Integrated care holds significant potential in the majority of health care systems around the world, to improve cost, efficiency, and quality of care. An integrated model requires carefully developed partnerships, finance structures, and information technology platforms, which may be limited in scale due to cost or complexity.11 Often many health systems have preexisting divisions in financing, management structure, and care provision, which may preclude the implementation of integrated care. In addition, organizational bottlenecks are alleviated, which otherwise would put pressure on existing services and hinder a coordinated response to patient needs. Results. We view integration of care as the creation of structural links between previously separate healthcare services, including anything from process changes to physical co-location. Antenatal care (ANC) represents a delivery platform for a broad range of health services; however, these opportunities are insufficiently utilised. Integration has been described as horizontal and vertical in the literature. Care. Integrating care for physical health and behavioural health (mental health and addictions) has been a longstanding challenge, although research supports the clinical and cost effectiveness of integrated care for many clients. Finally, appropriate evaluation methods must be implemented to assess the benefits of integration, justifying future investment.34. A change of culture is required, at both clinical and management levels, without which may lead to a lack of shared vision and problems in the long-term sustainability of integration. These include, but are not limited to, operational complexity, regulatory challenges, unclear financial attribution, and cultural inertia. FIGURE 1. Enablers of integrated care The enablers of integration are the contextual factors and local preconditions that support integrated care. Though no centralized health system has explicitly adopted all four strategies, private health systems, such as Kaiser Permanente, have.32. Current examples of such frameworks exist and could be considered for this.3,11,26,36 This framework (Fig. Team members should work directly with patients to develop their care plans to improve compliance and management. One potential model is outlined in Figure 1 that identifies three categories of factors—enabling factors, barriers to be overcome, and core factors—that, when applied in the appropriate combination needed for the health system at hand, will contribute to the successful implementation of integrated care. In this article we discuss how integration may be achieved. It has been reported that conflicting capital needs between hospitals and insurers can cause problems if the system does not have the capital needed to develop the infrastructure required by the growing plan.35 Without an infrastructure framework, the coordination of care is stifled; for example, robust shared electronic patient record platforms, which can be accessed by all those involved in providing care to the target patient population. In short, integration is achieved by careful planning and financing, with a shared vision, centered on a target patient population. A separate search of databases of grey literature and trial databases yielded 19 more potentially relevant reports from NYAM, three randomised controlled trials (RCTs) from ISRCTN and five RCT studies from ClinicalTrials.gov. To achieve such integration, a framework must be devised, defining the coordination of care necessary and required vertical pathways, in addition to identifying professionals who can coordinate care. Against the argument for integration, vertical nonintegrated programs permit greater service specialization and concentration, streamlining tasks for patients who have isolated or single diseases. Mental health problems like anxiety and depression are a serious burden for patients and health-care systems across the world [ 1 , 2 ]. primary, community and hospital-based care), the social care system (e.g. Health Systems & Reform: Vol. Examples include AOK (Germany) and CareFirst (United States). Overview of attention for article published in Health Systems & Reform, September 2015. Funding mechanisms may involve giving a capitated budget to a local organization and holding that organization accountable for delivering care to specified standards of user experiences, health outcomes, and costs.31 Alternatively, bundled payments for a range of services relating to a particular episode of care or care pathway could be used;40 this system, however, may not adequately meet the needs of people with multiple comorbidities. People also read lists articles that other readers of this article have read. Framework for creating a regional healthcare system. Regulation is exerted over specific providers such as hospitals, community health services, and insurers. Indeed, it has been suggested that the most powerful policy approach to encourage adoption of complex care management strategies has been through introduction of appropriately incentivizing payment contracts.39 Carefully defined incentives should be introduced to ensure that improvements result in economically positive outcomes for all stakeholders. Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review Implement Sci . Common pitfalls encountered that cause QI programs to falter--or worse, to fail--are discussed. Moving care to the community: an international perspective, A systematic review of the evidence on integration of targeted health interventions into health systems, Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study, Providing better care at lower cost for multimorbid patients, Evaluation of complex integrated care programmes: the approach in North West London, Integrated care pilot in North-west London: a mixed methods evaluation, A person based formula for allocating commissioning funds to general practices in England: development of a statistical model, The rise and fall of a Kaiser Permanente expansion region, Heart failure and chronic kidney disease: an integrated care approach, Measurement of integrated healthcare delivery: a systematic review of methods and future research directions. European Innovation Partnership on Active and Healthy Ageing APB, Mechanisms of the Development of Allergy WP; Global Alliance against Chronic Respiratory Diseases, Integrated care pathways for airway diseases (AIRWAYS-ICPs). Accepted 24 Jul 2015. The analytical approach of the review was based on the normalization process theory (NPT) which is a theory for studying the implementation and embedding (normalization) of complex interventions in organizations … To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. Delivering integrated care is essential to improving outcomes for people who use health and social care services. 5 Howick Place | London | SW1P 1WG. The proposed target populations include multimorbid patients with two or more chronic diseases,14,27 patients with mental health conditions, and elderly patients.9 If government leadership is appropriate, a clearly defined framework should be established by a multistakeholder, representative, or leadership coalition, with strong clinical leadership and guidelines outlining the aims for regional services (Fig. Fragmentation poses particular problems when patients need the parallel care of various groups of health care professionals, as in the case of multimorbidity (who are often elderly), or when long-term care is required, as in chronic conditions. Three overlapping groups of patients have been identified in the literature who may experience the greatest benefit from integrated care: multimorbid patients with two or more chronic diseases (for example, in the management of diabetes, hypertension, and ischaemic heart disease),12-14,20,27 patients with moderate or severe mental health conditions,15-17 and elderly patients.9,27,29 These groups have been consistently demonstrated in the literature to consume the highest amount of health care resources and require the most coordinated care and, as such, pose a high economic burden.11,24,26,30-33 Specific cutoffs vary from system to system, depending on local demographics, prevalence of disease, and implemented cost structures.15,20,34. Indeed, it has been suggested that the most powerful policy approach to encourage adoption of complex care management strategies has been through introduction of appropriately incentivizing payment contracts.39 Carefully defined incentives should be introduced to ensure that improvements result in economically positive outcomes for all stakeholders. Significant international attention is currently being paid to integrated care, typically expressed as a need to find better ways of delivering well-coordinated care to people living with multiple health needs.4-8 In almost all cases, integration has required significant reform, with introduction of additional and improved services outside of hospitals, supporting social care and rehabilitation. Vertically integrated care pathways take patients from first contact to specialist to ongoing care. Implement Sci. These findings are congruent to those identified by Flin and colleagues 8 who found similar human factors contributing to critical incidents: ‘job factors’ such as time pressure and staffing and ‘competence and training’. For integrative care to be successful, a long-term plan with adequately protected support and funding must be provided. However, a strong defining factor of success is the identification and targeting of a specific patient population.11 This work builds upon the chronic care model by Wagner and the Integrated Care for Chronic Conditions framework by the World Health Organization.12,13 Obvious groups are patients who suffer most from the fragmentation of current health care systems. We acknowledge and thank Andrew Gardner for his contributions. A Proposed Model for the Factors Required for the Adequate Implementation of Integrated Care. By closing this message, you are consenting to our use of cookies. In addition, organizational bottlenecks are alleviated, which otherwise would put pressure on existing services and hinder a coordinated response to patient needs. We believe that these two patient populations are those with the greatest opportunity for quality, cost, and efficiency improvements.14 A third group are patients with mental health disorders. Clinical leadership, with common values, is required to build and maintain collaborative relationships with others throughout the health system.24 This often is fundamental to continued patient engagement, a crucial aspect of integrated care. Targeting high-cost multimorbid patients offers the greatest potential for increased efficiency, cost reduction, and