Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012–2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.
The interest of policy makers in integrated care has been steadily growing over the last decade as a solution to tackle health challenges such as the increase in chronic diseases, multi-morbidity, the ageing of the population and the constrained use of resources. In most EU countries, funding is allocated to individual service providers and institutions rather than networks of organisations with shared goals. While integrated care was initially defined as ‘improved connectivity between different activities of the health system in order to provide better quality health services to users’, there is nowadays an increasing complexity attributed to its concept. The constructs commonly described in scoping literature include patient-centered care, care coordination, continuity of care, chronic disease management and integrated healthcare delivery [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. This has resulted in growing confusion over its tangible and non-tangible components, and consequently its outcomes.
Policy makers who want to launch themselves into the development and implementation of strategic reform in favour of the development of integrated health and social care are consequently looking for answers on how to master the complexity of the integrated care. Any such attempt calls for a comprehensive approach and system-perspective with an emphasis on a life course approach to care and thus prevention, effective management of multi-morbid conditions and multidisciplinary approaches to care. Engagement of patients, families and communities is an essential component if innovation and effective care is to be realized.
With the aim to support national and international policy makers in their ambitions to develop integrated care, we present a Policy Guide on Integrated Care (PGIC) that builds on both findings from the EU FP-7 Project INTEGRATE (www.projectintegrate.eu) and our own work with healthcare reform for patients with chronic conditions at the national and international level [19, 20, 21]. The methods that have provided the basis to the development of the PGIC have been explained in large detail in a first paper in this series . In short: six different sources were consulted. The first source were findings and recommendations from the different work packages of the EU Project INTEGRATE. A second source was a literature review on integrated care policies for people with chronic conditions. Other additional sources used were a) existing frameworks on chronic and people-centred/integrated care, b) key findings from other EU Projects targeting chronic illnesses/integrated care and c) a selected set of ‘best practices’ on integrated care from different countries and d) our own experiences with research and policy making in integrated care at the national and international level.
The starting point to the development of the PGIC is what patients with chronic conditions expect from any provider in the health care system, and what we think can be summarized as ‘compassionate and competent care’. Compassionate and competent care is essentially integrated, people-centered and values a bio-psycho-social approach to care emphasizing the importance of equity, and high-quality interventions across the life course and the entire health continuum and aims at better health outcomes, care experiences, and with a more efficient use of resources. The ultimate goal of the PGIC is to enable compassionate and competent care delivery. The PGIC builds upon three straightforward building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care. Each of these building blocks and their respective components will be further outlined below.
The Triple Aim framework serves as the foundation for organizations and communities to successfully navigate the transition from a focus on health care to optimizing health for individuals and populations . This framework put forward the simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. No single actor alone has the capability to successfully pursue improving the health of a population since the Triple Aim explicitly requires health care organizations, public health departments, social service entities, school systems and employers to cooperate . Fostering this cooperation requires an integrator that accepts responsibility for achieving the Triple Aim for the population . Policy makers can act as integrators by making the right investments and creating a cogent set of high-level measures to monitor progress. The three dimensions of the Triple Aim, taken together, provide a useful framework for measuring value in health care. Value can be conceptualized as the optimization of the Triple Aim, recognizing that different stakeholders may give different weights to the three dimensions.
When policy makers develop a vision on integrated care, three different components are considered important. First, they should profoundly understand the context for change. Second, they must understand the core principles that underpin integrated care. Third, they must understand the problems and societal challenges that can be addressed with integrated care.
A first part of the vision includes the understanding of the context for change that involves patients (people) and their families, the health workforce, health managers, insurers and policy makers.
The quality of care individuals of every generation seek is increasing. Widespread access to digital information due to new technology and greater personal expenditure on healthcare have both raised people’s expectations . Shaping policy to foster integrated care will essentially start with a better understanding of the diverse needs of people with chronic conditions. Health needs should be the starting point of any transformation . A growing number of people want more options and information about the care they receive, more input into decisions about their care and higher standards of treatment [25, 27]. People don’t want to be medicalised either, and they want to be treated humanely—to be respected as individuals and dealt with equitably and compassionately . People want having a comprehensive assessment with less redundancy, support for transitions into and out of the hospital as well as greater attention to mental health over the course of their disease process. On the staffing side, quicker response times, ongoing patient–provider communication and consistency between providers and across care units are considered important . All the aforementioned elements drive the need for change from the patient, family and citizen perspective.
