Overview of Characteristics and Components
Among 7267 citations, we identified 37 original frameworks, including 16 recent frameworks unidentified by previous reviews. Frameworks reflected a wide range of conceptual and structural diversity (Table 3). Among the 33 frameworks for which we had full texts, 54.5% were developed in the USA, 63.6% addressed overall health versus a specific disease (e.g., communicable disease) or setting (e.g., hospice, palliative care, intensive care), and 33.3% were considered patient-centered (i.e., explicitly naming patients/individuals as a key component that was placed at the center of the framework). Only one-third of frameworks explicitly identified a formal definition for care coordination or integration, with the McDonald et al. AHRQ definition as the most frequently cited.11 General theoretical bases for care coordination-specific frameworks were highly variable, with organizational design theory,58 which describes organization structure, as the most commonly cited (24.2%). The process used to select components for frameworks ranged from being unclear in the majority of frameworks to being based on formal literature review plus key informant discussions in a quarter of the cases. Frameworks most commonly emphasized means of coordination (e.g., personal and relationship-oriented mechanisms) (38%, Table 2) and most commonly (97%) included service delivery concepts, such as organizational and structural integration, person-centering (Table 3).
Comprehensiveness of Frameworks
The SELFIE framework was the most comprehensive in terms of the number of care coordination concepts it included (N = 56; e.g., named coordinator, remote monitoring, shared information systems).1 Most frameworks contained 50% or fewer of the SELFIE components. By structuring a wide range of care coordination concepts from micro to macro levels, the SELFIE framework offers a nomenclature that can be used as a starting point to describe and compare initiatives.
The 2018 framework by Singer et al.36 uses the related term “integration” and most comprehensively addressed relationships among five types of integration: structural, functional, normative, interpersonal, and process integration. The three hypothetical relationships it proposes include the following: (1) contextual factors are precursors to organizational and social integration; (2) more versus less structural integration is associated with more functional integration and that these in turn are associated with more normative, interpersonal, and process integration; and (3) these five types of integration will impact outcomes. This framework can be used to distinguish the main emphasis of an initiative or identify which types of integration are most relevant in different circumstances.
Primary Care-Focus of Frameworks
Most relevant to US primary care were three frameworks3, 16, 41 derived from primary care settings. The framework by Weaver and colleagues3 is the most comprehensive, addressing context, locus, and design domains, as well as service delivery, leadership and governance, and workforce domains (see full report). Its main purpose was to examine the factors leading to improved patient outcomes by distinguishing relationships among coordination mechanisms, processes, integrating conditions, and outcomes across multi-team systems. The 2012 primary care-focused framework by Kates et al.26 from Canada has a similar objective of describing key elements of high-performing primary care and supports required to attain it.26 Benzer et al.’s 2015 framework provides insights into how to facilitate the integration of mental health and primary care.16
Coordination of Care with External Partners as Focus of Frameworks
Most relevant to health care organizations coordinating care with external partners are five frameworks (15%)1, 3, 22, 23, 39 that explicitly emphasized distinctions among coordination levels. The SELFIE framework provides a comprehensive framework of components across micro, meso, and macro levels.1 By contrast, Gittell’s Relational Coordination Framework,22 Gittell’s Multi-level Framework,23 and the framework by Weaver et al.3 provide details on mechanisms linking intra- and inter-organization coordination. The Rainbow Model of Integrated Care (RMIC) provides an overview of both the six WHO types of integration and how they interact with different levels of care (micro, meso, macro).39
Team-Focus of Frameworks, Without Regard to Setting
Three care coordination frameworks were team-focused.24, 27, 33 The frameworks were from Australia,24 Canada,27 and the UK.33 Among these, the most comprehensive was the Integrated Team Effectiveness Model (ITEM), which addressed context, locus (setting and purpose), and design (mechanisms) domains and included service delivery, leadership and governance, workforce, and technologies and medical products primarily at the meso level. The team performance framework from Reader et al. was unique in that it focused on the intensive care unit.33
