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Shifting paradigms: Developmental milestones for integrated care

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  • Shaw, James
  • Gutberg, Jennifer
  • Wankah, Paul
  • Kadu, Mudathira
  • Gray, Carolyn Steele
  • McKillop, Ann
  • Baker, G. Ross
  • Breton, Mylaine
  • Wodchis, Walter P.

Abstract

Frameworks for understanding integrated care risk underemphasizing the complexities of the development of integrated care in a local context. The objectives of this article are to (1) present a novel strategy for conceptualizing integrated care as developing through a series of milestones at the organizational level, and (2) present a typology of milestones empirically generated through the analysis of four cases of integrated community-based primary health care (ICBPHC) in Canada and New Zealand. Our paper reports on an analysis of 4 specific organizational case studies within a large dataset generated for an international multiple case study project of exemplar models of ICBPHC. Drawing on earlier analyses of 359 qualitative interviews with patients, caregivers, health care providers, managers, and policymakers, in this article we present a detailed analysis of 28 interviews with managers and leaders of local models of integrated care. We generated a detailed timeline of the development of integrated care as expressed by each participant, and synthesized themes across timelines within each case to identify specific milestone events. We then synthesized across cases to generate the broader milestone categories to which each event belongs. We generated 5 milestone categories containing 12 more specific milestone events. The milestone categories include (1) strategic relational, (2) strategic process change, (3) internal structural, (4) inter-organizational structural, and (5) external milestones. We propose a comprehensive framework of developmental milestones for integrated care. Milestones represent a compelling strategy for conceptualizing the development of integrated care. Practically, policymakers and health care leaders can support the implementation of integrated care by examining the history and context of a given model of care and identifying strategies to achieve milestones that will accelerate integrated care. Further research should document additional milestone events and advance the development of dynamic frameworks for integrated care.

Suggested Citation

  • Shaw, James & Gutberg, Jennifer & Wankah, Paul & Kadu, Mudathira & Gray, Carolyn Steele & McKillop, Ann & Baker, G. Ross & Breton, Mylaine & Wodchis, Walter P., 2022. "Shifting paradigms: Developmental milestones for integrated care," Social Science & Medicine, Elsevier, vol. 301(C).
    • Handle: RePEc:eee:socmed:v:301:y:2022:i:c:s0277953622002817
    DOI: 10.1016/j.socscimed.2022.114975
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    References listed on IDEAS

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    1. Leijten, Fenna R.M. & Struckmann, Verena & van Ginneken, Ewout & Czypionka, Thomas & Kraus, Markus & Reiss, Miriam & Tsiachristas, Apostolos & Boland, Melinde & de Bont, Antoinette & Bal, Roland & Bus, 2018. "The SELFIE framework for integrated care for multi-morbidity: Development and description," Health Policy, Elsevier, vol. 122(1), pages 12-22.
    2. Grudniewicz, Agnes & Tenbensel, Tim & Evans, Jenna M. & Steele Gray, Carolyn & Baker, G. Ross & Wodchis, Walter P., 2018. "‘Complexity-compatible’ policy for integrated care? Lessons from the implementation of Ontario's Health Links," Social Science & Medicine, Elsevier, vol. 198(C), pages 95-102.
    3. Struckmann, Verena & Leijten, Fenna R.M. & van Ginneken, Ewout & Kraus, Markus & Reiss, Miriam & Spranger, Anne & Boland, Melinde R.S. & Czypionka, Thomas & Busse, Reinhard & Rutten-van Mölken, Mauree, 2018. "Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review," Health Policy, Elsevier, vol. 122(1), pages 23-35.
    4. Looman, Willemijn & Struckmann, Verena & Köppen, Julia & Baltaxe, Erik & Czypionka, Thomas & Huic, Mirjana & Pitter, Janos & Ruths, Sabine & Stokes, Jonathan & Bal, Roland & Rutten-van Mölken, Maureen, 2021. "Drivers of successful implementation of integrated care for multi-morbidity: Mechanisms identified in 17 case studies from 8 European countries," Social Science & Medicine, Elsevier, vol. 277(C).
    5. Lalani, Mirza & Bussu, Sonia & Marshall, Martin, 2020. "Understanding integrated care at the frontline using organisational learning theory: A participatory evaluation of multi-professional teams in East London," Social Science & Medicine, Elsevier, vol. 262(C).
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