Advanced Health Service Planning: Models of Care Analysis

This report provides a comprehensive analysis of various models of care, focusing on their application and effectiveness in rural settings. It begins by defining models of care and their significance in health service planning, followed by a detailed examination of specific models tailored to different population groups, health problems, and workforce considerations. The core of the report lies in a comparative analysis of these models, with a particular emphasis on those relevant to rural dwellers. The analysis includes integrated primary and acute care systems, patient-centered medical homes, disease-specific integrated care models, and telehealth. The report also discusses challenges such as transportation, financial barriers, and workforce shortages in rural healthcare. It highlights the importance of integrated care pathways, case management, and the potential of telehealth to improve healthcare delivery. The report concludes by assessing the strengths and weaknesses of each model, offering insights into which approaches are most suitable for overcoming the unique challenges faced by rural communities and improving access to quality healthcare.

Running head: ADVANCE HEALTH SERVICE MANAGEMENT
ADVANCE HEALTH SERVICE MANAGEMENT
Name of the Student
Name of the university
Author’s note

1ADVANCE HEALTH SERVICE MANAGEMENT
Part 1: Understanding Models of Care
 What are models of care?
A model of care is a multifactorial concept that defined the process, how the health care is
delivered, the role determination, the governance and the role relationship with the family,
patients and the health care team. The designing of a care model should be influenced by a
responsive to the dynamic and the ever changing health care environment. The aim of the
health care models are to provide the best practice of care and services within a health care
system based on an individual or a population group as they go through various stages of
diseases or clinical conditions.
 Importance of the models in health service planning
A health service planning is required to improve the health system deliver and the performance
of the system to meet the health care needs of the population. It involves the method that aligns
the delivery of the health care to meet the health care needs of a population. A model of care
gives a framework to the policy makers or a particular organization that helps them to identify
the needs that has to be addressed and the gaps in health care that needs to be fulfilled.
 Specific models of care
A gold coast Integrated care model was designed over an 18 months’ time for improving
facilities to the local public suffering from a chronic and complex condition (Connor, Cooper &
McMurray 2016).

2ADVANCE HEALTH SERVICE MANAGEMENT
Population group- This models of care can be specific to the population group suffering from
chronic condition. For example a model of care for a place containing maximum number of the
aboriginal patients will not be similar to the urban based models of care. In rural care settings,
more focus has to be given on the primary care and acute care settings (Davy et al. 2016).
A health problem- Chronic care models and individualized planning model is necessary for a
population having similar types of diseases, which can be seen in the gold coast chronic care
model (Davy et al. 2016). This is especially useful during any pandemic. For example, a
population where communicable diseases are in vogue, the health care model followed there
would focus largely on awareness campaign, screening and vaccination. One such example of a
chronic care model is the home based chronic care model.
Workforce – A care model that will be followed in a particular area will depend upon the
workforce. The health workforce working in an area having a large number of aboriginals will
contain more aboriginal health care workers to ensure smooth functioning of the facility (Davy et
al. 2016).

3ADVANCE HEALTH SERVICE MANAGEMENT
Part 2: Comparative Analysis of Models of Care
Comparative Analysis Models of Care for Rural Dwellers
Equal access to health care is grave to health, but the residents in the rural areas face a
number of barriers for accessing health care. The rural residents are often faced with barriers to
health care facilities that restricts their ability for obtaining the type of care that they require. In
order for the rural dwellers for getting sufficient access to health care, necessary and appropriate
health care services has to be accessible and attainable within an appropriate time frame. Even
when there is ample provision of health care services existing in the community, there are some
other factors for considering in terms of the health care system. For example, for having an
accessibility to health care servicesfacilities, the rural residents should have financial means for
paying for the services like health or dental insurance that is accepted by the health care
provider. Rural residents does not have means to reach or use services like transportation to the
services, that can be located at a remote area and the ability to take a paid time off to work to use
such services. The rural dwellers lacks confidence in their ability for communicating with the
health care providers, for example if the patients is not confidence enough to converse in
English. The concerned district mentioned in the case study contained a substantial proportion of
Torres Strait Islanders and the aboriginal residents. It should be remembered that health inequity
exists among the aboriginals and the Torres Strait Islanders. This also hinders their access to the
universal health care coverage.
In order to work on this inequalities and improving the access to health care, an
integration of the models of care is required. “Models of care can be defined as a multifaceted
concept that defies the way how the health services are delivered. A model of care generally

