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.
Highlights
In recent decades, integrated care has received increased attention globally
Implementation efforts may include activities across multiple phases, case studies representing efforts that are in the early stages of the EPIS framework are presented first, while case studies that are further along in implementation are presented
Access to Integrated Care Tailored for Children with Autism Spectrum Disorder
Summary
In recent decades, integrated care has received increased attention globally. Policymakers, providers, payers, and healthcare consumers propose that integrated care holds promise in facilitating healthcare improvements [1, 2]. A global aging population and advances in medical science and technology mean that individuals are living longer, but often with increased incidence and prevalence of Stadnick et al BMC Health Services Research (2019) 19:899. Sustainment (EPIS) framework [10], a widely cited implementation science framework [11], to prioritize goals and strategies to advance integrated care implementation research generalizable across countries and healthcare systems. Integrated care models have shown to produce beneficial impacts internationally [15] but the implementation strategies, implementation processes and implementation outcomes of integrated care have not been thoroughly investigated. Integrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. There is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems
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