Innovations in the nursing care of the chronically ill: a literature review from an international perspective

This literature review focuses on substitution-related innovations in the n ursing care of chronic patients in six western industrialized countries. Di fferences between primary and secondary care-orientated countries in the ki nd of innovations implemented are discussed. Health care systems are increa singly being confronted with chronic patients who need complex intervention s tailored to their individual needs. However, it seems that today's health care professionals, organizations and budgets are not sufficiently prepare d to provide this kind of care. As a result, health care policy in many cou ntries targets innovations which reduce health care costs and, at the same time, improve the quality of care. Frequently, these innovations are relate d directly to the 'substitution of care' phenomenon, in which care is provi ded by the most appropriate professional at the lowest cost level, and enco mpass advanced nursing practice, hospital-at-home care and integrated care. The main conclusion of this paper is that integrated care innovations are implemented in both primary care as well as in secondary care-orientated co untries. However, innovations in hospital-at-home care and advanced nursing practice are primarily implemented in primary care-orientated countries. W hether these innovations positively influence the quality of care, costs of care or patients' use of health care facilities remains rather unclear.