Abstract
This chapter describes that organised health systems have existed for less than a century and are in an urgent need to transform from the delivery of disease centred services to people centred, integrated health services. In doing so, different models and frameworks exist. Notwithstanding the growing number of integrated initiatives, it has been difficult to consistently demonstrate improved outcomes in research settings, and even harder to achieve larger scale implementation in practice. The reasons for this situation are multi-faceted. A promising approach for the evaluation of systems transforming toward the delivery of integrated health services is realist research. Applying the art and science of complexity may prove helpful to better understand the heterogeneity in effects for all stakeholders involved, including patients and healthcare providers.
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References
Au, M., Kehn, M., Ireys, H., Blyler, C., & Brown, J. (2018). Care coordinators in integrated care: Burnout risk, perceived supports, and job satisfaction. American Journal of Preventive Medicine, 54(6 Suppl 3), S250–S257. https://doi.org/10.1016/j.amepre.2018.01.044
Barbazza, E., Langins, M., Kluge, H., & Tello, J. (2015). Health workforce governance: Processes, tools and actors towards a competent workforce for integrated health services delivery. Health Policy (Amsterdam, Netherlands), 119(12), 1645–1654. https://doi.org/10.1016/j.healthpol.2015.09.009
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. Lancet (London, England), 380(9836), 37–43. https://doi.org/10.1016/S0140-6736(12)60240-2
Barr, V. J., Robinson, S., Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D., & Salivaras, S. (2003). The expanded chronic care model: An integration of concepts and strategies from population health promotion and the chronic care model. Hospital Quarterly, 7(1), 73–82. https://doi.org/10.12927/hcq.2003.16763
Bautista, M. A., Nurjono, M., Lim, Y. W., Dessers, E., & Vrijhoef, H. J. (2016). Instruments measuring integrated care: A systematic review of measurement properties. The Milbank Quarterly, 94(4), 862–917. https://doi.org/10.1111/1468-0009.12233
Baxter, S., Johnson, M., Chambers, D., Sutton, A., Goyder, E., & Booth, A. (2018a). The effects of integrated care: A systematic review of UK and international evidence. BMC Health Services Research, 18(1), 350. https://doi.org/10.1186/s12913-018-3161-3
Baxter, S., Johnson, M., Chambers, D., Sutton, A., Goyder, E., & Booth, A. (2018b). Understanding new models of integrated care in developed countries: A systematic review. NIHR Journals Library.
Beckfield, J., Olafsdottir, S., & Sosnaud, B. (2013). Healthcare systems in comparative perspective: Classification, convergence, institutions, inequalities, and five missed turns. Annual Review of Sociology, 39, 127–146. https://doi.org/10.1146/annurev-soc-071312-145609
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs (Project Hope), 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576. https://doi.org/10.1370/afm.1713
Boehmer, K. R., Abu Dabrh, A. M., Gionfriddo, M. R., Erwin, P., & Montori, V. M. (2018). Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis. PLoS ONE, 13(2), e0190852. https://doi.org/10.1371/journal.pone.0190852
Burger, S. A., Hay, H., Casanas i Comabella, C., Poots, A., & Perris, A. (2018). Exploring education and training in relation to older people’s health and social care. Oxford, UK: Dunhill Medical Trust.
Busetto, L., Luijkx, K., Calciolari, S., González Ortiz, L. G., & Vrijhoef, H. (2017). Exploration of workforce changes in integrated chronic care: Findings from an interactive and emergent research design. PLoS ONE, 12(12), e0187468. https://doi.org/10.1371/journal.pone.0187468
Busetto, L., Luijkx, K. G., Elissen, A., & Vrijhoef, H. (2016). Context, mechanisms and outcomes of integrated care for diabetes mellitus type 2: A systematic review. BMC Health Services Research, 16, 18. https://doi.org/10.1186/s12913-015-1231-3
Busetto, L., Luijkx, K., & Vrijhoef, H. J. M. (2016). Development of the COMIC model for the comprehensive evaluation of integrated care interventions. International Journal of Care Coordination, 19(1–2), 47–58. https://doi.org/10.1177/2053434516661700
Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., & Brown, A. (2015). Effectiveness of chronic care models: Opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Services Research, 15, 194. https://doi.org/10.1186/s12913-015-0854-8
De Savingy, D., Taghreed, A., Alliance for Health Policy and Systems Research, & World Health Organization. (2009). Systems thinking for health systems strengthening. https://doi.org/10.1155/2010/268925
