Comparative case studies in integrated care implementation from across the globe: a quest for action

Abstract

BackgroundIntegrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. Furthermore, there is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems.MethodsGuided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011), a multiple case study design was used to address two research objectives: 1) To highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and 2) To synthesize the shared and unique challenges and successes across studies using the EPIS framework.ResultsThe seven reported case studies represent integrated care implementation efforts from five countries and continents (United States, United Kingdom, Vietnam, Israel, and Nigeria), target a range of clinical populations and care settings, and span all phases of the EPIS framework. Qualitative synthesis of these case studies illuminated common outer context, inner context, bridging and innovation factors that were key drivers of implementation.ConclusionsWe propose an agenda that outlines priority goals and related strategies to advance integrated care implementation research. These goals relate to: 1) the role of funding at multiple levels of implementation, 2) meaningful collaboration with stakeholders across phases of implementation and 3) clear communication to stakeholders about integrated care implementation.Trial registrationNot applicable.

The World Health Organization (WHO) approach to healthy ageing

“…Future research should be directed towards developing methods and applications enabling a comparison between different interventions and crucial factors affecting the efficacy of integrated care [24,25]. Moreover, most studies on integrated care focused mainly on micro-clinical care processes with a relative lack of information on the meso-organizational and macro-system level care integration strategies [26,27].…”

A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project

“…Awareness of these factors will also allow for a more accurate evaluation of the care model in future and interpretation of the results, and can also support other researchers or professionals who are looking for guidance on how to analyze context and use the findings within their intervention development. Stadnick et al (2019) recently conducted seven case studies of integrated care initiatives across multiple countries, where they reflected on the shared contextual factors which influenced the implementation of these projects [ 55 ]. Among the inner context factors, several of the important considerations identified such as knowledge, education, training and confidence of service providers; monitoring fidelity; and shaping providers’ roles and responsibilities, will be relevant in the INSPIRE project and can guide where to enhance our efforts [ 55 ].…”

“…Stadnick et al (2019) recently conducted seven case studies of integrated care initiatives across multiple countries, where they reflected on the shared contextual factors which influenced the implementation of these projects [ 55 ]. Among the inner context factors, several of the important considerations identified such as knowledge, education, training and confidence of service providers; monitoring fidelity; and shaping providers’ roles and responsibilities, will be relevant in the INSPIRE project and can guide where to enhance our efforts [ 55 ]. Establishing a “community-academic partnership” was the main bridging factor they identified [ 55 ], which will remain of great importance during all phases of the INSPIRE care model.…”

“…Among the inner context factors, several of the important considerations identified such as knowledge, education, training and confidence of service providers; monitoring fidelity; and shaping providers’ roles and responsibilities, will be relevant in the INSPIRE project and can guide where to enhance our efforts [ 55 ]. Establishing a “community-academic partnership” was the main bridging factor they identified [ 55 ], which will remain of great importance during all phases of the INSPIRE care model. By describing and linking the ultimate program goals with the activities that will be done to achieve these goals, the logic model revealed our thinking about what should work and how [ 31 32 33 ], mitigating the “black box” phenomenon which can otherwise occur when describing an intervention [ 46 52 ].…”

COVID-19 and beyond: how lessons and evidence from implementation research can benefit health systems’ response and preparedness for COVID-19 and future epidemics

“…For example, in Oyo State, Nigeria, the Ministry of Health incorporated mental health screening and treatment tools, developed and implemented between 2017 and 2020 by an IMCHA research team, into the routine assessment of pregnant women receiving antenatal care. 13 This improved mental health outcomes for the normally underserved perinatal women living with depression. For example, the research team reported that the intervention, delivered from the second trimester through to the postnatal period, produced significantly better remission from perinatal depression compared with treatment as usual (control arm), with 37.0% remission in the control arm and 55.7% remission in the intervention arm at the 6-month postnatal assessment (p<0.005).…”