Measurement-Focus of Frameworks
Four frameworks were self-described as measurement-focused.34,35,36, 41 Three are from the USA35, 36, 41 and one is from the UK.34 Among these, the 2018 framework by Singer et al.36 is the most recent and most comprehensive, encompassing all expert-defined domains and subdomains of context, locus, and design and 12 SELFIE components in service delivery, leadership and governance, workforce, financing, and information and research.36 The Singer 2018 framework provides clear definitions of five different types of integration (i.e., structural, functional, normative, interpersonal, and process), describe how they interrelate, and propose how to measure them. Among other measurement-focused frameworks, Shigayeva et al.’s was the second most comprehensive, describing examples of four general levels of increasing integration based on TB and HIV/AIDS program integration.34 Other measurement-focused frameworks include Singer et al., which describes ideal targets for each of five coordination dimensions and two of patient-centeredness.35 Zlateva et al. suggest short-term and long-term outcomes specific to five care coordination domains essential to the Patient Centered Medical Home (PCMH).41
Measurement Tools or Initiatives Deriving from Frameworks
Minkman’s Development Model for Integrated Care (DMIC) is the only framework we identified that has both led to the development of a partially validated survey (face and construct validity) and formation of multidisciplinary teams incorporating the DMIC into stroke, acute myocardial infarction (AMI), or dementia care.29 Otherwise, we identified measures or tools stemming from 39% of the included frameworks.19, 36, 46,47,48,49,50,51,52,53,54,55,56 Most were surveys of health care providers, and most had some to extensive levels of validation. Other frameworks that showed potential for measure development or field use include several with qualitative assessments of a framework concept21, 23, 24, 29 and that hinted at future measures.1, 3, 31, 32, 36 Oliver’s Integrative Model is the only other framework that we identified that has explicitly led to development of an initiative, which involved incorporating telemedicine for hospice patients and caregivers.30
Several previous reviews have provided frameworks for summarizing care coordination measures.8, 15, 30 These reviews identified improvement in measurement quality as a future research need.11, 15, 38 The McDonald 2014 AHRQ Measures Atlas increased access to existing care coordination measures aligned with theoretical frameworks and noted that professional and system perspectives are missing in existing measures.11
Implementation-Focus of Frameworks
Only three frameworks described implementation strategies for settings in Australia,24 Canada,26 and the UK.18 Of these, the Kates et al. and Bradbury frameworks are the most comprehensive.18, 26 Kates et al. are unique in proposing an implementation strategy that includes incorporation of a quality improvement “coach,” an effective spread strategy, and description of system-level enablers. Bradbury is unique in describing their actual experiences translating theory into practice.18
Quality Improvement or Management Focus of Frameworks
Three frameworks focused on quality improvement/quality management and highlighted conditions thought to be associated with effective integration.21, 26, 29 All three address design concepts and variably address context and locus domains. The frameworks share several similar components, such as patient engagement, innovation, measurement and improvement, and partnerships. Among these, Minkman’s Development Model for Integrated Care (DMIC) is the most comprehensive, containing the greatest number of components.29
Focus of Frameworks on Care Coordination in Specialty Settings
Several frameworks focused on coordination in specialty settings,22, 23, 28, 30, 32, 37 such as how to integrate family involvement into hospice interdisciplinary team meetings,30 describing cognitive workflow in critical care,28 consideration of patient’s need for coordination based on interdisciplinarity, biological susceptibility, and procedural intensity,25 examples of best practices for care coordination approaches mapped to clinical, educational, and administrative work activities in surgery,40 and providing an understanding of elements of PCMH coordination initiatives.41 Although some situational factors addressed in these frameworks are unique to the specialty setting, such as the specific clinical workflow to manage an emergency in an intensive care unit, they demonstrate and reinforce the many mechanisms and mediation concepts that are common to all frameworks, such as trust, accountability, and communication.