Background: Fragmented specialized care for the frail elderly as claimed by WHO needs horizontal integration across settings. The home of the patient seems to be a promising place to integrate hospital care, primary care and social services for high-risk discharges where the quality of rehabilitation makes a difference. Objective: The study aims to reveal how integrated home care may be organised to improve quality of care as compared to usual hospital care. Method: A qualitative case study of the use of a neuroeconomic model in relation to multidisciplianry collaboration on a RCT of integrated home care for stroke patients. Results: (1) The classical understanding of CNS is that of a dual system of ANS and Cortex. The new neuroeconomic understanding is that of a reciprocal balance of Limbic System (LS) and Neocortex (NC). This applies directly in favour of integrated homecare compared to hospital rehabilitation as relaxation of LS at home (BP declines 5-7 mmHg) in itself improves cognitive integration to the benefit of rehabilitation i.e. reduced risk of ‘death or disability’ for stroke patients and less readmissions for patients suffering from COPD and heart failure (2) Mental balance between LS and NC is not a continued but a discrete variable of general risk attitude with four sub-groups corresponding to the classical tempers which form the base for neuroeconomic guidelines for multidisciplinary collaboration Conclusion: Neuroeconomics presents a positivistic framework for personal and interpersonal aspects of multidisciplinary collaboration in modern specialized, evidence-based health care for elderly, high-risk, medical patients. Further, such positivistic framework may be accepted across cultural differences.
Program & Abstract Book: Lanzhou 2012 International Forum on Clinical Medicine, 2012, p. 15-16