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

Laura G. González-Ortiz; Stefano Calciolari; Nick Goodwin; Viktoria Stein

doi:10.5334/ijic.4198

Figures & Tables

Flowchart of the literature selection process.

Table 1

Results of the search across the identified 12 conceptual domains.

Domain	No.	Element/item	Reference
Healthcare system	1	Universal coverage or enrolled population with care free at point of use	[5 19]
	2	Emphasis on chronic and long-term care	[5 20]
	3	Emphasis on population health management	[5 21 22]
	4	Alignment of regulatory frameworks with goals of integrated care	[5 6 16]
	5	Data on chronic illnesses (eg. registries)	[23]
	6	Understand needs and priorities of local populations	[9 21 22 24]
	7	Mobilize and coordinate resources	[16 22]
	8	Adequate financing system linked with quality improvement	[22 23 25]
	9	Funding payment flexibilities to promote integrated care	[5]
10	Allocating financial budgets for the implementation and maintenance of integrated care	[7 25]
11	Funding of a program or service	[26]
12	Changes to funding arrangements	[26]
13	Finances for implementation and maintenance	[27]
14	Reaching agreements on the financial budget for integrated care	[7]
15	Prepaid capitation at various levels	[14]
16	Financing mechanism allowing for pooling of funds across services	[6 14 19]
17	Creating financial and regulatory incentives that encourage cooperation among health care providers	[6]
Community resources and policies	18	Integrate policies: collaboration/coordination across health-related policy fields (eg. environment, education, transportation, housing)	[9 16 25]
	19	Location policy	[9]
	20	Inter-organisational strategy	[6 9 20]
	21	Creating interdependence between organisations	[7 9]
	22	Reaching agreements on introducing and integrating new partners in the care chain	[7]
	23	Formal connections between organisations: varying from linkage with community to merging of organisations	[6 7 20 21 25 26]
	24	Achieving adjustments among care partners	[7]
	25	Reaching agreements about letting go care partner domains	[7]
	26	Reaching agreements among care partners on the consultation of experts and professionals	[7]
	27	Reaching agreements among care partners on managing client preferences	[7]
	28	Reaching agreements among care partners on scheduling client examinations and treatment	[7]
	29	Reaching agreements among care partners on discharge planning	[7]
30	Making transparent the effects of the collaboration on the production of the care partners	[7]
31	Structural meetings with external parties such as insurers, local governments and inspectorates	[7]
32	Structural meetings of leaders of care-chain organizations	[7 21]
33	Role of volunteers and third sector to support needs of patients and carers	[5 22]
34	Building systems of care at the neighborhood level	[5 22]
35	Building community awareness and trust with services (gives legitimacy to new approaches to care, and increase likelihood of appropriate, and earlier, referrals)	[5]
36	Family caregivers (involvement and support)	[5 14 18 20 28]
37	Coordinated home and community health	[5 22]
38	Build resilience among carers to promote home-based care	[5 22]
39	Raise awareness and reduce stigma	[16]
40	Social value creation	[9]
41	Provide complementary services	[16]
Self-management support	42	Patient education	[5 22]
	43	Patient empowerment	[23]
	44	Using self-management support methods as a part of integrated care	[5 7 9 21]
	45	Patient engagement and participation, i.e. patients provide input on various levels	[6 9 20 23]
46	Electronic tools for patients to be engaged and active in self-management	[20 23]
47	Patient navigation/clinical pathways	[20]
48	Reminders for patients	[23 26]
Delivery system design	49	Paradigm shift from acute to chronic care and from reactive to proactive care delivery	[20 25]
	50	Population-based needs assessment: focus on defined population	[6 21 22 25]
	51	Defining the targeted client group	[5 7]
	52	Developing care programmes for relevant client subgroups	[7]