Divo, M. J., Martinez, C. H., & Mannino, D. M. (2014). Ageing and the epidemiology of multimorbidity. The European Respiratory Journal, 44(4), 1055–1068. https://doi.org/10.1183/09031936.00059814
Drewes, H. W., Steuten, L. M., Lemmens, L. C., Baan, C. A., Boshuizen, H. C., Elissen, A. M., et al. (2012). The effectiveness of chronic care management for heart failure: Meta-regression analyses to explain the heterogeneity in outcomes. Health Services Research, 47(5), 1926–1959. https://doi.org/10.1111/j.1475-6773.2012.01396.x
Elissen, A. M., Steuten, L. M., Lemmens, L. C., Drewes, H. W., Lemmens, K. M., Meeuwissen, J. A., et al. (2013). Meta-analysis of the effectiveness of chronic care management for diabetes: Investigating heterogeneity in outcomes. Journal of Evaluation in Clinical Practice, 19(5), 753–762. https://doi.org/10.1111/j.1365-2753.2012.01817.x
Fabbricotti, I. (2007). Taking care of integrated care: Integration and fragmentation in the development of integrated care arrangements. International Journal of Integrated Care, 7, e09. https://doi.org/10.5334/ijic.179
Field, M. G. (1973). The concept of the “health system” at the macrosociological level. Social Science & Medicine, 7(10), 763–785. https://doi.org/10.1016/0037-7856(73)90118-2
Foglino, S., Bravi, F., Carretta, E., Fantini, M. P., Dobrow, M. J., & Brown, A. D. (2016). The relationship between integrated care and cancer patient experience: A scoping review of the evidence. Health Policy (Amsterdam, Netherlands), 120(1), 55–63. https://doi.org/10.1016/j.healthpol.2015.12.004
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., et al. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet (London, England), 376(9756), 1923–1958. https://doi.org/10.1016/S0140-6736(10)61854-5
Golden, B. R., & Martin, R. L. (2004). Aligning the stars: Using systems thinking to (re)design Canadian healthcare. Healthcare Quarterly (Toronto, Ontario), 7(4), 34–42. https://doi.org/10.12927/hcq.16803
Grooten, L., & Vrijhoef, H. J. M. (2018). Scaling-up strategies of integrated care initiatives: A systematic literature review. International Journal of Integrated Care, 18(s2), 252. https://doi.org/10.5334/ijic.s2252
Hartgerink, J. M., Cramm, J. M., Bakker, T. J. E. M., van Eijsden, A. M., Mackenbach, J. P., & Nieboer, A. P. (2014). The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients. International Journal of Integrated Care, 13(5). https://doi.org/10.5334/ijic.1279
Hassenteufel, P., & Palier, B. (2007). Towards neo-Bismarckian health care states? Comparing health insurance reforms in Bismarckian welfare systems. Social Policy & Administration, 41, 574–596. https://doi.org/10.1111/j.1467-9515.2007.00573.x
Himmelstein, D. U., Thorne, D., Warren, E., et al. (2009). Medical bankruptcy in the United States, 2007: Results of a national study. American Journal of Medicine, 122(8), 741–746. https://doi.org/10.1016/j.amjmed.2009.04.012
Institute of Medicine (US) Committee for the Study of the Future of Public Health. The Future of Public Health. Washington (DC): National Academies Press (US). (1988). A history of the public health system (pp. 56–72). Washington, DC: National Academies Press (US). Available from https://www.ncbi.nlm.nih.gov/books/NBK218224/
Janse, B., Huijsman, R., de Kuyper, R., & Fabbricotti, I. N. (2016). Delivering integrated care to the frail elderly: The impact on professionals’ objective burden and job satisfaction. International Journal of Integrated Care, 16(3), 7. https://doi.org/10.5334/ijic.2014
Judge, K. (1988). Organisation for Economic Co-operation and Development (OECD), financing and delivering health care: A comparative analysis of OECD countries, social policy studies no. 4, OECD, Paris, 1987. 101 pp. Journal of Social Policy, 17(4), 547–548. https://doi.org/10.1017/S0047279400017050
Kirst, M., Im, J., Burns, T., Baker, G. R., Goldhar, J., O’Campo, P., et al. (2017). What works in implementation of integrated care programs for older adults with complex needs? A realist review. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care, 29(5), 612–624. https://doi.org/10.1093/intqhc/mzx095
Kodner, D. L., & Spreeuwenberg, C. (2002). Integrated care: Meaning, logic, applications, and implications—A discussion paper. International Journal of Integrated Care, 2, e12. https://doi.org/10.5334/ijic.67
Kruis, A. L., Smidt, N., Assendelft, W. J., Gussekloo, J., Boland, M. R., Rutten-van Mölken, M., & Chavannes, N. H. (2013). Integrated disease management interventions for patients with chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews (10), CD009437. https://doi.org/10.1002/14651858.CD009437.pub2
Lanham, H. J. (2013). A complexity science perspective of organizational behavior in clinical microsystems. In J. Sturmberg & C. Martin (Eds.), Handbook of systems and complexity in health. New York, NY: Springer.
