The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care

Abstract

Objective:As part of the EU-funded Project INTEGRATE, the research sought to develop an evidence-based understanding of the key dimensions and items of integrated care associated with successful implementation across varying country contexts and relevant to different chronic and/or long-term conditions. This paper identifies the core dimensions of integrated care based on a review of previous literature on the topic.Methodology:The research reviewed literature evidence from the peer-reviewed and grey literature. It focused on reviewing research articles that had specifically developed frameworks on integrated care and/or set out key elements for successful implementation. The search initially focused on three main scientific journals and was limited to the period from 2006 to 2016. Then, the research snowballed the references from the selected published studies and engaged leading experts in the field to supplement the identification of relevant literature. Two investigators independently reviewed the selected articles using a standard data collection tool to gather the key elements analyzed in each article.Results:A total of 710 articles were screened by title and abstract. Finally, 18 scientific contributions were selected, including studies from grey literature and experts’ suggestions. The analysis identified 175 items grouped in 12 categories.Conclusions:Most of the key factors reported in the literature derive from studies that developed their frameworks in specific contexts and/or for specific types of conditions. The identification and classification of the elements from this literature review provide a basis to develop a comprehensive framework enabling standardized descriptions and benchmarking of integrated care initiatives carried out in different contexts.

Quality of health care according to people with Down syndrome, their parents and support staff—A qualitative exploration

“…However, person‐centred care is not standard practice, health care is traditionally orientated around curing separate conditions instead of addressing the total picture, and care is organised within separate silos (Kinnear et al, ; Valentijn, Schepman, Opheij, & Bruijnzeels, ; Wiering et al, ), which is also seen in our results. Attention is increasingly directed towards integrated care models as an answer to fragmented care, lacking person‐centeredness (González‐Ortiz, Calciolari, Goodwin, & Stein, ). Although studies investigating the effect of integrated care models on outcomes are scarce, integrated care is considered promising in health care for people with complex needs and/or chronic disease (Busetto, Luijkx, Elissen, & Vrijhoef, ; Van Duijn, Zonneveld, Montero, Minkman, & Nies, ; González‐Ortiz et al, ).…”

“…Attention is increasingly directed towards integrated care models as an answer to fragmented care, lacking person‐centeredness (González‐Ortiz, Calciolari, Goodwin, & Stein, ). Although studies investigating the effect of integrated care models on outcomes are scarce, integrated care is considered promising in health care for people with complex needs and/or chronic disease (Busetto, Luijkx, Elissen, & Vrijhoef, ; Van Duijn, Zonneveld, Montero, Minkman, & Nies, ; González‐Ortiz et al, ). In integrated care, coordination of (medical and social) care, around people's needs (person‐centred), is crucial (González‐Ortiz et al, ).…”

“…Although studies investigating the effect of integrated care models on outcomes are scarce, integrated care is considered promising in health care for people with complex needs and/or chronic disease (Busetto, Luijkx, Elissen, & Vrijhoef, ; Van Duijn, Zonneveld, Montero, Minkman, & Nies, ; González‐Ortiz et al, ). In integrated care, coordination of (medical and social) care, around people's needs (person‐centred), is crucial (González‐Ortiz et al, ). The user‐led definition illustrates the meaning of integrated care from a patient's perspective: “My care is planned with people who work together to understand me and my carer(s), put me in control, coordinate and deliver services to achieve my best outcomes” (WHO Europe, ).…”

Key Lessons Learned in the Strategic Implementation of the Primary Care Collaborative Memory Clinic Model: A Tale of Two Regions

“…A growing body of literature on integrated care provides evidence that collaboration between healthcare professionals can be enhanced through development of a structure for team work, sharing of team resources and organizational supports (administration, facilities) and mechanisms for communication and coordination (San Martin-Rodriguez et al 2005). Interprofessional team-based care, with ongoing care coordination, communication and information sharing among all care providers, is the mainstay of personcentred care (American Geriatrics Society Expert Panel on Person-Centered Care 2016) and has been identified as essential for integrated care (Gonzalez-Ortiz et al 2018). Community-based integrated systems of care for older adults have demonstrated improved quality, coordination and continuity of care and health outcomes for older adults (Bernabei et al 1998;Johri et al 2003;McAdam 2008 , meso (organizational) and macro (community and system) levels and how these levels interact and collaborate to affect change (Chaudoir et al 2013;Durlak and DuPre 2008;Wandersman et al 2008).…”

The Odyssey of Integration: Is Management its Achilles’ Heel?

“…Leadership was traditionally conceptualised as primarily focussed on those in senior positions but more recent thinking emphasises distributed leadership across multiple management levels [6,7], and indeed the contribution of other stakeholders such as clinicians and those with lived experience [8,54,55]. Supportive and engaged leadership by managers is seen to make a positive contribution but neglect or resistance by leaders present major risks to the achievement of successful outcomes [1,4,[9][10][11][12][13]54]. Evaluations of individual programmes also reflect the importance of proactive management to successful implementation [e.g.…”