	53	Designing care for clients with multi- or co-morbidities	[7]
	54	Understand best ways to organize and implement care	[24]
	55	Collaborative involvement in planning, policy development and patient care delivery	[6]
	56	Service characteristics	[9]
57	Co-location of services	[5 9 14 21 26]
58	Specialized clinic or centres	[27]
59	Patient-centered philosophy (focus on patients’ need)	[6 9 29]
60	Promotion of functional independence and wellbeing, not just the management or treatment of medical symptoms (holistic focus)	[5 9 28]
61	Commitment to the view that the patient is the customer	[6]
62	Interaction between professional and client	[9]
63	Care plans including collaborative goal setting between patients and clinicians	[9 20 26]
64	Centralized information, referral and intake	[5 14]
Delivery system design	65	Single point of entry and a single point of contact for patients and carers	[5 7 21]
	66	Case management (relational continuity with a named coordinator)	[5 6 7 9 14 20 21 26 27]
	67	Case management	[5]
	68	Arrangements for priority access to another service	[26]
	69	Disease management	[14]
	70	Professional attitude and fulfilment of work as drivers of integration	[14]
	71	Multidisciplinary teamwork	[5 14 16 20 21 26 27 29]
	72	Developing a multi-disciplinary care pathway	[6 7 27]
	73	Creating interdependence between professionals (inter-professional networks)	[5 9 14 18 20]
74	Teamwork (joint working) and care coordination	[5]
75	Arrangements for facilitating communication	[7 26]
76	Information sharing, planned/organised meetings	[20]
77	Using a uniform language in the care chain	[7]
78	Using uniform client-identification numbers within the care chain	[7]
79	Shared assessment	[21 26]
80	Coordinated or joint consultations	[26]
81	Using feedback and reminders by professionals for improving care	[7 23 27]
82	Agreements on referrals, discharge and transfer of clients through the care chain	[5 6 7 14]
Delivery system design	83	Clinical follow-up	[27]
	84	Continuity of care	[9 18 22 29]
	85	Assisted living/care support at home	[5 21]
	86	Service management (e.g., collective telephone numbers, counter assistance and 24-hour access)	[9 14 21]
	87	Medication management	[5]
	88	Essential and new pharmaceuticals and medical devices	[23]
	89	Collaboratively assessing bottlenecks and gaps in care	[7]
	90	An adequate workforce (in terms of number, competencies and distribution)	[5 9 22 23]
	91	Workforce educated and skilled in chronic care (graduate)	[5 6 16 20]
92	Cross-training of staff (to ensure staff culture, attitudes, skills are complementary)	[6 7 9 14 16 22]
93	Reaching agreements among care partners on tasks, responsibilities and authorizations	[7 23]
94	Establishing the roles and tasks of multidisciplinary team members	[5 7 20]
95	Professionals in the care chain are informed/aware of each other’s expertise and tasks	[5 6 7 20]
96	Education for professionals (continuous education)	[6 16 20 22 23]
97	Training (joint or relating to collaboration)	[14 21 26]
98	Inter-professional education	[6 7 9 20 23]
99	Stimulating a learning culture and continuous improvement in the care chain	[7]
Decision support	100	Share registries and/or methods to track care/health	[5 14 23 26]
	101	Implementing care process-supporting clinical information systems	[7 26]
	102	Shared decision support	[26]
	103	Support/supervision for clinicians	[26]
	104	Clear communication strategies and protocols	[6]
	105	Standardised diagnostic and eligibility criteria	[5 7 14]
	106	Multidisciplinary and comprehensive assessment	[5 14]
	107	Developing criteria for assessing client’s urgency	[7]
	108	Case finding and use of risk stratification	[5]
	109	Common decision-support tools (practice guidelines, protocols)	[5 14 21 23]
	110	Multidisciplinary guidelines and protocols	[5 7 14]
	111	Existence of evidence-based clinical practice guidelines with automated tools to enforce their use	[6 7 20 29]
112	Join planning	[5 7 9 14 20 21 26]
113	Using a single client-monitoring record accessible for all care partners	[7]
114	Using a protocol for the systematic follow-up of clients	[7]
