Abstract
Introduction: Many countries with publicly funded health systems, such as Canada, are looking to transform how people receive long-term care and services by shifting more care into the community and strengthening community-based options . Despite the potential of integrated home and community care to address the needs of an aging population in their desired location, the influence of these programs on the broader health system is not well understood.
Methods: We conducted a scoping review following Levac et al.’s 2010 methodology. A comprehensive literature search was undertaken in three databases (Ageline, CINAHL, MEDLINE) to identify literature published in the last decade that examined the outcomes of integrated home and community care programs related to the health system (acute care, emergency services, primary care, informal care, and facility-based long-term care) through the lens of the Quadruple Aim (client/caregiver experience, provider well-being, population health, costs care) and Health Equity. Major integrated care journals and citations of included articles were also hand searched. Consultation meetings were held with leadership of a local integrated care team and operations and strategy leaders of a Canadian health social enterprise to support interpretation of results and the development of meaningful messaging applicable to program development, evaluation planning and policy work.
Results: 5,656 titles and abstracts underwent screening, with 569 full-text articles assessed for eligibility and 50 articles moving the extraction phase. Due to unclear descriptions of interventions, including what care was provided by whom, or how the care model facilitated integrated care delivery in home and community settings, many identified articles were excluded. Preliminary findings indicate an evidentiary focus on hospital or emergency medical service utilization outcomes of integrated home and community care programs (i.e., readmission rates, length of stay, and emergency department visits), along with population health outcomes. Few articles investigated economic impacts of patient and/or provider experiences or health equity related to programs. There is a predominance of articles focusing on integrated community palliative care programs. Local and international programs which were identified as important examples of integrated home and community care in practice, were not represented in the peer-reviewed literature. More detailed findings and results from consultations will be available at ICIC24.
Learnings and next steps: Synthesis and application of evidence on integrated home and community care models requires researchers to ensure clear description of model components and study settings in study reporting. To support development and use of evidence on the outcomes of integrated home and community care programs for transformative system change, more collaboration between health services researchers and health and social care organizations in a learning health system model is needed. Ensuring future research focuses on outcomes beyond hospital-based service utilization is needed to build rationale across the continuum of care for broader uptake, scale and spread. Consensus on meaningful short and long-term metrics within each component of the Quadruple Aim and Health Equity framework could support more robust and consistent evaluation of integrated home and community care programs and comparison of outcomes to support political, operational, clinical and financial decision-making.