But we may not forget that what many people want is just the obvious – delivering what is needed and promised in a joined up and reliable fashion. In this sense, health care providers cannot blame the client for ‘being more demanding’ in a reluctance to move away from the ‘object of care’ mentality.
Professional caregivers who deal with complex and multiple health problems in their patients can no longer rely on traditional approaches to care which focuses on individual diseases. Integrated care requires a return to core Hippocratic principles . New paradigms of care delivery are needed with the shift to population health management and proactive care to be essential. But current guidelines are not designed to consider the cumulative impact of treatment recommendations on people with several conditions, nor to allow comparison of relative benefits or risks . In people with multimorbidity current guideline recommendations rapidly cumulate to drive polypharmacy, without providing guidance on how best to prioritise recommendations for individuals in whom treatment burden will sometimes be overwhelming. But multimorbidity alone cannot explain the complexity of care needs and further stratification of the general population based on care needs is necessary for allocating resources and developing personalized, and patient-centered care plans . The notions of self-care, co-ownership of therapeutic options, discussing planned outcomes and informed expression of choice will require re-thinking of the professional identity of involved health care professionals. In addition, eHealth and mHealth solutions will become increasingly important for improving participatory continuity of care.
Health managers that have succeeded in fostering integrated care have gone beyond mainstream frameworks for quality improvement based on clinical measurement and audit and have adopted a strategic organizational approach to patient focus . Delivering individualised, integrated care entails dissolving ‘the classic divide between primary care and secondary care, between physical and mental health, between health and social care, between prevention and treatment’ and between private and public institutions. In the future, new paradigms of data custodianship will be needed in a complex multi-provider setting. The construct, legal mandate, resourcing, governance and audit need careful consideration, in order to ensure trust by all parties, as well as efficiency and reliability .
Hospital payment models still largely make use of fee-for-service or case payments (e.g. diagnostic related groups) promoting volume with little consideration for quality of care. Primary and social care funding is often very distinct and differently sourced from that for hospital care despite the fact that these services support the same people and have key inter-dependencies . Most existing payment models are creating barriers to innovation by rewarding volume, not value for the money spent. Moreover, insurers promote health services contractual arrangements with single providers perpetuating the “silo effect” and enhancing fragmentation of care, inhibiting the creation of innovative care delivery models that will likely find new ways of integrate care . There are also perversities of some contracting regimens, which contract bundles of supportive care based on short-term (e.g. annual) cycles, jeopardizing care continuity, patient choice and patient-centered quality outcomes.
The current way of caring for people with chronic conditions is economically unsustainable because in most EU countries it is based on a costly, hospital-centred health system. In many countries, the workforce available to provide health and care services is static or diminishing, due to cost constraints on levels of professional staff and to limited numbers available to undertake lower-paid caring tasks . Nowadays the ‘medical model’ is still the model for which virtually all of the resources are used. i.e., physicians, hospitals, nursing homes. In such model, interventions can quickly lose their connection with population health, and the wider determinants of health are often neglected . Using the social determinants of health model (which is a more recent force), it is important to understand how education, wealth, and similar characteristics affect the health status of individuals and communities. To this complex scene must now be added revolutions in information and mobile technology and the unprecedented growth of research and applications in the area of nanoscience and nanotechnology. Other anticipated innovations in medicine relate to drug delivery, diagnostics, cell therapy and production of biocompatible materials.
A second part of the vision is knowledge that policy must possess on the core principles that underpin integrated care. Effective health and care delivery must by definition focus on the individual, which means that ‘patient-centeredness’ is a core principle that underpins integrated care. Other important principles are: e.g. ‘led-by whole systems thinking’, ‘comprehensive’, ‘evidence-informed’, ‘co-produced’, ‘collaborative’, ‘empowering’, ‘engaging’, ‘respectful’, ‘endowed with rights and responsibilities’, ‘governed through shared accountability’, ‘goal-oriented’, ‘safe’, ‘effective’, ‘efficient’, ‘timely’, ‘sustainable’ and ‘equitable’ . All these principles are drivers of excellent experience of care.
