Evaluating the structure-process of integrated care for people with multimorbidity – Systematic review

Background: The United Kingdom faces significant challenges in addressing the needs of individuals with complex health conditions, particularly those living with multimorbidity. In England, one in four adults has two or more long-term health conditions, leading to decreased quality of life and increased demand for healthcare services. The current healthcare system is often fragmented, requiring patients to navigate multiple services and treatments, increasing their treatment burden. Integrated care is proposed as a potential solution to these issues, with its organisational structure closely linked to effective care integration.

 

 However, it is unclear which aspects of integrated care enhance its effectiveness compared to other models of care. This study aims to explore the organisational structures and processes within integrated care systems that improve health and social care outcomes for adults with multimorbidity. The review is registered with PROSPERO (CRD420251143298).

 

Approach: We will conduct a systematic review by searching relevant studies across various databases, including ASSIA (ProQuest), CENTRAL (Wiley), CINAHL (EBSCOHost), The Cochrane Library (Wiley), Embase (Ovid), Medline (Ovid), PsycINFO (Ovid). We will incorporate international evidence to facilitate cross-country comparisons and studies published between 1990 and 2025, reflecting the evolution of integrated care. Inclusion criteria will focus on studies that explore the management of adults with multimorbidity, emphasising integrated care across various health and social care settings. All study types will be included, comprising both randomised and non-randomised controlled trials.

 

Data synthesis will follow a three-stage approach, integrating framework analysis, the Rainbow Model of Integrated Care (RMIC), and the Pillar Integration Process (PIP). Framework analysis will systematically code and map research findings. The RMIC's five dimensions: macro (system integration), meso (organisational and professional integration), micro (clinical integration), functional (IT systems and financing), and normative (shared values and culture), will provide the conceptual framework. Reporting will adhere to the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement.

Expected Results: This review is expected to identify key organisational arrangements and processes that support effective integrated care for multimorbidity. Insights will be provided into how primary, secondary, and regional health systems foster collaboration across health and social care sectors. The analysis will extend beyond a descriptive summary, leading to a synthesis of best practices in integrated care systems and the identification of crucial organisational structures that enhance outcomes for those with multimorbidity.

 

Implications: The review aims to offer valuable guidance for policymakers, practitioners, and researchers in designing effective and equitable integrated care systems. By analysing diverse data across healthcare systems, we can better understand various approaches to integrated care structures and processes. This understanding can help identify best practices for transitioning from fragmented, organisation-centred care to person-centred care for individuals with multimorbidity.

 

Additionally, the review will highlight challenges faced by different countries and explore innovative solutions applicable to future research priorities. Ultimately, the goal is to provide a comprehensive overview that underscores the significance of integrated care and its potential to improve health outcomes through collaborative learning and sharing successful strategies.