4ADVANCE HEALTH SERVICE MANAGEMENT
outlines the best practice delivery by the application of a set of service principles across the
identified clinical practice and the care continuums.
One important model of care is an integrated primary and acute care system that joins
the GP, community, hospitals and the mental health care services (NSW Agency for clinical
innovation. 2017). Rural dwellers might face challenges in transportation probably due to the
large distance and economic condition. Although there are primary care services in present in the
rural areas, but the rural residents often have to travel to the main cities for getting specialised
services. Hence, there is need for the mixing of primary acute care system and mental health
service in the same system. Outreach services, community hospitals and use of telemedicine can
be increased. There is a need for a shift of health care services from the secondary care to
community based services or self-management programs. An integrated care pathway (ICP), is
an outline of the planned care for particular group of patients (van der Vlegel-Brouwer, 2013).
Much attention needs to be given in the patient pathway that is related to hospital settings or the
case management mechanism used by managed care organisation (NSW Agency for clinical
innovation. 2017). Shortage of staffs in the rural areas can be an important problem in the rural
healthcare settings. In such cases, the health personnel can be replaced by the lay health workers
and the paraprofessional often in collaboration with the interdisciplinary teams. This not only
alleviates the shortage of the staffs and also helps to overcome the cultural barriers. Some of the
real life implementation of the models of care are PRISMA, which is a Canadian model, that has
been designed for integrating the delivery of the services for the community dwelling people
having moderate to severe impairment, who needs coordination of many services. In the
Australian context, the Australian gold coast Integrated care model can be identified (Connor,
Cooper & McMurray 2016). The main objective of this care model was to manage the high risk

5ADVANCE HEALTH SERVICE MANAGEMENT
patients having complex and chronic conditions in teamwork with the general practitioners (GP)
for reducing the presentation to the department of health service emergency departments and to
decrease the rate of the planned hospitalisations. A process map is also provided outlining the
care protocols. The Australian gold coast model of care was not adpted specifically for the rural
population. Hence, nothing surely can be said about its effectiveness for the rural dwellers.
Case management is a part of the integrated model of care that encompasses
communication. It facilitates of care along with a continuum by effective coordination of the
resources (van der Vlegel-Brouwer, 2013). Some of the goals of the case management involves
achievement of the optimal health, access to care and appropriate utilisation along with the
preservation of the patient’s right. Some of the crucial component of the case management
includes selection of the target individuals for whom, that case management can be more
appropriate, assessment and individual care planning. Andreasson, Eriksson and Dellve, (2016)
have argued that case management might not be applied to the rural health care settings as a
tailored care planning for each of the patients, which would require enough staffing in the
hospital settings. On the other hand (Pelcastre-Villafuerte et al. 2014) have stated that adults with
complex care needs in rural settings would require case management.
Another models of care is patient centred medical home (PCMH). This model of care has
been developed as a model for transformation of the organisation and delivery of the primary
care services. This model of care has emerged due to lack of access to primary care or for those
who face challenges in navigating the fragmented system of care or increased health care costs
(WHO 2018). It is mainly a group practice that is physician directed and provide care that is
accessible, comprehensive, incessant, synchronised and delivered in the context of the
community. The elderly people are the most vulnerable group in accessing care services. One of