A third part of the vision is that policy makers must understand what problems can be addressed with integrated care, applying different perspectives. An overview of problems in care delivery for people with chronic conditions that can be addressed with integrated care is provided in Table 1.
|Perspectives||Issues in chronic care delivery that can be addressed by integrated approaches to care organization and/or financing|
|Health care manager and insurer perspective||
|Policy maker perspective||
A strategy on integrated care essentially includes a range of measures that can be implemented at the local health economy level, but with appropriate support and inclusion of directives developed at the national and international level. Policy makers should opt for a comprehensive and life course approach that is grounded in the right to health for every individual .
Numerous entry points can be identified to the development of a strategy on integrated care for people with chronic conditions. Policy makers have the freedom to choose from the different entry points as presented in this paper, meaning there is no preferred chronological order. Any regulatory framework created by policy makers should allow for creativity and self-organisation from the bottom-up rather than prescribing a detailed blue print policy . Policy makers can opt for both top-down and bottom-up strategies with integrative potential. Central to any strategy is the idea of value chains. What is crucial in these “chains” ideas is that each link in the chain adds up some value to the previous one.
A first potential entry point is the implementation of regulatory frameworks for collaborative entities and teams (coupled with financial incentives and/or changes in payment systems). The objectives of such regulatory frameworks are: improved 1. care co-ordination, 2. integration of medical and social/mental/community care, 3. inter-professional and inter-organisational governance, 4. relationship continuity with health professionals, 5. use of evidence-based medicine and 6. continuous discharge planning.
Collaborative entities and teams range from disease-based collaborative structures over Accountable Care Organizations (ACOs). Policy makers can opt for one overarching regulatory framework that applies to all types of collaborative entities and teams, or opt for more specific frameworks in support of different types of collaborative initiatives. It is key to any regulatory framework for collaborative entities and teams to include: a set of disease and non-disease specific integrated care indicators. No established set of indicators for measuring integrated care is currently available, and indicators used can be disease and/or non-disease specific. Overall, there is a strong need for international comparable integrated care indicators to highlight where significant variations between countries (or regions) exist, and to consequently call for their explanation and possible filling .
Provider payments should be strategized to encourage performance improvement to achieve the Triple Aim. Value-based payments reforms range from incremental approaches aimed at improving existing volume-based models using coordination and performance-based incentives or monitoring over bundled payment and retrospective/prospective full capitation models. Important aspects of payment reform design are alignment of the incentives with system goals, a strive for consistency in incentives and payment methods across providers/payers and to address provider protection from unavoidable risk as well as variation in patient morbidity.
A second potential entry point is the development of regulatory frameworks for population health management. The objectives of regulatory frameworks for population health management are: Improving 1. outcomes of care, 2. experiences of care and 3. reduction of per capita cost. Population health management has made significant inroads due to the emergence of integrated care delivery systems. It is concerned with both the definition and measurement of health outcomes and the roles of determinants . It also involves providing a wide spectrum of health care services that are directed at behavioral changes and encouraging healthy lifestyles to obtain optimal outcomes. Population health management implies the use of ‘Triple Aim’ indicators which proposes three linked goals — improving the individual experience of care, reducing per capita cost of care, and improving the health of populations.
A third potential entry point is the implementation of new regulatory frameworks for educational and professional reforms for doctors, nurses, physiotherapists, occupational therapists, dieticians, social workers, amongst others. The objectives of policies on frameworks for educational and professional reforms are: 1. the development of new skill-sets/competencies for the entire health workforce, 2. improved inter-professional education and 3. improved staffing and task delegation within the health workforce. Meeting changing health care needs must begin at the foundation, in essence, in education . Especially medical education still focuses on what a physician does in face-to-face contact with the patient . Looking to the future, medical education should evolve to include preparation for (the ideal of) biopsychosocial chronic care  and a team approach to care  via practical training for multispecialty collaborative practice and preparing physicians to be leaders of primary care teams that include e.g. non-physician providers, cost-effective care in clinical practice, increased training in geriatrics, and “on ramps” and “off ramps” along the physician career path for flexible training over a lifetime . A central feature of educational and professional reforms is the emphasis on patient-centered decision making (PCDM) which is the process of identifying clinically relevant, patient-specific circumstances and behaviors to formulate a contextually appropriate care plan [60, 61]. Advanced Practitioner education and roles are important. There also need to be a mechanism of support to practitioners working solo in domiciliary settings- help with advice and reflective practice, but also a support mechanism in the event of putative adverse outcomes, where they may be landed with inappropriate blame.
