Table 1
List of integrated care projects by location, key intervention components, and level of integration from the conceptual framework for integrated care.
| PROJECT NUMBER | PROJECT DESCRIPTION | LOCATION | KEY COMPONENT(S) | LEVEL OF INTEGRATION |
|---|---|---|---|---|
| 1 | Online pathway for the diagnosis, referral, and management of primary mental health care | Remote to very remote | Introduction and training for a stepped care mental health model in emergency departments Software platform to give providers shared access to patient information | Professional Organisational |
| 2 | Improving access and care planning for the management of COPD* | Major city | Creation of a multidisciplinary pulmonary rehabilitation pathway GP† education and best practice adherence auditing for rehabilitation pathway components | Professional |
| 3 | Community outreach service for Hepatitis C virus diagnosis and treatment | Inner regional | Hub-and-spoke model in which a multidisciplinary telehealth team (hub) supported GPs and community workers to deliver care in the community, and nurses to lead community assessment and mobile liver imaging services (spokes) | Clinical Professional Organisational |
| 4 | Primary and secondary co-management of paediatric ADHD** patients | Major city | Weekly remote consultations between GPs and specialists to improve clinical confidence in managing ADHD patients within primary care | Professional |
| 5 | Integration of funding models for allied health in rural communities | Outer regional | Service coordination for allied health based on community needs Integration of funding streams Increased telehealth and allied health assistant access | Professional Organisational |
| 6 | Telehealth and emergency department redesign for partnerships between aged care facilities and emergency care | Outer regional | Dedicated emergency department team for low acuity presentations Telehealth assessment of aged care facility patients between emergency and aged care nurses to avoid unnecessary emergency presentations Secure patient data sharing service between hospitals and aged care facilities | Clinical Professional Organisational |
| 7 | Multidisciplinary clinics to treat patients with concomitant gastroenterological and hepatological symptoms | Major city | Identification and enrolment of applicable patients for 12-week care management pathway Multi-disciplinary, GP-led community monitoring of patients post-pathway | Clinical Professional |
| 8 | Teledentistry model for remote monitoring of dental caries using intraoral cameras | Very remote | Provision of intraoral cameras and data sharing service to enable on-site community workers and remote dentists to conduct telehealth assessment and referral | Professional Organisational |
| 9 | Multidisciplinary support teams for chronic respiratory diseases including allied health, home visiting services and patient education | Major city to inner regional | Specialist care hotline for GPs to consult with clinics for rapid referral Multidisciplinary care team and increased allied health support to provide home visits and education | Clinical Professional |
| 10 | Novel linkages between acute and community-based services for cognitively impaired older persons | Outer regional | Emergency department screening to identify and redirect elderly to more appropriate services Specialist outreach for community-dwelling elderly | Clinical Professional |
| 11 | Older persons enablement and rehabilitation for complex health conditions | Outer regional | Integration of primary and secondary care to create a shared management structure for complex older patients Early intervention and outreach service for patients at risk of imminent deterioration and hospitalisation | Clinical Professional Organisational |
| 12 | Facilitating social work liaisons for cognitively impaired patients with complex guardianship status requiring tribunal | Major city | Appointment of one hospital-based and one tribunal-based coordinator to coordinate patient hearings Engagement with patients and guardians on tribunal process | Professional Organisational |
| 13 | Paediatric shared care model for children with developmental, behavioural, and learning difficulties | Inner regional | Centralised intake model for paediatric referrals Development and delivery of a GP Diploma of Child Health | Clinical |
| 14 | Delivering GP education and tools to manage health and developmental needs of children in out of home (foster) care | Major city | Data sharing platform for children’s health providers Health system navigators for children in out-of-home care Development and training for GP digital assessment tools to establish best practice and understand care needs of children in out-of-home care | Professional Organisational |
| 15 | Integrating emergency, acute, and primary services for a patient-centred model of diabetes care | Inner regional | Aboriginal & Torres Strait Islander focused virtual team to plan post-referral care pathways Redirection of low acuity diabetes care to GPs, supported by additional primary care diabetes education and training Ambulance visits linked with diabetes educator to reduce unnecessary ambulance transfers | Clinical Professional Organisational |
| 16 | “One-stop-shop” model for the localisation and coordination of mental healthcare and social services | Inner regional | Centralised referral, triage, and treatment pathway for adults with mental illness Co-location of varied clinical and non-clinical services to enable patients to access requisite successively Shared provider/social work access to patient records to manage care and assess outcomes | Clinical Professional |
| 17 | Integrated diagnosis, management and discharge of frail elderly patients in hospital | Major city | Identification of admitted elderly at risk of functional decline to a multidisciplinary care ward Development of a comprehensive discharge plan engaging patient’s family and external care providers | Professional Organisational |
[i] * Chronic Obstructive Pulmonary Disease; ** Attention Deficit Hyperactivity Disorder; † General Practitioner.
