A Multilevel Framework for Complex Care: A Critical Interpretive Synthesis

Abstract

Health systems are poorly equipped to respond to complex health and social needs, which span sectors and diagnoses. This study puts forward a framework for complex care policy. The framework was developed using critical interpretive synthesis, a method for developing theory on the basis of a transparent search and critical analysis of a heterogenous body of the literature. Seventy-three results were included from a systematic search. We suggested that complex needs can be understood as a pattern of unmet needs occurring at the intersection of fragmented health systems and services, multimorbidity, and social marginalization. We proposed a multilevel framework to inform complex care policy design that accounts for each of these issues and their intersections at the individual, service, and system level. We further identified five principles that have relevance at all levels of complex care. Our framework centres clients and their relationships with providers and suggests how services and systems can support client-level interactions. Conceptualizing complex care policy as a multilevel intervention offers a tool for understanding unexpected effects. Further work is needed to test and refine this framework and to contextualize it for particular populations and settings.