115	Information sharing, planned/organised meetings	[20]
116	Shared decision-making and problem solving	[6]
117	Shared-care protocols and evidence based practice guidelines	[5 6 9 14 18 20 23 29]
118	Shared clinical records	[5 14 21]
119	Integrated clinical pathways	[6]
120	Decision aids to patients	[23]
121	Providing understandable and client-centered information	[7]
122	Assistance in accessing primary health care	[26]
Clinical information system	123	Intelligence systems for data collection	[18 22 23 25]
	124	Centralised system-wide computerised patient record system (data accessibility from anywhere in the system)	[6 20 23]
	125	Integrated electronic health records	[5 6 7 14 18 20 22 23 27]
126	Electronic registry for planning care and risk-stratifying patients	[20]
127	Technologies that support continuous and remote patient monitoring	[5 20 21]
128	Reminders to clinicians and patients (e.g., medication management)	[5 23]
Leadership	129	Local leadership and long-term commitments	[5 6 7 27]
130	Leaders with a clear vision on integrated care	[27]
131	Distributed leadership	[5 6 7 21 25]
132	Managerial leadership	[5 6 7 9 18]
133	Visionary leadership	[9]
134	Clinical leadership	[5 9 25]
135	Organisational leadership for providing optimal chronic care	[20]
136	Conflict management	[9]
137	Reputation	[9]
Governance	138	Good governance	[9 18 22 23]
Governance	139	Inter-organisational governance	[9]
140	Inter-professional governance	[9]
Performance & Quality	141	Action oriented to understand and support more effective ways for improving quality and enabling change	[5 6 24 27 29]
	142	Collaborative learning in the care chain in order to innovate integrated care	[7]
	143	Involving leaders in improvement efforts in the care chain	[7]
	144	Involving client representatives by monitoring the performance of the care chain	[7]
	145	Using a systematic procedure for the evaluation of agreements, approaches and results	[5 7 9 20 23 25]
	146	Reaching agreements about the uniform use of performance indicators in the chain care	[7]
	147	Establishing quality targets for the performance of care partners	[7]
	148	Establishing quality targets for the performance of the whole care chain	[7]
	149	Installing improvement teams at care-chain level	[7]
	150	Evaluate outcomes	[24]
151	Client satisfaction	[7 9 22]
152	Performance management (common outcomes evaluation, performance indicator)	[5 7 9 18 21 22 24]
153	Monitoring successes and results during the development of the integrated care chain	[7 20]
154	Regular feedback of performance indicators	[9]
155	Shared accountability/risk and responsibility for care	[5 6]
156	Integrating incentives for rewarding the achievement of quality targets	[6 7 18 20 24]
157	Gathering financial performance data for the care chain	[7]
158	Gathering data on client logistics (e.g. volumes, waiting periods and throughput times) in the care chain	[7 21]
159	Monitoring and analysing mistakes/near-mistakes in the care chain	[7]
160	Monitoring whether the care delivered corresponds with evidence-based guidelines	[7]
Organisational culture	161	Shared vision and values for the purpose of integrated care	[5 6 9 18 25 27]
162	An integration culture institutionalised through policies and procedures	[5 6 7 9 20 27]
163	Organisational culture for providing optimal chronic care	[20 25]
164	Striving towards an open culture for discussing possible improvements for care partners	[7]
165	Linking cultures	[9]
Contextual factors	166	Population features (e.g., demographic composition)	[9 28]
	167	Advocacy	[16]
	168	Rurality of the area	[28]
169	Environmental climate	[9]
170	Environmental awareness	[9]
171	Labour market	[9 28]
Social capital	172	Quality features of the informal collaboration	[9]
Social capital	173	Trust (on colleagues, caregivers and organisations)	[5 6 7 9]
174	Reputation	[9]
175	Interpersonal characteristics	[9]

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

Figures & Tables

Figure 1

Table 1

Paradigm

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