Table 1
Response options for perceived levels of integration between organizations.
| LEVEL OF INTEGRATION | DESCRIPTION |
|---|---|
| Not linked | We did not work together (to serve patients with multiple chronic conditions) at all and have separate program goals |
| Communication | We shared patient information only when it was advantageous to either or both programs |
| Cooperation | We shared patient information and worked together when an opportunity arose |
| Coordination | We worked side-by-side as separate organizations to achieve common program goals; efforts were coordinated to prevent overlap |
| Collaboration | We worked side-by-side and actively pursued opportunities to work together to support patients with multiple chronic conditions, but did not establish a formal agreement |
| Partnership | We worked together as a formal team with specified responsibilities to achieve common goals (had a Memorandum of Understanding or other formal agreement) |
| Fully linked | We mutually planned and shared staff and/or resources to organize and deliver care for individuals with multimorbidity |
Table 2
Description of network and node level measures.
| MEASURE | DESCRIPTION |
|---|---|
| Density | A network-level metric that represents the overall level of connectedness among organizations in the network, based on the proportion of actual links relative to the maximum number of possible links in the network [55]. Density scores range from 0 to 1 – lower scores indicate low levels of connectedness, i.e. a 0 would entail no connections between members in the network, whereas a 1 means that all network members are connected to one another [15]. |
| Degree centralization | A network-level measure that depicts how centralized a network is overall, i.e., the extent to which network activity is influenced by one or group of organizations based on the number of connections each network member has with others [54, 60, 61]. Degree centralization ranges from 0 to 1 – a higher value of degree centralization indicates that a small number or group of organizations have a major influence on network activity. |
| Degree centrality | Degree centrality is a node-level measure and typically denotes the number of links each member has with other members in the network – organizations with high degree centrality are considered to be well connected within the network [62]. For directed networks, there are two possible measures of degree centrality: (1) in-degree centrality represents the number of incoming ties to a particular member, and (2) out-degree centrality reflects the number of outgoing ties [63] |
Figure 1
Regular contact (monthly or more often) between organizations in two Health Links in Ontario – node size depicts degree centrality for each network member (data collected in 2018).
Figure 2
Perceived level of integration (at minimum the presence of a coordinated relationship) between organizations across two Health Links in Ontario – node size depicts degree centrality for each network member (data collected in 2018).
Figure 3
Referral relationships between organizations in two Health Links in Ontario, Canada–node size depicts in-degree centrality for each organization, and the arrowhead reflects the direction of the referral (i.e., being sent or received) (data collected in 2018).
Figure 4
Information sharing relationships between organizations in two Health Links in Ontario – node size depicts in-degree centrality for each organization, and the arrowhead indicates the direction of information sharing between network members (data collected in 2018).
Figure 5
Joint care planning relationships between organizations in two Health Links in Ontario – node size depicts in-degree centrality for each network member (data collected in 2018).
Figure 6
Resource sharing relationships between organizations in two Health Links in Ontario – node size depicts in-degree centrality for each organization, and the arrowhead indicates the direction of resource transfer between network members (data collected in 2018).