Impact of Integrated Care on Patient-Related Outcomes Among Older People – A Systematic Review

Abstract

Introduction: The growing number of older adults with multiple needs increases the pressure to reform existing healthcare systems. Integrated care may be part of such reforms. The aim of this systematic review was to identify important patient-related outcomes of integrated care provided to older adults. Methods: A systematic search of 5 databases to identify studies comprising older adults assessing hospital admission, length of hospital stay, hospital readmission, patient satisfaction and mortality in integrated care settings. Retrieved literature was analysed employing a narrative synthesis. Results: Twelve studies were included (2 randomised controlled trials, 7 quasi-experimental design, 2 comparison studies, 1 survey evaluation). Five studies investigated patient satisfaction, 9 hospital admission, 7 length of stay, 3 readmission and 5 mortality. Findings show that integrated care tends to have a positive impact on hospital admission rates, some positive impact on length of stay and possibly also on readmission and patient satisfaction but not on mortality. Conclusions: Integrated care may reduce hospital admission rates and lengths of hospital stay. However due to lack of robust findings, the effectiveness of integrated care on patient-related outcomes in later life remain largely unknown. Further research is needed to establish the effect of integrated care on these patient-related outcomes. Prospero registration number: CRD42018110491.

Why do evaluations of integrated care not produce the results we expect?

“…[1][2][3] Studies like these stick out, even in an equivocal evidence base that cannot agree whether integrated care initiatives can reduce the use or cost of services in the community and in hospitals. [4][5][6][7] The curious studies we highlight raise questions about why such unexpected results are still being found decades into the integrated care journey in England, and whether the aims of integration, specifically surrounding reducing hospital admissions and improving system efficiency, will ever be consistently achieved. In this paper, we examine potential flaws in the design, delivery and evaluation of integrated care programmes and make recommendations to improve how integrated care initiatives are planned and evaluated.…”

Challenges in measuring integrated care models: International knowledge and the case of Québec

“…Hopman et al 41 ; Kaufman et al 42 ; Liljas et al 26 ; Looman et al 43 ; Mitchell et al 45 model. Furthermore, H ebert et al 48 argue that the correlation of implementation measures and effects "will help to decrease the "black box" effect of health services intervention and to avoid a "type 3 error" in measuring the effect of an intervention that has not really been or was not sufficiently implemented" (p. 10).…”

“…Reviews on effects revealed five main categories of indicators i) effects on the patient's health, 26,[40][41][42][43]45 ii) effects on caregivers and professionals, 40,43 iii) effects on the integration process, 42,43,45 iv) effects on health care usage 26,[41][42][43] and v) effects on service costs or resource use. 40,41,43,45 Although these reviews provide many outcome indicators, it is not clear which indicators are best used in various conditions.…”

“…et al 26 Lyngso et al 27 Suter et al 22 Mitchel et al 45 Sunderji et al 29 Baxter et al 40 Hopman et al 41 Allen and Rixson 39 Kaufman et al 42 Marino et al 44 Was an ''a priori'' design provided? Were the methods used to combine the findings of studies appropriate?…”

Evaluating Large-Scale Integrated Care Projects: The Development of a Protocol for a Mixed Methods Realist Evaluation Study in Belgium

“…To address this challenge, the integration of health services has been promoted in many countries. However, most studies deal with integrated care interventions in a local setting and include a rather limited number of people [8][9][10][11][12]. It is well known that such innovations and programmes often have difficulties scaling up to provide sustainable, long-term interventions on a societal, whole-system level [13][14][15].…”