Lassey, M. L., & Jinks, M. J. (1997). Healthcare systems around the world: Characteristics, issues, reforms. Pearson.
Liljas, A., Brattström, F., Burström, B., Schön, P., & Agerholm, J. (2019). Impact of integrated care on patient-related outcomes among older people—A systematic review. International Journal of Integrated Care, 19(3), 6. https://doi.org/10.5334/ijic.4632
Lipsitz, L. A. (2012). Understanding health care as a complex system: The foundation for unintended consequences. JAMA, 308(3), 243–244. https://doi.org/10.1001/jama.2012.7551
Marengoni, A., Angleman, S., Melis, R., Mangialasche, F., Karp, A., Garmen, A., et al. (2011). Aging with multimorbidity: A systematic review of the literature. Ageing Research Reviews, 10(4), 430–439. https://doi.org/10.1016/j.arr.2011.03.003
Mewes, J., Ahmed, S., & Vrijhoef, H. (2018). How do integrated care programmes work for patients with cardiovascular disease, chronic obstructive pulmonary disease, depression, diabetes and multi-morbidity? A rapid realist review. International Journal of Care Coordination, 21(3), 87–97. https://doi.org/10.1177/2053434518788593
Middleton, L., Rea, H., Pledger, M., & Cumming, J. (2019). A realist evaluation of local networks designed to achieve more integrated care. International Journal of Integrated Care, 19(2), 4. https://doi.org/10.5334/ijic.4183
Nason, R. (2017). It’s not complicated: The art and science of complexity in business. Toronto: University of Toronto Press.
Neumeyer-Gromen, A., Lampert, T., Stark, K., & Kallischnigg, G. (2004). Disease management programs for depression: A systematic review and meta-analysis of randomized controlled trials. Medical Care, 42(12), 1211–1221. https://doi.org/10.1097/00005650-200412000-00008
Nolte, E., & McKee, M. (2009). Caring for people with chronic conditions—A health systems perspective. Das Gesundheitswes, 71, A127. https://doi.org/10.1055/s-0029-1239177
Nurjono, M., Shrestha, P., Ang, I., Shiraz, F., Yoong, J. S., Toh, S., & Vrijhoef, H. (2019). Implementation fidelity of a strategy to integrate service delivery: Learnings from a transitional care program for individuals with complex needs in Singapore. BMC Health Services Research, 19(1), 177. https://doi.org/10.1186/s12913-019-3980-x
Nurjono, M., Shrestha, P., Lee, A., et al. (2018). Realist evaluation of a complex integrated care programme: Protocol for a mixed methods study. British Medical Journal Open, 8, e017111.
Nurjono, M., Yoong, J., Yap, P., Wee, S. L., & Vrijhoef, H. (2018). Implementation of integrated care in Singapore: A complex adaptive system perspective. International Journal of Integrated Care, 18(4), 4. https://doi.org/10.5334/ijic.4174
OECD Health Division Team. (2018). Feasibility study on health workforce skills assessment. Supporting health workers achieve person-centred care. Directorate for Employment, Labour and Social Affairs, OECD.
Ouwens, M., Wollersheim, H., Hermens, R., Hulscher, M., & Grol, R. (2005). Integrated care programmes for chronically ill patients: A review of systematic reviews. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care, 17(2), 141–146. https://doi.org/10.1093/intqhc/mzi016
Pawson, R., & Tilley, N. (1997). Realistic evaluation. London: Sage. https://doi.org/10.4135/9781412950596.n474
Peterson, K., Anderson, J., Bourne, D., Charns, M. P., Gorin, S. S., Hynes, D. M., et al. (2019). Health care coordination theoretical frameworks: A systematic scoping review to increase their understanding and use in practice. Journal of General Internal Medicine, 34(Suppl 1), 90–98. https://doi.org/10.1007/s11606-019-04966-z
Pimouguet, C., Le Goff, M., Thiébaut, R., Dartigues, J. F., & Helmer, C. (2011). Effectiveness of disease-management programs for improving diabetes care: A meta-analysis. CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 183(2), E115–E127. https://doi.org/10.1503/cmaj.091786
Piña, I. L., Cohen, P. D., Larson, D. B., Marion, L. N., Sills, M. R., Solberg, L. I., & Zerzan, J. (2015). A framework for describing health care delivery organizations and systems. American Journal of Public Health, 105(4), 670–679. https://doi.org/10.2105/AJPH.2014.301926
Reis, Z., Maia, T. A., Marcolino, M. S., Becerra-Posada, F., Novillo-Ortiz, D., & Ribeiro, A. (2017). Is there evidence of cost benefits of electronic medical records, standards, or interoperability in hospital information systems? Overview of systematic reviews. JMIR Medical Informatics, 5(3), e26. https://doi.org/10.2196/medinform.7400
Roccaforte, R., Demers, C., Baldassarre, F., Teo, K. K., & Yusuf, S. (2005). Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. European Journal of Heart Failure, 7(7), 1133–1144. https://doi.org/10.1016/j.ejheart.2005.08.005
