Comparing International Models of Integrated Care: How Can We Learn Across Borders?

Introduction: Providers, managers, health system leaders, and researchers could learn across countries implementing system-wide models of integrated care, but require accessible methods to do so. This study assesses if a common framework could describe and compare key components of international models of integrated care. Theory and methods: A framework developed for an international study of programs that address high needs high cost patients was used to describe and compare 11 case studies analyzed in two international research projects; the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study in Canada and New Zealand, and the Vilans research group exploring models in the Netherlands. Comparative summaries were generated, with findings discussed at a 2019 International Conference on Integrated Care workshop. Results: The template was found to be useful to compare integrated case analyses in different contexts, and stands apart from other case comparison approaches as it is easily applied and can provide practical guidance for frontline staff and managers. Areas of improvement for the template are identified and two updated versions are presented. Conclusions and discussion: There is value to using a common template to provide guidance in international comparison of models of integrated care. We discuss the applicability of the approach to support scale and spread of integrated care internationally.


If another definition is more appropriate please elaborate: [open text]
Referral, intake, enrollment and assessment Q4. Program can use different strategies to apply referral, intake or enrollment. Which one of the following statements do you think best describes the process for patient referral, intake and enrollment in this program?
There is an informal process for referring and in-taking people into the program Clear process exists but implemented variably by different program navigators or health care administrators Single or established group of designated patient navigator(s) responsible for intake of all new patients in structured manner (eg, referral pathways built into data systems)

Q5. Which option best defines the entry process to your model of care
Professional entry (eg, requires referral from a professional) Self-entry (eg, patients or families can self-refer into the program) Blended (eg, combination of both professional and self-entry) Q6. Are assessments part of the intake process?

Q7. Do assessments occur after the intake process?
Yes, at regular intervals (eg, once every 3 months, at discharge) Yes, at random intervals (eg, when a provider decides it's time) No, assessments are only done at intake Care teams Q8. Many programs involve primary care providers (family physicians, general internists, geriatricians, pediatricians, nurse practitioners). Which one of the following statements do you think best describes the involvement of primary care providers in the program?
Limited involvement of primary care providers, including nurse practitioners. Regular contact with at least one primary care provider, but primary care provider is not responsible for comprehensive management of patient needs through this program Primary care provider clearly responsible for managing the care needs and care processes of the program's designated patients Q9. Programs often have a focus on integrating health and social care services. Which one of the following statements do you think best describes the integration of health and social care services in the program?
Comparing international models of integrated care Research paper for consideration for IJIC Supplementary Materials Program involves a limited number of different health and social care provider types and is focused on specific social or health services or settings Program involves multiple different health and social care provider types, care settings and organizations and provides both health and social care but not in highly coordinated manner Program involves a wide range of health and social care provider types working in a coordinated system of delivery of integrated and comprehensive health and social care services in a range of settings with a range of organizations. No structured protocols or coordinated process for care transitions across sectors or care settings Protocol exists for some transitions but not others or protocols exist but are not routinely used Clear protocol and strong commitment to ensuring smooth transitions across sectors or care settings Sharing information Q15. Sharing patient care and system performance data in a timely fashion is important. Which one of the following statements do you think best describes the processes and data infrastructure for timely data sharing in the program?

Q10. Identify the types of providers involved in your model (check all that apply)
No clear process or procedure for sharing data across providers and organizations involved in patient care Process and procedures exist to share information across providers and organizations involved in patient care, but not via shared access to single data infrastructure platform.
Partnering health care providers and organizations have timely access to shared data infrastructure platform.

Patient and caregiver engagement
Definition -patient and caregiver engagement: "the process of building the capacity of patients, families, carers, as well as health care providers, to facilitate and support the active involvement of patients in their own care, in order to enhance safety, quality and people-centredness of health care service delivery.

Q18. Which one of the following statements do you think best describes the process for supporting patient empowerment and self-management transitions in care in the program?
Promoting patient self-management and empowerment not a clear component of organizational strategy, no clear processes to support patient self-efficacy and empowerment in place Promoting patient self-efficacy and empowerment occurs to some degree, but no formal support for or training in processes to promote patient self-efficacy and empowerment.
Strong organizational support for, training in, and culture that promotes patient self-efficacy and empowerment

Q17. What activities take place to support patient self-management (check all that apply)
Educational materials and information sharing Chronic disease management support groups Self-monitoring supports (eg, blood glucose monitors, mobile apps) Self-management part of care planning Training for patients Training for providers

Q18. Which one of the following statements do you think best describes the process for caregiver support in the program?
Caregiver support and coaching is not a clear component of organizational strategy, no clear processes to promote caregiver support and coaching in place Caregiver support and coaching occurs to some degree, but no formal support for or training for caregiver support and coaching Strong organizational support for, training in, and culture that promotes caregiver support and coaching

Q20. Which one of the statements do you think best describes the current state of this program?
Pilot program that is still evolving and not yet firmly established with ongoing funding Established program with ongoing funding based at its initial site only Established program with ongoing funding that has been replicated in sites OR Q20. What is the maturity level of your program?
Initial/start up phase (eg, planning phase) Experimental and execution phase (eg, pilot phase) Expansion and monitoring phase (eg, expanding to new sites) Consolidation and transformation phase (eg, established sustained program) Program measures Q21. We are interested in the current goals for the program. Do the program goals include one or more of the following?(check all that apply) Better health outcomes Better patient/caregiver experience Better provider experience Lower costs Q22. Which one of the following statements do you think best describes the extent to which the program routinely collects data program activities?
Data on program activities are rarely if ever collected in a routine fashion Data on program activities have been used at times for assessing implementation or monitoring specific changes to the program Data on program activities is routinely collected and used to monitor the program

Q23. If data is collected, how is it used?(check all that apply)
Data on program activities is used to evaluate success Data on program activities is used to demonstrate accountability to stakeholders Data on program activities is used to drive funding decisions Data on program activities is used to drive program decisions Comparing international models of integrated care Research paper for consideration for IJIC Supplementary Materials 9 Q24. Some programs have undergone formal external evaluation, either as part of the requirements from the funder or as part of a research project. Which one of the following statements do you think best describes the extent to which the program has been formally evaluated?
There has been no formal evaluation There has been a formal evaluation by a funder There has been formal evaluation as part of a research study PART 2: POLICY ENVIRONMENT

Q24. What best describes the funding model for the program?
There is a well-defined budget or annual financial statement for the program The budget for the program is part of a larger program that does have a budget or funding source There was a budget for a pilot or initial set up of the program, but no ongoing funding