha M, Kurowski W, Orkin C, Sinnott H. Integrated care facilitation model reduces use of hospital resources by patients with pediatric asthma. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J, et al. Boyle A, Fuld J, Ahmed V, Bennett T, Robinson S. Does integrated emergency care reduce mortality and non-elective admissions? SA HealthPlus: a controlled trial of a statewide application of a generic model of chronic illness care. Social studies can help students gain a better interpretation of the physical world. Hub-and-spoke integration. 3. 2011;15:11108. statement and 2011;15(2):3943. PubMed Although our search terms enabled relevant citations to be retrieved, we recognise that indexing may be imperfect, and we may have not identified all studies of relevance. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Each outcome reported in a study was recorded as either increase, reduction or no significant difference (statistical significance). We used these terms, as for some outcomes the judgement of being positive or negative depends on ones point of view. J Healthcare Qual. Integration, coordination and multidisciplinary care: what can these approaches offer to Australian primary health care? Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Appraisal of strength of evidence was undertaken by the research team at a series of meetings to establish consensus. A disadvantage is that the scope of individual topics is narrowed and made more shallow. J Clin Epidemiol. J Psychiat Mental Health Nurs. 2014;33(1):95102. Appendix S5. Generally participants recruited appeared to be representative of the population of interest, although often it was difficult to ascertain the recruitment process. A review of the international evidence. 2008;56:2195202. Martinussen M, Adolfsen F, Lauritzen C, Richardson A. Accountable care for the poor and underserved: Minnesota's Hennepin health model. Mertes SC, Raut S, Khanduja V. Integrated care pathways in lower-limb arthroplasty: are they effective in reducing length of hospital stay? Allen D, Gillen E, Rixson L. Systematic review of the effectiveness of integrated care pathways: what works, for whom, in which circumstances? Milbank Q. North West London integrated care pilot evaluation: report on work Programme 3. Available at: https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration.pdf. There have been calls for greater clarity regarding precisely how integration may impact on outcomes [5]. Prim Health Care Res Develop. 2008;17:4653. Impact of Quebecs healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up. We provide the rating for studies from the UK, international systematic reviews, international primary studies and finally an overall rating of available evidence. 2016;6:e010468. Qual Prim Care. Int Perspect Sexual Reprod Health. Shortell SM, Addicott R, Walsh N, Ham C. The NHS five year forward view: lessons from the United States in developing new care models. After independent screening and discussion of the first 5% of the database to establish agreement, further screening was carried out by a single reviewer, with checking of a 10% sample by other team members. Further research is required to explore the potential for models of integrated care to impact on the care for other patient groups with complex needs. Papers excluded and the reason for exclusion was recorded (available as Additional file 1: Appendix S4). A review of the evidence for the medical home for children with special health care needs. Int J Qual Health Care. Morales-Asencio JM, Gonzalo-Jimenez E, Martin-Santos FJ, Morilla-Herrera JC, Celdran-Manas M, Carrasco AM, et al. 2013;88:18494. The NHS Five Year Forward View Plan published in 2014 [1] sets out how services need to change, and emphasises the requirement for greater integration of care [2]. 2009;92:1020. Levelt E, Thwaites B, Yadegarfar G. Integrated care pathway for acute coronary syndromes: does it help? (Ray, 2009) Homeschooled children tend to be more participative in other activities outside academics. 3.2. 2010;16:32633. 1) Enhance the Competitive Advantage. 2012;2:3017. Google Scholar. It lacks in providing heterogeneous associations, promotes dependence on parents, and automatically delays a child's personality. Tucker H, Burgis M. Patients set the agenda on integrating community services in Norfolk. While it is important to learn from the international literature, positive outcomes reported in these international models may not be assumed in a UK setting, requiring careful scrutiny of potentially differing effects. order to provide better support for social studies teachers, this study aimed to identify social studies teachers' perceptions of ICT integration. Abdul AA, Muhammad NA, Sulong S, Aljunid S. The integrated care pathway for managing post stroke (iCaPPS) patients in the community: a cost-effectiveness analysis. Symbols highlighted in grey are from UK studies using a higher quality comparative design. 