Introduction: Notwithstanding care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of integrated care lacks specificity and clarity. This article presents a literature review to identify mechanisms for achieving integrated care objectives.

Background: For some time now, integrated care has been put forward to create a more demand-driven, patientcentred and cost-effective care system. Various conceptual frameworks have been developed to shed light on the complex concept. However, they lack insight into the mechanisms driving integrated care in practice. The aim of this paper is to gain insight into how integrated care is realised in practice. Methods: Six cooperation projects in Flanders were compared on five integration mechanisms. A content analysis of secondary sources on each of the cases and semi-structured interviews with representatives of these cases was conducted. The data were analysed using comparison tables. Results: Six cases representing five cooperation models in the Flemish health and social care were analysed for the presence of integrated care mechanisms. Six of the 22 mechanisms are present in all case examples. Half of the identified mechanisms concern the integration of professionals. Integrated care in these Flemish cases refers mainly to organising a case meeting, appointing a case manager and dividing the tasks between care professionals. Integration of support is less developed. Conclusions: The bottom-up approach to study the practical implementation of mechanisms is a fruitful approach, since it brings into light the complex realities and practicalities of the mechanisms of integration and how they are shaped by local actors in local contexts. The approach shows how Flemish and Belgian policy makers are struggling to scaling up these integration models, whilst at the same time responding to local conditions and needs.

Given that integrated care includes many different aspects, a study of how integration of care can be best be developed calls for an equally integrated research approach. The CORTEXS research project on integrated care in Flanders (Belgium) has developed a research design that takes (part of) this multi-facetedness and complexity into account. The research design involves multiple disciplines, levels of analysis, and methods. (1) The multidisciplinary research team combines expertise in organization sciences (including sociology, management and social innovation) with proficiency in care-specific disciplines (including care quality and safety, medical law, health economics and patient participation). (2) Integrated care is studied from the micro-level of care recipients and their informal caregivers, over the meso-level of intra-and inter-organizational processes, to the macro-level of legal and financial frameworks. (3) At each level, the most appropriate research methods are applied, including document analysis, process mapping, network analysis, comparative case analysis and economic modeling. The research comprises five work packages (WPs), each aimed at a specific research question: (WP1) Which models of integrated care for chronic and long term care needs can be found in the literature, and how can they be used for the further development of integrated care in the Flemish context? (WP2) What are the organizational components of integrated care models, and which options do they offer for supporting patient interests and quality of work for the health professionals? (WP3) What are the

Abstract:Purpose: To systematically study scientific articles that provide a description and/or a refinement of an integrated care model or program, and to identify the relations between objects and components in a taxonomy of integrated care.Background: Although care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of 'integrated care' lacks specificity and clarity. Based on well-known models, this article initiates a taxonomy that is systematically filled up with literature to unravel the concept of integrated care. Methods:A systematic literature review on models describing integrated care was performed. Data were extracted related to the object and components of integration which are the basis of the taxonomy. Usefulness of the taxonomy was explored in interviews with health care insurers in the Netherlands. Results:The 34 studies that met the inclusion criteria presented specifications of four objects of integration (functional, organizational, professional and service). Components (focus, degree, patient centeredness and normative aspects) described the characteristics of these objects. The health care insurers confirmed the benefits of the taxonomy, yet signified the volatility of daily practice as well. Conclusions:The concepts described present a clarification of integrated care, which may be used as starting point for the development and refinement of models of integrated care with a stronger methodological grounding. Especially, since most studies assessed in this review lacked both empirical data and a description of the methods used.