Scottish Government

Ten approaches to help you deliver better outcomes and an enhanced experience of care for older people and for people living with long term conditions
A collaborative resource to support partnerships
ISBN 978 0 7559 8005 5
This document is also available in pdf format (448k)

Contents

Improvement Action
Ten things you can do now that make a difference
Where it's happening… and who can help

Introduction
1. Stratify your population and identify those at high risk
2. Target and deliver a proactive case/care management approach
3. Introduce advanced/anticipatory care plans
4. Communicate and share data across the system
5. Develop intermediate care alternatives to acute hospital care
6. Provide telehealth and telecare support
7. Develop a falls prevention pathway and services
8. Provide pharmaceutical care
9. Ensure timely access, flexible homecare and carer support
10. Promote mental health and wellbeing in later life
Further Reading, Resources and Sources of Evidence
Appendix 1: A Logic Model improvement framework for Complex Care

It may be Complex, but it's Logical

There is growing interest in the use of the Logic model to illustrate the links between service inputs, outputs, activities and intended outcomes. This approach sets improvement and change in the context of the bigger picture and provides a road map to communicate the vision and to focus and improve its implementation. It offers a useful framework to integrate planning, delivery and evaluation, helps you identify what service approaches and resources are needed and what to measure for short term, intermediate and longer term outcomes.

Appendix 1 is a simplified Logic model framework that illustrates the ten improvement actions for complex care and their anticipated impact on outcomes and performance across the whole system.