The Evolution of Integrated Healthcare Strategies

Abstract

This paper reviews and synthesizes over twenty-five years of international research to examine the evolution of integrated healthcare strategies as described in the academic literature. An electronic search of the health sciences literature was conducted using PubMed and EMBASE. A total of 106 articles were identified for inclusion and thematically analyzed using a conceptual framework of strategic content for systems-level integration. Six major, inter-related shifts in the conceptualization and practice of health systems integration were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. Environmental changes, a growing focus on patient-centered care, and emerging evidence of the impact of integration may explain the variation over time in integration objectives, desired scope, and implementation and evaluation methods. The identified shifts provide a descriptive framework against which to assess, compare, and track integration strategies; they also provide a framework for assessing new literature on integrated healthcare.