Table 2
The five health services evaluation criteria across ICIF projects.
| CRITERIA | OUTCOME MEASURES |
|---|---|
| Health service capacity | Services appropriately redirected from acute or emergency to primary or outpatient |
| Length of stay in hospital or emergency department | |
| Patient outcomes | Patient satisfaction |
| Health-related quality of life | |
| Healthcare accessibility | |
| Integration of care | Clinical: Evidence of greater patient-centred care, including patient engagement and care coordination |
| Professional: Evidence of increased intra-professional partnerships, and shared care between providers | |
| Organisational: Evidence of greater cohesion in continuum of care and improved coordination across care organisations and networks | |
| Workforce development | Provider satisfaction with workload, support, and quality of care |
| Provider skills development for improved care delivery | |
| Organisational risk | Implementation success relative to barriers and facilitators |
Table 3
Definitions and examples of integration used in evaluating each project.
| INTEGRATION DOMAIN | DEFINITION [17] | IMPLEMENTATION IN PRACTICE | EXAMPLES FROM PROJECTS |
|---|---|---|---|
| Clinical | Coherence in the primary process of care delivery to individual patients | Care is designed around the needs of the patient and addresses a range of factors contributing to patient health. Users are actively engaged as partners to improve their own well-being. |
|
| Professional | Partnerships between professionals both within and between healthcare organisations | Care involves a range of providers, across multiple specialities, modalities, or locations with a shared vision to improve healthcare delivery. |
|
| Organisational | Collective action across the entire care continuum | Interorganisational relationships, knowledge sharing, alliances, contracting and common mechanisms for governance and evaluation are observed, not necessarily limited to healthcare. |
|
Figure 1
Organisational risk scale of project implementation.
Figure 2
Organisational risk matrix of implementation environment vs implementation success for all projects.
Table 4
MCDA with equal weighting, sorted by cost per point. Fractions are rounded to the nearest decimal point.
| PROJECT | CAPACITY | OUTCOMES | INTEGRATION | WORKFORCE | RISK | TOTAL | NET COST | COST PER POINT |
|---|---|---|---|---|---|---|---|---|
| 4 | 0 | 0 | 0.7 | 1 | 2 | 3.7 | $210,950 | $57,014 |
| 5 | 0 | 0.4 | 1.3 | 0 | 1 | 2.7 | $238,476 | $88,324 |
| 15 | 2 | 1.2 | 2.0 | 2 | 1.5 | 8.7 | $784,865 | $90,214 |
| 14 | 0 | 0 | 1.3 | 2 | 1.5 | 4.8 | $471,029 | $98,131 |
| 11 | 1 | 1.2 | 2.0 | 1 | 2 | 7.2 | $913,336 | $126,852 |
| 17 | 2 | 1.2 | 1.3 | 1 | 0.5 | 6.0 | $821,383 | $136,897 |
| 3 | 1 | 1.2 | 2.0 | 0 | 1.5 | 5.7 | $850,006 | $149,124 |
| 12 | 2 | 0.4 | 1.3 | 0 | 2 | 5.7 | $889,698 | $156,087 |
| 10 | 0 | 0 | 1.0 | 0 | 0 | 1.0 | $162,954 | $162,954 |
| 7 | 0 | 0.8 | 1.3 | 2 | 1.5 | 5.6 | $1,362,603 | $243,322 |
| 9 | 1 | 0.4 | 1.3 | 0 | 0.5 | 3.2 | $792,507 | $247,658 |
| 2 | 2 | 1.2 | 0.7 | 2 | 1.5 | 7.4 | $1,842,953 | $249,048 |
| 13 | 0 | 0.8 | 0.7 | 1 | 0.5 | 3.0 | $786,052 | $262,017 |
| 6 | 2 | 0.4 | 2.0 | 1 | 2 | 7.4 | $2,048,999 | $276,892 |
| 16 | 2 | 1.6 | 1.3 | 2 | 1.5 | 8.4 | $2,411,938 | $287,135 |
| 8 | 0 | 0.4 | 1.0 | 1 | 0.5 | 2.9 | $1,277,109 | $440,382 |
| 1 | 0 | 0 | 0.7 | 0 | 0.5 | 1.2 | $1,675,243 | $1,396,036 |
Figure 3
MCDA cost-per-point presented on a cost-effectiveness plane for panels (A) equal rating, (B) quantitatively oriented rating, (C) qualitatively oriented rating, and (D) policy analyst suggested rating.
Table 5
List of four alternative weighting paradigms and observed range (minimum/maximum).
| PROJECT | RANK (COST PER POINT) | RANGE | |||
|---|---|---|---|---|---|
| UNWEIGHTED | QUANTITATIVE | QUALITATIVE | AUTHOR PERCEPTIONS | MINIMUM, MAXIMUM | |
| 1 | 17 | 17 | 17 | 17 | [17, 17] |
| 2 | 12 | 10 | 14 | 9 | [9, 14] |
| 3 | 7 | 7 | 7 | 7 | [7, 7] |
| 4 | 1 | 2 | 1 | 1 | [1, 2] |
| 5 | 2 | 6 | 2 | 3 | [2, 6] |
| 6 | 14 | 4 | 11 | 12 | [4, 14] |
| 7 | 10 | 15 | 10 | 14 | [10, 15] |
| 8 | 16 | 16 | 16 | 16 | [16, 16] |
| 9 | 11 | 9 | 12 | 10 | [9, 12] |
| 10 | 9 | 13 | 8 | 15 | [8, 15] |
| 11 | 5 | 5 | 5 | 5 | [5, 5] |
| 12 | 8 | 4 | 6 | 6 | [4, 8] |
| 13 | 13 | 14 | 13 | 13 | [13, 14] |
| 14 | 4 | 8 | 3 | 8 | [3, 8] |
| 15 | 3 | 1 | 4 | 2 | [1, 4] |
| 16 | 15 | 11 | 15 | 11 | [11, 15] |
| 17 | 6 | 3 | 9 | 4 | [3, 9] |