Challenges in measuring integrated care models: International knowledge and the case of Québec

Abstract

Introduction The implementation of integrated care models requires significant efforts, especially due to institutional and organisational inertial forces that characterize health and social care systems of developed countries. It is therefore crucial to deploy strategies that promote continuous adjustment to these barriers so as to improve the benefits of integrating care. Measuring the implementation and effects of integrated care models are key component of these strategies. However, measuring integrated care also faces major challenges. This study aims to identify and characterise integrated care measurement challenges. Methods A review of reviews on the measurement of integrated care identified 12 papers. A thematic analysis was conducted to identify and categorize measurement challenges. Document analysis was done on the measurement of an integrated care model for older adults in Québec. Results Eight categories of measurement challenges were identified. These challenges include difficulties in measuring structures, processes, and effects of models; conceptual ambiguity and heterogeneity of organisational forms; involving multiple actors in the measurement strategy; and including multiple data sources, amongst others. These challenges revealed and explained potential gaps in the measurement of integrated care for older adults in Québec. For instance, the Québec measurement strategy did not include effects indicators. Conclusion Although the measurement of integrated care is a complex endeavour, there is a need for adequate measurement strategies that allow to appreciate important elements of integrate care. The findings of this study could be used as a reflexive tool in advancing research and practice of measuring integrated care.

Dimensions of Proximity: An Actionable Framework to Better Understand Integrated Practices in Cancer Networks

“…Coordination problems must be addressed by the various dimensions of proximity [17]. Interactions at different levels in the network enhance dimensions of proximity, though they are less successful at creating institutional proximity, potentially due to professional culture and specialization [35] which others have associated with inertia in health systems [36].…”

Optimising Integrated Stroke Care in Regional Networks: A Nationwide Self-Assessment Study in 2012, 2015 and 2019

“…This is challenging since, among other things, data collection for further development of integrated care networks is hindered by the use of multiple registries in the organisations involved and the absence of a well-structured approach to systematically collect relevant and meaningful outcome data. A comprehensive quality improvement programme with a focus on continuous evaluation of the context, mechanisms and outcomes of integrated stroke care would be regarded helpful in enabling the provision of patient-centred, integrated care services [ 23 24 ].…”

Ethical challenges and principles in integrated care

“…Despite considerable agreement about the value and importance of healthcare integration, it has implications that are potentially ethically problematic and/or controversial. These might be broadly summarized as: consequences of integration for professional autonomy and responsibility 33 ; a lack of consensus about how to measure the effectiveness of integration, 34 not least because measurement itself may be a complex task in its own right 35 ; and practical and financial obstacles to institutionalizing integration. Given the widespread enthusiasm for integration, there is a case to be made that the first two of these have received insufficient attention in spite of the controversy that they reveal.…”