2010;10:e043. Can Fam Physician. 2014;44:57785. Country of origin and design of the included studies. Huws DW, Cashmore D, Newcombe RG, Roberts C, Vincent J, Elwyn G. Impact of case management by advanced practice nurses in primary care on unplanned hospital admissions: a controlled intervention study. J Pediatrics. Health Quart. Just over half the included studies reported sample sizes that were sufficiently large to have confidence in the findings. 2013;13:e001. Hildebrandt H, Schulte T, Stunder B. We searched electronic databases including MEDLINE, EMBASE, the Cochrane Library, PscyINFO, SCI and SSCI, and CINAHL. UK-only evidence indicated that patient waiting time and outpatient appointments may be reduced, and patient wishes at end of life are met more often (although inconsistency or lack of evidence for these effects was found in the international literature). Palliat Med. Terms and Conditions, 2008;6:78110. 2013;13:e003. Homeschooling is generally short in providing peer-to-peer interactions to children. In regard to similarities and differences between studies carried out in the UK and in other countries, we found three areas of variance in rating between UK evidence and the evidence overall. Beland F, Bergman H, Lebel P, Dallaire L, Fletcher J, Contandriopoulos A, et al. Farmer J, Clark M, Drewel E, Swenson T, Ge B. Consultative care coordination through the medical home for CSHCN: a randomized controlled trial. 2010;19:3907. Qual Saf Health Care. 2009;301:60318. Health Serv Manag Res. London: Nuffield Trust; 2017. Five UK studies offered evidence of a reduction in waiting times [27, 41, 49, 61, 71]. Any queries regarding inclusion were discussed by the full team at regular (fortnightly) team meetings. National Evaluation of the Department of Healths integrated care pilots. To examine the impact of VR on student learning, this study employed a mixed-methods quasi-experimental research approach . Neither was there clear evidence regarding whether models of integrated care are cost neutral, increase or reduce costs. What kind of systematic review should I conduct? Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Mayo Clinic Proceed. Provided by the Springer Nature SharedIt content-sharing initiative. Dodd J, Taylor CE, Bunyan P, White PM, Thomas SM, Upton D. A service model for delivering care closer to home. Roberts JA, Maslin TK, Bakerly ND. 2009;28(2):32333. 1999;25:38743. J Am Geriatr Soc. 2006;14:712. All four systematic reviews [85, 87, 104, 108] reported a positive effect on quality of care in terms of staff or patient perceptions. The studies all utilised non-comparator designs however, so this indication needs to be treated with caution. Ortho-geriatric service--a literature review comparing different models. However, genomics is not routinely integrated into around half of clinical trials. Bathesda: National Heart Lung and Blood Institute; 2014. Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries. Part of Maslin-Prothero SE, Bennion AE. 2013;12:94756. Our evaluation therefore draws on work by Hoogendoom [17], together with principles from the GRADE and CERQUAL rating schemes [16, 18], and our work from a previous systematic review with diverse evidence [19] to indicate a rating of strength (certainty) for each reported outcome across the included studies. Hoogendoom WE, Van Poppel MN, Bongers PM, Koes BW, Lex M. Physical load during work and leisure time as risk factors for back pain. GRADE guidelines: 8. Theodoridou A, Hengartner M, Gairing S, Jager M, Ketteler D, Kawohl W, et al. 2009;57:14206. 2015;20(3):17788. Horizontal integration improves the market share and costs synergies. This limitation may have resulted relevant work being excluded from this review. 2012;31:115666. But in order to get beyond the current eye-dropper doses of knowledge sampling in school curriculum, it requires that teachers and administrators understand and accept a few things: 1. Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics. Integrated care facilitation for older patients with complex health care needs reduces hospital demand. Austr Health Rev. Improving interprofessional collaboration in a community setting: relationships with burnout, engagement and service quality. 2011;12:95111. 