Abstract
Background and aim:Many health systems attempt to develop integrated and population health-oriented systems of care, but knowledge of strategies and interventions to support this effort is lacking. We aimed to identify specific redesign strategies and interventions, and to present evidence of their effectiveness.Method:A modified scoping review process was carried out. Fifteen relevant examples of integrated care organizations that incorporated a broad population health approach in countries of the Organization for Economic Cooperation and Development described in 57 articles and reports were included in analysis.Results:Seven key redesign strategies and multiple redesign interventions have been identified and are described. Most commonly used redesign strategies included focusing on health and wellness, embracing intersectoral action and partnerships, addressing health in vulnerable groups, and addressing a wide range of determinants of health, including making improvements in health services. Redesign interventions included creative and innovative ways of addressing clinical and non-clinical issues such as establishing housing surgeries in primary care, establlishing vast social and provider networks to support patients with complex needs and also broadening of the scope of services, workforce redesign and other. Potential reductions in the utilization of care and costs could be derived by the wider adoption of these strategies and interventions.Conclusion:Development of integrated and population health-oriented systems of care requires the redesign of how services are organized and delivered, and how organizations and care systems operate. Combining integration of care with the population health approach can be supported by a set of cohesive strategies and interventions aimed at preventing disease, addressing social determinants of health and improving health equity at both population- and individual-level.
Highlights
IntroductionExtending the benefits of integrated care to the general population, requires combining the scope of integrated care with a population health approach [2, 10,11,12,13]
Health systems worldwide face increasing challenges from growing numbers of complex multimorbid patients, the rising costs of care and an increasing recognition of the impact that results from a failure to address the social determinants of health [1,2,3,4]
Neither the integration of care and nor the population health approach are novel concepts; some general strategies and design principles have been proposed for both the integration of health services [3, 15,16,17,18] and the population health approach [2, 19,20,21,22,23] the linkage of these concepts remains challenging
Summary
Extending the benefits of integrated care to the general population, requires combining the scope of integrated care with a population health approach [2, 10,11,12,13] This approach to care considers a wide range of factors and interrelated conditions that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to improve the health and well-being of those populations [11]. This approach commonly shifts the focus to prevention, multiple determinants of health, equity in health, intersectoral action and partnerships, and understanding the needs and solutions through community outreach [14]. Combining integration of care with the population health approach can be supported by a set of cohesive strategies and interventions aimed at preventing disease, addressing social determinants of health and improving health equity at both population- and individual-level
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