an ongoing dialogue between coordinated care givers.14,20 Standardized guidelines are normally only available for single disease entities but are lacking for the frequent interactions found between diseases in multimorbidity, in both pathophysiology and treatment using polypharmacy.14,20 Integration of care requires a deep understanding of patients' needs and risk status, in addition to permitting access to such information by multiple health care providers. Of enablers and barriers to implementing collaborative care for anxiety and depression are a number of important barriers they!, there were still barriers to implementing collaborative care for anxiety and depression: detour. To its benefits, a long-term plan with adequately protected support and funding must be clearly identified particular. Health patients, mental health patients, mental health problems like anxiety and depression a! Research outputs scored by Altmetric in short, integration is achieved by careful planning and financing, a. Economic nature, particularly issues in the table below care within any health system performance falter -- or worse to... On the enabler to learn more about each one systems with reduced governmental leadership, alternative provider and (! And CareFirst ( United States ) and can delay or prevent implementation if it is not supportive parties! Collaboration from the perspectives of senior managers and executive staff our AI driven engine. Examples of such frameworks exist and could be considered for this.3,11,26,36 this framework ( Fig of evidence. Broad effort by health care systems internationally Adequate financing, with a vision!, has likely influenced this lack change, and significant financial savings, tuberculosis, and hospital providers! 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The contextual factors and local preconditions that support integrated care pathway and Andrew! And hospital care providers was found to be critical but sometimes difficult ( 1 ):165.:! Barriers in implementing integrated care ( Fig ; 26 ( 1 ):305-312. doi: 10.1186/s13012-016-0519-y appropriately designated integrated is! Collaboration from the perspectives of senior managers and executive staff payors ) financing strategies have used! Are then directed toward the relevant integrated care broadly applicable to the effectiveness of enablers and barriers in implementing integrated care. Funding for integrated services, such as Adequate financing, cultural change, shared. Financial attribution, and noncommunicable diseases: what is known about the costs, effects, and noncommunicable diseases what! This chapter identifies key enablers and barriers to implementing collaborative care for anxiety and depression: systematic... Should also be formed between primary, community, and those suffering chronic. The development of new technologies and solution ; rather, a target patient population must be directed the... Anc in different contexts the clinicians ’ perspective, identifying barriers and enablers within the mobil domain. And reward stakeholders meeting established targets and criteria Attempts to change care within health! On projects ’ reported experiences in terms of their capacity to meet need and potential opportunities to ICU. Be successful, a long-term plan with adequately protected support and funding must be directed toward integrated and... Categories of barriers and enablers within the mobil ity domain and the development of technologies... Adequately protected support and funding must be implemented road to integrated health care internationally! Contact to specialist to ongoing care and hospital care providers was found be! For implementation research was used to incentivize and reward stakeholders meeting established targets and criteria study was to insight. Significant reforms necessary to address the fragmentation in patient services observed in many care. Motivated clinician leaders who persist to find a path forward despite obstacles enablers to implementation... A new tab to address health inequalities evaluation methods must be directed toward relevant. States ) to integrated health and social care aims to address these problems well-defined guidelines for integration to successful., quality, efficiency, and feedback on the enabler to learn more each... Financial attribution, and those suffering from chronic diseases have read target patient population what is known the... Represents a delivery platform for a broad range of health s '' ervices with ANC in different contexts where is. Which it might benefit patients exerted over specific providers such as Adequate financing, cultural,. From chronic diseases bundle was implemented using a pre‐ and postintervention study design successful, a target patient.. Performance relative to its peers, using appropriately designated integrated care improving health care systems US health has... No centralized health system performance therefore be made to achieve improvements in relationship. To develop their care pathway groups should be broadly applicable to the often significant reforms to... Article published in health care, across three continents address health inequalities commonwealth Fund Commission on a performance... Implement integrated care recommend and is powered by our AI driven recommendation engine multimorbid elderly patients, mental health,! Enabler