Schöttle, D., Karow, A., Schimmelmann, B. G., & Lambert, M. (2013). Integrated care in patients with schizophrenia: Results of trials published between 2011 and 2013 focusing on effectiveness and efficiency. Current Opinion in Psychiatry, 26(4), 384–408. https://doi.org/10.1097/YCO.0b013e328361ec3b
Sheiman, I., Shishkin, S., & Shevsky, V. (2018). The evolving Semashko model of primary health care: The case of the Russian Federation. Risk Management and Healthcare Policy, 11, 209–220. https://doi.org/10.2147/RMHP.S168399
Sikka, R., Morath, J. M., & Leape, L. (2015). The quadruple aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24(10), 608–610. https://doi.org/10.1136/bmjqs-2015-004160
Stevens, F. C. J., & Van Der Zee, J. (2008). Health system organization models (including targets and goals for health systems). In International Encyclopedia of Public Health (pp. 247–256). Academic Press. https://doi.org/10.1016/B978-012373960-5.00309-9
Strandberg-Larsen, M., & Krasnik, A. (2009). Measurement of integrated healthcare delivery: A systematic review of methods and future research directions. International Journal of Integrated Care, 9, e01. https://doi.org/10.5334/ijic.305
Sturmberg, J. P., O’Halloran, D. M., & Martin, C. M. (2013). Healthcare reform: The need for a complex adaptive systems approach. In J. Sturmberg & C. Martin (Eds.), Handbook of systems and complexity in health. New York, NY: Springer.
Toth, F. (2016). Classification of healthcare systems: Can we go further? Health Policy, 120(5), 535–543. https://doi.org/10.1016/j.healthpol.2016.03.011
Turner, A., Mulla, A., Booth, A., Aldridge, S., Stevens, S., Begum, M., & Malik, A. (2018). The international knowledge base for new care models relevant to primary care-led integrated models: A realist synthesis. NIHR Journals Library, 6, 1–176.
Valentijn, P. P., Schepman, S. M., Opheij, W., & Bruijnzeels, M. A. (2013). Understanding integrated care: A comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care, 13, e010. https://doi.org/10.5334/ijic.886
Olmen, J. V., Criel, B., Damme, W. V., Marchal, B., Belle, S. V., Dormael, M. V., Hoerée, T., Pirard, M., & Kegels, G. (2010). Analysing health systems to make them stronger. Studies in Health Services Organisation & Policy, (27). Retrieved from http://bit.ly/b3KoQR
Vodopivec, V., & Vrijhoef, H. J. (2019). Integrated healthcare models for rheumatoid arthritis: A descriptive systematic review. International Journal of Care Coordination, 22(1), 10–18. https://doi.org/10.1177/2053434519836425
Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice: ECP, 1(1), 2–4.
Walraven, G. (2019). The 2018 Astana Declaration on primary health care, is it useful? Journal of Global Health, 9(1), 010313. https://doi.org/10.7189/jogh.09.010313
Wendt, C., Frisina, L., & Rothgang, H. (2009). Healthcare system types: A conceptual framework for comparison. Social Policy & Administration, 43, 70–90. https://doi.org/10.1111/j.1467-9515.2008.00647.x
World Health Organization. (1978). Declaration of Alma-Ata. In International Conference on Primary Healthcare, Kazakhstan.
World Health Organization. (2007). Everybody’s business—Strengthening health systems to improve health outcomes: WHO’s framework for action. World Health Organization. https://apps.who.int/iris/handle/10665/43918
World Health Organization. (2013). Health 2020, a European policy framework and strategy for the 21st century. Geneva: WHO Regional Office for Europe.
World Health Organization. (2015). WHO global strategy on people-centred and integrated health services: Interim report. World Health Organization. https://apps.who.int/iris/handle/10665/155002
World Health Organization. (2016a). Framework on integrated, people-centred health services. Interim report. Geneva, Switzerland.
World Health Organization. (2016b). Integrated care models: an overview. Working document. Geneva, Switzerland: World Health Organization, Health Services Delivery Programme, Division of Health Systems and Public Health.
World Health Organization. (2018). Declaration of Astana. In Global Conference on Primary Health Care from Alma-Ata Towards Universal Health Coverage and the Sustainable Development Goals, Astana, Kazakhstan, October 25–26, 2018.
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Vodopivec, V., Vrijhoef, H.J.M. (2020). The Organisation of Healthcare Services. In: Tevik Løvseth, L., de Lange, A.H. (eds) Integrating the Organization of Health Services, Worker Wellbeing and Quality of Care. Springer, Cham. https://doi.org/10.1007/978-3-030-59467-1_4
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