Cc why bother elements

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Learn more. Ask Question. Asked 8 years, 9 months ago. Active 4 years, 10 months ago. Viewed 9k times. Improve this question. Swanny Swanny 2, 17 17 silver badges 20 20 bronze badges. Add a comment. Active Oldest Votes. Markup is for describing content, not appearance. Covert channel analysis which is relevant only when multi-level information flow or unobservability policies are present moved into VAN.

Misuse analysis mostly moved into the AGD families that address the documents subject to such analysis. However, aspects of this remain in VAN, since the AGD documents are considered when performing vulnerability analysis. SOF analysis no longer explicitly addressed. Removed the notion of the developer performing any vulnerability assessment.

There are additional aspects of the interface that introduced in v3. Overview of Common Criteria Changes 1. Part 1- Introduction and general model 1. Part 2- Security functional components 1.

Part 3- Security assurance components a. ADV - Development d. ATE - Test e. AVA - Vulnerability Assessment 1. Mapping of ADV requirements 2. Mapping of ATE requirements 2. Mapping of AVA requirements 1. Part 1- Introduction and general model Part 1 was made clearer, better reflecting the whole CC. Part 2- Security functional components Part 2 has had little changes from v2.

Part 3- Security assurance components The changes to part 3, and their causes, are so varied that it would not be useful to attempt a consolidated global summary. ADV - Development The problems with v2. A summary mapping of the ADV requirements of versions 2. A summary mapping of the ATE requirements of versions 2. All of which begs the question: why bother?

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The four new additions to the periodic table have only temporary names at the moment. Japonium has been suggested as a candidate for element , which would make it the first element starting with J. Now if scientists can just come up with a good name starting with Q, the periodic table would be alphabetically complete. Edition: Available editions United Kingdom. Patients are often provided with counselling, coaching and education as well as incentives such as gifts to support self-management.

Out of 87 programmes reviewed, 38 identified facilitators for integrated care programmes for chronic diseases. Only 26 described financial incentives, some for the patients, some for the provider and a few for both. Payment systems that incorporate financial incentives are key for encouraging providers to participate in and implement integrated care programmes for chronic diseases.

Performance-based incentives provide additional payments to participating providers such as pay-for-performance schemes. Innovative payment models such as bundled payment schemes or gain-sharing also encourage care providers to achieve improved value for money [ 19 , 20 , 21 ]. Financial incentives encouraging patients to enroll in integrated care programmes include reduced or waived copayments or a personal health budget providing patients with either cash or vouchers to purchase home-based care services [ 22 ].

Although none of the models described a personal health budget or direct financial contributions to service users, subsidies for medicines and services were more common. Non-financial incentives for patients included rewards for desired behavioural change and vouchers for services performed within a specific programme [ 23 , 24 ]. Non-financial incentives for care providers were also identified, for example giving out awards and memberships in an integrated care network as a reward for physicians and healthcare workers participating in an integrated care programme [ 19 , 24 ].

Facilitators of integration at the system level consist of rules and policies that facilitate an environment promoting the integration of care and making integration possible.

Strong leadership and political commitment as well as community engagement acted as strong facilitators of the programmes. Many programmes function under national guidelines and frameworks of care integration which facilitate the engagement of care professionals as well as leadership and strengthen the credibility of the programme [ 25 ]. Barriers were found on multiple fronts, for users, providers and the broader environment or community where integration was taking place.

Stigma in the community and instability such as regular displacement of patients or conflict in the region was also found to undermine the success of care integration. A significant barrier for patients was a lack of engagement within the programmes. These barriers threaten not just the implementation but also the sustainability of newly implemented care integration programmes. Developing a list of indicators for the performance assessment might be the first step to understanding whether these integrated care programmes have achieved the objectives intended.

We have summarized indicators related to the structure, process and outcome of the programmes, which we found in the literature and presented these in Table 5. The performance of the structure of the integrated care programmes was mainly assessed based on the proportion of specialists to other doctors, the sharing of medical records between hospitals and other care providers as well as access to medical technology. The performance of the process of the integrated care programmes was assessed based on access to health care ie.

The performance of the integrated programmes outcome was assessed based on the number of hospital readmissions, care utilization ie.

Gaps in scheduled care, clear process when moving between care providers, information sharing between care providers etc. Mortality, rate of complications etc. Indicators used to evaluate the performance of integrated care programmes for chronic diseases were rarely applied by these integrated care programmes.

Overall, only 3 programmes were found to mention indicators related to the performance of the structure of the models. Access to healthcare was the indicator most often used to evaluate the process of the models and clinical outcomes was the indicator most often used to evaluate the outcomes of the models. Care utilization, quality of life, care satisfaction and total cost of care were also frequently used to evaluate outcomes.

From the indicators evaluating the performance it can be seen overall, that integrated care programmes increase access to healthcare, improve clinical outcomes and patient satisfaction. Some programmes also showed improved performance in areas of public health, such as reporting improved patient knowledge and compliance. Integrated care is one strategy for achieving universal health coverage UHC and sustaining UHC in the face of the growing need for long-term and complex care [ 8 ].

Understanding the mechanisms and elements of integrated care programmes in the context of these diverse countries is important for drawing lessons for the future. The programmes which have been identified, range from those in an early development phase such as a community health center-led integrated care pilot for NCDs in Huangzhou, China to more developed programmes which have been nationally implemented such as the Aged Care Transition ACTION Program in Singapore [ 26 , 27 ].

The programmes also vary in the level of integration ranging from linkages to fully developed integrated care programmes. Since there is much variation between the settings, target diseases and populations as well as specific interventions, at this point it is not possible to draw firm conclusions regarding the effectiveness of the programmes.