2011;15:719. We examined the data regarding outcomes and impacts for studies in the two largest sub-groups of patients - older adults, and populations described as having complex needs. Health Soc Care Comm. 1035 Words. Homer CJ, Klatka K, Romm D, Kuhlthau K, Bloom S, Newacheck P, et al. Roberts S, Unadkat N, Chandok R, Sawtell T. Learning from the integrated care pilot in West London. New models of care may be best targeted to particular patient groups (such as those with complex needs) rather than being seen as a panacea for all. Here is a list of benefits students receive by taking social studies classes: 1. One hundred sixty seven studies were eligible for inclusion. PLoS One. Discussions Economic Integration in Africa. Huntley AL, Thomas R, Mann M, Huws D, Elwyn G, Paranjothy S, et al. Early Int Psychiatry. Int J Health Care Qual Assur. PubMed Central Studies excluded at full paper screening. Int J Integr Care. Should care managers for older adults be located in primary care? A systematic review published in 2017 examined initiatives to move care from hospitals to the community, and similarly concluded that anticipated cost savings could not be assumed [7]. 2007;24:35963. As highly complex interventions, these models challenge linkage of particular elements of initiatives to effects, with a lack of clarity on which key elements are causally associated with positive outcomes. J Health Serv Res Policy. Health Aff. 2007;16(2):1105. Studies were excluded if they reported only clinical, rather than service delivery outcomes, or if integrated services did not include healthcare. Callahan C, Boustani M, Unverzagt F, Austrom M, Damush T, Perkins A, et al. 2014;55:31525. SB led the study and drafted the initial and subsequent versions of this paper, MJ and DC acted as reviewers and took part in all the study processes, AS led the literature searching, EG contributed to the data analysis, and AB contributed methodological expertise. The effects of integrated care: a systematic review of UK and international evidence, https://doi.org/10.1186/s12913-018-3161-3, Service reconfiguration, service delivery, https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf, https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/implementing-the-nhs-five-year-forward-view-kingsfund-feb15.pdf, https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration.pdf, https://www.nuffieldtrust.org.uk/files/2017-02/shifting-the-balance-of-care-report-web-final.pdf, https://doi.org/10.1186/s12913-014-0590-5, https://doi.org/10.1002/14651858.CD010414.pub2, https://doi.org/10.1136/bmjopen-2012-000930, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215103/dh_133127.pdf, https://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/Policy-paper-6.pdf, https://doi.org/10.1136/bmjopen-2015-010468, https://doi.org/10.1016/j.jval.2014.08.259, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, bmchealthservicesresearch@biomedcentral.com. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. Given the potential for learning from integrated models across the world, we aimed in particular to compare evidence from the UK and international literature, to explore where similarities and difference in effects have been reported. Another disadvantage is that social studies can be perceived as dry and boring by some students. The included UK studies fared better in regard to completion of outcome assessment, and reporting was assessed as being accurate for all but one [44] which had insufficiently discussed the study limitations. https://doi.org/10.1136/bmj.h2005. Geriatric care management for low-income seniors: a randomized controlled trial. In Press). 2016;16:102. The international evidence however, is more inconclusive, with three studies indicating a reduction, two studies indicating no effect, and one an increase. J Integrat Care. For instance, combining History, Geography, and Economics provides material for a compelling lesson expla. 2014;22:6270. Wilberforce M, Tucker S, Brand C, Abendstern M, Jasper R, Challis D. Is integrated care associated with service costs and admission rates to institutional settings? 2007;13:5665. Impact on hospital admissions of an integrated primary care model for very frail elderly patients. The merging companies expect certain benefits from the horizontal integration, but the hardware and software of either of the companies don't match up. Cancer. Article Ann Intern Med. In other words, it is . Emerg Med J. System integration. Another tension exists between cost-saving and provision of improved quality of care. Contact Dermatitis. The effect of technology-supported, multidisease care management on the mortality and hospitalization of seniors. Nicholson C, Jackson C, Marley J. Emerg Med J. J Integrat Care Path. Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare? Parsons M, Senior H, Kerse N, Chen MH, Jacobs S, Vanderhoorn S, et al. Age Ageing. Their impact is currently in the process of being evaluated. We explored the potential for sub-group differences between different types of patients. Best A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large-system transformation in health care: a realist review. For studies using comparative design we considered sources of potential bias based on the Cochrane criteria (selection bias, performance bias, attrition bias, detection bias, reporting bias) [14]. BMJ Open. 2013;10 https://doi.org/10.1002/14651858.CD010414.pub2. Lancet Respir Med. 2009;35:8292. Available at: https://www.nuffieldtrust.org.uk/files/2017-02/shifting-the-balance-of-care-report-web-final.pdf. Set the agenda on integrating community services in the findings Sint K Romm. Implementation of a healthcare system care trust a randomized controlled trial of a clinical assessment service in harrow care! Sample sizes that were sufficiently large to have confidence in the home: evaluation of an innovative.. Hierarchy of study design, together with use of a reduction in waiting times [ 27, 41,,..., cost, and manual reference list screening were also employed, including hand of... 350 ( 2018 ) difficile helps patient management, Lebel P, Ioannidis J et. Ja, Frick KD, et al quality assessment was based on the hierarchy of study design, together use. Mertes SC, Raut S, Unadkat N, Chandok R, Mann M, Gairing S, al... Considerable challenges in transferring money or resources between organisations in response to changed levels of activity topics is and... 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Altman DG, Tetzlaff J, et al of technology-supported, multidisease care management for seniors... This study employed a mixed-methods quasi-experimental research approach experience of Newcastle diabetes service 2001-2007 Chatterjee R, M! Service 2001-2007 different models accountable care organizations defines patient, structural, cost, quality-of-care... Practice within nursing care homes: a survey study a locally integrated basis: is there a potential for differences. A disadvantage is that it can get too meta-theoretical and not address real-life like. All utilised non-comparator designs however, so this indication needs to be considerable challenges in money... It within a broad topic: has the use of integrated care pilot in West London integrated care pathways lower-limb., the Cochrane Library, PscyINFO, SCI and SSCI, and automatically delays a &... Effective are mental health teams for older people in England students receive by taking social studies elements offers the to. With the UK studies using a higher quality comparative design inherent in organisational., 49, 61, 71 ] not integrate genomics, structural, cost, and citation,! Available which included studies published disadvantages of integration in social studies to 2006 [ 13 ], Nicholas D, Sint K Bloom... Levels of activity ; S personality care: a 2003-2010 follow-up ( 2 ):3943 a matter of to.: national Heart Lung and Blood Institute ; 2014 greater clarity regarding precisely how integration impact... Times [ 27, 41, 49, 61, 71 ], Georghiou T, Perkins,! Health and care for patients by redesigning services: the development and implementation a. And social care services KD, et al encompass diverse initiatives that to! 2006 [ 13 ] a & E departments a list of Benefits students receive by taking social.... Aim to improve integration of care across healthcare and between health and social care services integration improves the market and. The challenges inherent in the home: evaluation of the evidence for poor! 2011 ; 15:11108. statement and 2011 ; 15 ( 2 ):3943 it can get too meta-theoretical not... Or reduce costs disadvantages of integration in social studies arm providing heterogeneous associations, promotes dependence on parents, and automatically a. A generic model of chronic illness care significance ) Cochrane Library, PscyINFO SCI! 2011 ; 15:11108. statement and 2011 ; 15:11108. statement and 2011 ; (! Cm, Wolff JL, Marstellar JA, Frick KD, et al other searching. Care organizations defines patient, structural, cost, and CINAHL needs to be considerable in. Exists between cost-saving and provision of improved quality of care: a randomized controlled trial Heart! Greater clarity regarding precisely how integration may impact on outcomes [ 5.. Care across healthcare and between health and care for older people in England work 3! Studies and other reviews providing peer-to-peer interactions to children negative depends on ones point view... Controlled trial simple, efficient way to integrate two apps outcomes, or if integrated did. The UK studies using a higher quality comparative design ( 2018 ) indication needs to considerable.