6ADVANCE HEALTH SERVICE MANAGEMENT
the primary reason is that elderly patients might feel it difficult to reach acute care hospitals
present in the urban areas that are much far from the rural dwelling (Iacobucci 2014). A home
based primary care services si a health care services that are provided to the veterans in their
home. A physician supervises the health care team who provides the services. These services are
meant for those veterans who have complex health care needs.
An integrated primary care system model is more suitable in comparison to the patient
centred medicinal home, because medical homes are physician centred and making of such
establishments can incur huge amount of costs (van der Vlegel-Brouwer, 2013).. In case of less
number of resources, provision of personalised care services might be difficult, hence getting all
sorts of care of care under one roof will serve as a more feasible options for the rural dwellers.
Another important care models are the disease specific integrated care models. Some of
the nations have developed chronic care models in order to provide a better integration of care
for people with certain diseases and long term clinical conditions like COPD, cardiovascular
disease, bronchial asthma or COPD (Brundisin et al. 2018). One important example that can be
cited in this respect is the “chains of care” , which is a cohesive model that has been designed in
Sweden, with the aim of associating primary, community and hospital care by the help of
integrated pathways based on the local contracts between the providers . A chain of care mainly
includes screening elements in a primary care centre, developments of the treatment plans in the
specialist care centre and rehabilitation care provided in the community. This model can be
considered as a virtual integration, which places the patients at the centre for enhancing access to
services and decrease variations in the quality of care. The aim of this model is similar to the
integrated care models (Vasan et al. 2017). Hence, such types of models can be included within
the integrated service in a rural area.

7ADVANCE HEALTH SERVICE MANAGEMENT
One of the health care models that have evolved with time is the Telehealth, although a
large amount of ambiguity is there that can lead to a reduced demand for the service and greater
efficiencies in the care process (Bradford, Caffery & Smith, 2016). Tele health can potentially
revolutionize the health care delivery procedures by challenging some of the predetermined
notions regarding health care delivery and by creating certain alternative models (Speedie et al.
2018). Telehealth is capable of posing challenge to the assumptions that the health care is
inextricable associated to the location of the providers. Various models like interactive video
conferencing and store forward technologies already exists. Telehealth has also been found to be
challenging episodic nature of care (Speedie et al. 2018). Telehealth also have the potential to
reduce the health care costs, and mitigate problems like shortage of staffs. However, the
achievements of the goals are difficult to achieve, especially in the rural settings. This model
might not be feasible I the current health financing system. Furthermore rural dweller can have
limited health literacy restricting communication between the patient and the therapist. Another
barrier related to tele-health is the internet connection and the breaching of privacy and
confidentiality. Hence, although tele-health is an important model, its implementation might be
always possible. A great deal of work is still to be done before the importance of the telehealth
models are recognised.
Population based models are the ones where the integrated care is entirely made on the
basis of stratification of the population and the different types of services that will need. In this
model promotion and preventive service will be provided to the community for controlling the
exposure to the risk factors.
After the analysis of all the models, it can be said that an integrated health care model can
be beneficial for this district where the strength of the aboriginal people is large. The aboriginal

8ADVANCE HEALTH SERVICE MANAGEMENT
residing in that particular health district lacks health literacy and the insurance rights that they
might get. Hence an integrate approach is required such that individuals get the entire health
coverage and claims for insurance can be settled easily without much effort by the aboriginals.
Majority of the chronic care patients would receive support for self-management of the clinical
condition. Scuffham et al. (2017) have confirmed that that diseases like scurvy, obesity and
cardiovascular diseases are high among the aboriginal population. Hence, the integrated care
services that needs to be introduced in the health care, which would focus on the health
promotion and campaigning for mitigating the spread of the diseases or maintenance of
cleanliness.
As stated earlier, integrated care will give access to an allied range of health care
providers, medical specialists and nurses that will be helpful to address the multidimensional
needs of the population (Rygh & Hjortdahl 2017). They can provide support either by standalone
services or “hubs of support” and also the referral services to super speciality hospitals if
required (S.A.R.R.A.H, 2017).
Integrated care management increases coverage and contains cost, as the consumers have
to reach only one centre, where they can get access to primary care, acute care facilities as well
as the mental health care services.
Integrated services will also contain scopes for family medical therapy by maintaining a
bio-psychosocial framework. This effort would cover these four broad areas of the patient needs
in healing and growth. The integrated care model will look after the physiological health, the
psychosocial health like individual focused counselling the psychological interventions, and
relational, family and the social health and spiritual health.