However, one can already make some observations regarding the general facilitators and barriers of care integration as well as the level of evaluation of the programmes. The frameworks for analyzing integrated care fall into two categories: the framework based on the Valentijn model, and the framework based on the WHO framework. The Valentijn model describes six dimensions of integrated care including 1 systemic integration, 2 organisational integration, 3 functional integration, 4 professional integration, 5 service integration, and 6 normative integration.

In this framework, systemic integration reveals the macro level of the integrated care, professional and organisational integration illustrates the meso level of the integrated care, clinical integration describes the micro level of the integrated care. Functional and normative integration play the role of enablers to connect the different levels with each other [ 48 ]. Alternatively, the WHO framework analyzes care integration using five key elements including 1 empowering individuals and communities through health education, knowledge sharing and training programmes, 2 strengthening participatory governance and mutual accountability, 3 improving health service delivery by prioritizing primary care outpatient and ambulatory care, strengthening population health and enabling new technologies, 4 coordinating care from different levels for people, making connections and communication between health providers and 5 creating a favorable environment through improving management, upgrading the information system and optimizing the incentive mechanism for health providers [ 6 ].

To date, integrated care has been more commonly implemented in western countries, however the concept has been gaining popularity and piloted in Asia-Pacific region also, [ 5 ] and therefore many of the programmes and studies in the Asia-Pacific region are reflections of those in western countries.

As the Asia-Pacific has a huge ageing population across diverse settings with a rise in those requiring care for complex and chronic conditions, there are many lessons to be learned from understanding which features of integrated care programmes are contributing to their success [ 11 ].

As the settings in Asia-Pacific vary vastly from highly developed urban Singapore to less-developed rural India, we can understand how elements of integration are adapted to a variety of settings and have an idea of which elements are the most important in all settings. Although there is no single approach or model which best supports integrated care, there are several factors which contribute to the success of integrated care programmes [ 28 ].

Facilitators and barriers can be categorized according to external context laws, regulations, an already existing health system, strategic direction , system organization financing, organizational leadership, structure of existing services, culture , intervention organization intervention size and complexity, resources, credibility , as well as providers and research staff shared values, engagement, communication [ 26 ].

The particular factors influencing the success of a programme varies according to the context. A systematic review of the facilitators and barriers of implementing chronic care models in countries across North America and Europe found that the strongest general facilitators included strong networks and communication, a culture and implementation climate which supported integration and uptake of chronic care, strong leadership, provider knowledge and beliefs about the programmes to be implemented [ 29 ].

General barriers in these settings were related to the execution of integrated care programmes, lack of organizational readiness, no support and accountability from senior leadership as well as a negative attitude and a lack of buy-in from care providers [ 28 ]. In comparison, across countries in Asia-Pacific region many barriers arise from health system instability and a lack of information management stemming from inadequate IT infrastructure and low resources [ 5 ].

Integrated care programmes can address some of these obstacles to provide a continuum of care for chronic conditions. For example, as integrated care emphasizes information sharing, it can be used to facilitate communication between providers and patients as well as within multidisciplinary teams. Care integration aims to reduce overlap between services and improve coordination of care between professionals thus improving cost effectiveness, although it must be noted that integration does not solve a lack of resources [ 5 , 30 ].

An important difference between integrated care programmes in western countries and the Asia-Pacific is the care coordinator. A review of seven integrated care programmes in western countries described care coordinators as the distinguishing feature contributing to the success of all the programmes and also found the engagement of patients and their communities to be essential [ 31 ].

In our review, the enabling factors varied by specific context and study country. Many of the programmes identified in India clearly mentioned the success of programmes rested upon adapting them to the local context to ensure acceptability with the local staff and patients [ 33 , 34 , 35 ]. In Singapore, strong government involvement and leadership was frequently cited as a facilitator [ 36 , 37 , 38 ]. Government support was also identified as a facilitator in the Philippines along with strong community involvement [ 39 , 40 ].

Facilitators of integrated care programmes in China included community involvement, government support and existence of national guidelines [ 21 , 25 , 41 , 42 ]. Clearly strong leadership and a supportive setting is essential and can influence the success of integrated care programmes [ 43 ]. The role of technology and sophisticated IT systems in integrating healthcare is also necessary for managing and sharing patient or service-related information.

However, IT literacy is inconsistent across Asia-Pacific and electronic medical records are not the norm in all healthcare settings in the region [ 6 ]. Various payment methods have an important role in encouraging patient participation, clinical guideline maintenance and treatment adherence, in addition to achieving health targets [ 22 ].

These varying payment methods have offered financial incentives to support the structure, process and the outcome elements of integrated care models [ 22 ]. In many western countries financial incentives for integration of care most often target providers, but some also focus on health insurers and patients [ 22 , 44 ].

We have found that the financial performance of integrated care programmes in the literature was not frequently evaluated. Cost-effectiveness was discussed in very few programmes in India, Singapore and China [ 27 , 37 , 38 , 45 ]. These programmes cited lowering of costs by reduced hospitalization and increased efficiency of services. A monitoring and evaluation mechanism to provide feedback is also important for identifying potential issues and informing programme leaders and policy makers, however these were not often done adequately based on the literature we have reviewed.

The goals of integration as defined by the WHO is to enhance the quality of care and quality of life, increase consumer satisfaction and increase system efficiency [ 46 ]. Performance evaluation should measure the degree to which these goals are met. A systematic review of integrated care models in the UK and abroad, found that the three most frequent indicators of care integration which provide the strongest measure of effect included higher patient satisfaction, increased perceived quality of care and increased patient access to services [ 47 ].

In accordance with these findings, this review also found that improved access to healthcare and increased patient satisfaction were the most frequently cited performance indicators.