Background Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions. Aim To identify and define the characteristics of intermediate care models. Methods A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted. Results Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models. Discussion There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination. Conclusions This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.

The International Foundation for Integrated Care (IFIC) recently celebrated its 20 th International Conference (ICIC20) through a virtual event that brought together patients and carers, academics, care professionals, NGOs, policy-makers and industry partners from across the global integrated care community [ 1 ]. The International Journal for Integrated Care (IJIC) used this opportunity to host a workshop on published research in integrated care, specifically to reflect on the quality of existing scientific enquiry. A lively discussion on the current state of integrated care research concluded that there remained significant shortcomings to current methodologies – for example, in their ability to provide the depth of understanding required to support the knowledge needed to best inform policy and practice, particularly when addressing people-centredness. In part, the debate recognized how the nature of existing research funding, and prevailing attitudes and preferences towards certain research methodologies, were partly to blame (as has been noted by IJIC previously [ 2 3 ]). The workshop debated how research and researchers must change their focus in order to better contribute to the tenet of people-centred integrated care.

Integrated care offers an opportunity to address healthcare efficiency and effectiveness concerns and is especially relevant for elderly patients with different chronic illnesses.In current care standards for chronic care focus is often on one disease. The chronic care model (CCM) is used as the basis of integrated care programs. It identifies essential components that encourage high-quality chronic disease care, involving the community and health system and including self-management support, delivery system design, decision support, and clinical information systems. Improvements in those interrelated components can produce system reform in which informed, activated patients interact with prepared, proactive practice teams. There is however a lack of research evidence for the impact of the chronic care model as a full model. Integrated care programs have widely varying definitions and components and failure to recognize these variations leads to inappropriate conclusions about the effectiveness of these programs and to inappropriate application of research results. It seems important to carefully consider the type and amount of data that are collected within the disease management programs for several purposes, as well as the methods of data collection.Understanding and changing the behavior of complex dynamic chronic care system requires an appreciation of its key patterns, leverage points and constraints. A different theoretical framework, that embraces complexity, is required. Research should be designbased, context bound and address relationships among agents in order to provide solutions that address locally defined demands and circumstances.

Purpose The purpose of this paper is to support the ongoing dialogue and shed light on the different views on integrated care. An overarching definition of integrated care is proposed combining the ways of thinking of the four quality paradigms the authors identify. The idea of epistemic fluency offers a way-out of ongoing discussions about “what integration is”. Design/methodology/approach Four paradigms of quality are presented and applied to healthcare. Epistemic fluency is proposed as the capacity to understand, switch between and combine different kinds of knowledge. The authors compare previously developed definitions of integrated care to the various combinations of paradigms. Findings All four paradigms of care quality are present in healthcare and in the most used definitions of integrated care. The Reflective Paradigm and the Emergence Paradigm receive least attention. Some definitions combine more than one paradigm. An overarching definition of integrated care is proposed. Research limitations/implications In this paper, only the most prominent definitions of integration have been considered. Practical implications Integration research and practice requires a widely accepted definition of integrated care, embracing all four paradigms of care quality. Our suggestion provides a common foundation that may prevent misunderstanding. Originality/value The use of quality management paradigms to frame the debate on defining integrated care is new and leads to new insights for teaching, research and practice.

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