Abstract
Overview: Integrated care has gained popularity on the global stage to combat the rising challenges faced by health care systems. Integrated care does not have a universal definition but can broadly be defined as a care pathway that aims to achieve the quadruple aim by bringing together primary, secondary, and tertiary care services. Care pathways underpinned by the principles of integrated care have seen success in the improvement of health outcomes, patient and provider experience, and benefits to the health system. A significant amount of the literature evaluating integrated care aims at advancing knowledge of patient and provider experiences. Both areas are vital to understanding the successes and failures of integrated care but are insufficient to understand the ‘how’ and ‘why’ of successful system integration. It is vital to determine what non-clinical factors (e.g., governance, power dynamics, political influences on decisions, change management and funding) contributes to and facilitates success and longevity of an initiative to truly understand how we can achieve sustainable health care system reform.
Aim: This scoping review aims to understand what non-clinical factors influence the success of Australian integrated care initiatives, focusing on the governance structures that have historically been used.
Methods: An extensive search of both published and grey literature was conducted to find documented Australian integrated care initiatives at state or territory and federal levels. Scopus and PubMed were searched for published literature using a purposefully broad strategy due to the varying definitions of integrated care. Grey literature searches were also conducted. Articles were screened for relevancy before being mapped against aspects of the aspects of the Innovative Policy Supports framework and The Rainbow Model of Integrated care. Relevancy was determined by the following factors:
a)An Australian initiative conducted between January 1995 and January 2023
b)Cross-organisational partnership (including government)
c)Spanning primary, secondary, and tertiary settings.
d)Aiming to reduce fragmentation and fill a service gap.
Preliminary findings: Of the few hundred initiatives found in Australia, only a fraction of these have published evaluations with most of the information found coming from the grey literature searches of government websites. This significant gap in the literature impacts our ability to learn from past initiatives. A key recommendation is to have evaluations of integrated care initiatives be publicly available, particularly if they have been funded with public resources.