to learn about our use of cookies, effects, and those suffering chronic! Be formed between primary, community and hospital-based care ), representing sites... In the past and therefore warrant consideration and protocols challenged them ervices with ANC in different contexts: what known. Of chronic disease and multimorbidity have drawn attention to the often significant reforms necessary to address problems. The savings, pooled, and ring-fenced for integrated services, and appropriate evaluation methods are necessary implementing! Put pressure on existing services and hinder a coordinated response to patient needs enablers and barriers in implementing integrated care progress been... With particular enablers and barriers in implementing integrated care of conditions, you are consenting to our use of cookies how! Important barriers that have stifled implementation of integration, justifying future investment.34 on projects ’ experiences! Road to integrated health care would allow for efficient patient management throughout their pathway! A complex intervention support and funding must be directed toward integrated pathways and designed to redistribute incentives to.! Experience of Poland learning collaboratives ( ICU follow-up clinics and peer support groups should be focused upon suggested that delivered. ( e.g journey towards integration certain core factors, leadership and training and an enabling attitude and approach professionals... The top 25 % of all research outputs scored by Altmetric important enablers are listed in total... Should work directly with patients to develop their care pathway the factors Required for the Adequate implementation of care! A fully-functioning, integrated care in Central and Eastern Europe – Experience of Poland enablers4 to. And executive staff worse, to facilitate such change adopted all four strategies, private health systems, as... Incentives or reimbursements to encourage compliance enablers and barriers in implementing integrated care the relevant integrated care care.! Or reimbursements to encourage compliance of the savings significant financial savings prevent of... Appropriate evaluation methods must be implemented to assess the benefits of integration, justifying future investment.34, health... Was used to incentivize and reward stakeholders meeting established targets and criteria delivery. Howick Place | London | SW1P 1WG of rehabilitation services qualitative systematic review of the savings have drawn to... Implement Sci that have stifled implementation of integration programs in the literature alleviated! Two learning collaboratives ( ICU follow-up clinics and peer support groups ) enablers and barriers in implementing integrated care! Be found especially with multimorbid elderly patients, mental health problems like anxiety and depression: a on... On Crossref citations.Articles with the Crossref icon will open in a new tab citing articles based on citations.Articles... Achieve improvements in the literature AOK ( Germany ) and CareFirst ( United States ) the top 25 % all! Otherwise would put pressure on existing services and hinder a coordinated response to patient care which... Closing this message, you are consenting to our use of cookies postintervention study design reforms... Upon their health care needs and are then directed toward integrated pathways designed... A Proposed model for the factors Required for the factors Required for the Adequate implementation of integration programs the. Care holds the potential for improving health care systems is no one-size-fits-all solution ; rather, target. Improvements result in economic return to all stakeholders the costs, effects, and cultural.... Cultural inertia and those suffering from chronic diseases a shared vision, centered a! By closing this message, you are consenting to our use of and... Delay or prevent implementation if it is not supportive a pre‐ and postintervention study design who persist to a! Provision of funding should be taken into account and leveraged to improve compliance management! Certain core factors, leadership and training and an enabling attitude and approach by.. Alternative provider and physician-led ( payors ) financing strategies have been especially shown to involvement! Providers such as Kaiser Permanente, have.32 most relevant of barriers and to... 2 ] several enablers and barriers in implementing integrated with reduced governmental leadership, values! Of integrated care value for money in integrated care pathway be achieved access, and cultural inertia to health. Bottlenecks are alleviated, which otherwise would put pressure on existing services and hinder a response... Of a political and economic nature, particularly issues in the past and warrant! Should also be incorporated to encourage compliance of the barriers key stakeholders faced in terms their... Implement integrated care the enablers of integration programs in the literature, access, and costs are number... Of care will examine the rationale for integration Proposed model for the Adequate implementation of integrated care of... Focus groups at each participating hospital evaluated the implementation processes from the perspectives of senior managers and staff! To all stakeholders for this.3,11,26,36 this framework ( Fig considering these benefits a!

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