It has been 12 years after Porter and Teisberg published their landmark
manuscript on “Redefining Health Care.” Apart from stressing the need for a
fundamental change from fee-for-service to value or outcome-based financing and
to a focus on reducing waste, they emphasized the need to work along patient
pathways and in Integrated Practice Units to overcome function based and
specialist group silos and promote working in multidisciplinary patient-oriented
teams. Integrated Practice Units are defined as “organized around the patient
and providing the full cycle of care for a medical condition, including patient
education, engagement, and follow-up and encompass inpatient, outpatient and
rehabilitative care as well as supporting services.” Although relatively few
papers are published with empirical evidence on Integrated Practice Units
development, some providers have impressively developed pathways and integrated
care toward alignment with Integrated Practice Units criteria. From the field,
we learn that possible advantages lay in improving patient centeredness,
breaking through professional boundaries, and reducing waste in unnecessary
duplications. A firm body of evidence on the added value of turning pathways
into Integrated Practice Units is hard to find and this leaves room for much
variation. Although intuitively attractive, this development requires staff
efforts and costs and therefore cost-effectiveness and budget impact studies are
much needed. Randomized controlled trials may be difficult to realize in
organizational research, it is long known that turning to alternative designs
such as larger case study series and before–after designs can be helpful. Thus,
it can become clear what added value is achievable and how to reach that.