Doctoral thesis

Essays on care integration and frailty : Challenges and perspectives


156 p

Thèse de doctorat: Università della Svizzera italiana, 2013 (jury note: magna cum laude)

English Our work focuses on understanding the challenges and opportunities of health care delivery to the elderly, an issue which has become salient for European health systems. While a growing body of research assesses the challenging complexity associated with aging and frailty through care integration numerous questions remain: What are the antecedents of successful care integration and how does integration affect care outcomes? What are the patterns of utilization among the frail elderly and what services are most relevant for integration? The first essay comprises an investigation of integration models for the frail elderly in Europe and North America, through an extensive literature review and a comparative case study analysis. We develop a conceptual framework positing that the success of integrated care initiatives does not result from the mere technical intensity of integration, rather it is a function of the correct matching of operating tools implemented with environmental, cultural and organizational factors. In the second essay we empirically test the framework in the Italian NHS. We use confirmatory factor analysis to validate the measurement models and structural equation models to test the proposed relationships. The third essay extends our approach to the association between care utilization and frailty, in the elder European population. We focus on identifying the effect of an individual’s frailty state on primary, secondary and tertiary care utilization using data from the SHARE survey. We use Poisson and logistic regression models, accounting for the panel structure of the dataset and unobserved heterogeneity at the country and individual level.
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