9ADVANCE HEALTH SERVICE MANAGEMENT
Lastly, an integrated care model provides a timely care. In an integrated care , the
presence of sufficient number of health care professionals and multidisciplinary care team
ensures, that a flexible and a prompt response is obtained from the caregivers.

10ADVANCE HEALTH SERVICE MANAGEMENT
References
Andreasson, J., Eriksson, A., & Dellve, L. 2016. Health care managers' views on and approaches
to implementing models for improving care processes. Journal of nursing
management, 24(2), 219-227.
Bradford, N. K., Caffery, L. J., & Smith, A. C. 2016. Telehealth services in rural and remote
Australia: a systematic review of models of care and factors influencing success and
sustainability. Rural and remote health, 16(4), 3808.
Brundisini, F., Giacomini, M., DeJean, D., Vanstone, M., Winsor, S., & Smith, A. 2013. Chronic
disease patients’ experiences with accessing health care in rural and remote areas: a
systematic review and qualitative meta-synthesis. Ontario health technology assessment
series, 13(15), 1.
Connor, M., Cooper, H., & McMurray, A. 2016. The Gold Coast Integrated Care
Model. International journal of integrated care, 16(3), 2.
Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., & Brown, A. 2015. Factors influencing the
implementation of chronic care models: a systematic literature review. BMC family
practice, 16(1), 102.
Iacobucci, G. 2014. NHS plan calls for new models of care and greater emphasis on prevention.
NSW Agency for clinical innovation. 2017. Understanding the process to develop a Model of
Care, An ACI Framework. Access date: 19.8.2019. Retrieved

11ADVANCE HEALTH SERVICE MANAGEMENT
from:https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0009/181935/HS13-
034_Framework-DevelopMoC_D7.pdf
NSW Agency for clinical innovation. 2017.Models of Care. Access date: 19.8.2019. Retrieved
https://www.aci.health.nsw.gov.au/resources/models-of-care
Pelcastre-Villafuerte, B., Ruiz, M., Meneses, S., Amaya, C., Márquez, M., Taboada, A., &
Careaga, K. 2014. Community-based health care for indigenous women in Mexico: a
qualitative evaluation. International journal for equity in health, 13(1), 2.
Rygh, E. M., & Hjortdahl, P. 2017. Continuous and integrated health care services in rural areas.
A literature study. Rural & Remote Health, 7(3).
S.A.R.R.A.H, 2017.Models of Allied Health Care in Rural and Remote Australia. Access date:
19.8.2019. Retrieved
from:https://sarrah.org.au/sites/default/files/docs/models_of_care_may_2016_final.pdf
Scuffham, P. A., Mihala, G., Ward, L., McMurray, A., & Connor, M. 2017. Evaluation of the
Gold Coast Integrated Care for patients with chronic disease or high risk of
hospitalisation through a non-randomised controlled clinical trial: a pilot study
protocol. BMJ open, 7(6), e016776.
Speedie, S. M., Ferguson, A. S., Sanders, J., & Doarn, C. R. 2018. Telehealth: the promise of
new care delivery models. Telemedicine and e-Health, 14(9), 964-967.
van der Vlegel-Brouwer, W. 2013. Integrated healthcare for chronically ill. Reflections on the
gap between science and practice and how to bridge the gap. International journal of
integrated care, 13.