A fourth potential entry point is a life course approach to the development of health literacy and e-literacy. Health literacy refers to people’s knowledge, motivation and competence to access, understand, appraise and apply health information in order to make judgments and take decisions about health care, disease prevention and health promotion to maintain or improve quality of life throughout their lives . The objectives of policies to improve health literacy are: 1. empowerment of citizens, patients, family (caregivers) and communities through improved knowledge, self-management, self-identification, trust, authority to partner, self-efficacy, and co-production of services, 2. Improving access and navigation of the healthcare system, 3. Improving compliance to follow-up appointments, medication and instructions for at-home care, 4. Increased patient satisfaction and, 5. Lowering health care spending.
Health literacy underlines the importance of managing health, self-monitoring, communication with health professionals, and role and emotions related to chronic conditions. Low health literacy is linked to less use of preventive care, reduced safety of care due to medication errors and poor adherence to medication and treatment, more hospitalisation, worse health outcomes and greater risk of death . Health literacy concepts are now being established, but need to be bedded into e-literacy as a specific area of citizen activity . Because patients and families are diverse in their desire and ability to engage, it is important to consider how we can tailor efforts to meet patients and families where they are, address specific needs and concerns, and best facilitate their engagement .
A fifth potential entry point to the promotion of integrated care, and especially the prevention of chronic diseases, is the prevention of childhood adverse experiences. The objectives of policies to prevent ACEs are: 1. prevention of chronic illnesses and risk-behaviors, 2. improved quality of life of citizens, and 3. cost reduction. There is compelling evidence that different types of trauma in early life are important risk factors for poor health in adulthood, including autoimmune and other chronic diseases of all kinds [87, 88, 89, 90, 91, 92, 93]. Research on the biology of stress shows that being exposed to “toxic” levels of stress during early life harms the developing brain and other organs. Toxic stress occurs when a child experiences strong, frequent or prolonged adversity, such as economic hardship, abuse or exposure to violence, substance abuse, mental illness and parental divorce. An estimated 50% of the population in Europe has experienced at least one ACE which makes it an important public health concern . Countries that do better for children often do better for adults, but well-being outcomes for these two groups are not always well-aligned . This implies that these countries need to do better for their children if they are to maintain the levels of well-being enjoyed by today’s adults over time.
The components that determine success of a national integrated care programme are multifactorial in nature and are characterized by a complex interplay. The Policy Guide on Integrated Care (PGIC) provides an insight and support to what policy makers can do at both the national and international level to improve integrated care for people with chronic conditions. Based on the findings from the FP-7 EU Project Integrate we argue that a comprehensive systems perspective should guide the development of integrated care towards better health practices, education, research and policy.
The research to inform this article was realized through Project INTEGRATE (www.projectintegrate.eu). The project received funding from the European Commission’s seventh Framework Programme for research, technical development and demonstration under grant agreement number 305821.
Marc Carreras, Research group on health services and health outcomes (GRESSIRES) – Serveis de Salut Integrats Baix Empordà (SSIBE) and Universitat de Girona- Department of Business Studies, Spain.
Michaela Kerrissey, PhD Candidate, Harvard University, USA.
José Joaquín Mira, Professor, Universidad Miguel Hernández, Spain.
The authors have no competing interests to declare.
Kodner, DL and Spreeuwenberg, C (2002). Integrated care: meaning, logic, applications, and implications--a discussion paper. International journal of integrated care 2: e12.DOI: https://doi.org/10.5334/ijic.67 Epub 2006/08/10.
Grone, O and Garcia-Barbero, M (2001). Integrated care: a position paper of the WHO European Office for Integrated Health Care Services. International journal of integrated care 1: e21.DOI: https://doi.org/10.5334/ijic.28 Epub 2006/08/10.
Ahgren, B and Axelsson, R (2011). A decade of integration and collaboration: the development of integrated health care in Sweden 2000–2010. International journal of integrated care 11(Spec Ed): e007. Epub 2011/06/17.
Axelsson, R and Axelsson, SB (2006). Integration and collaboration in public health--a conceptual framework. The International journal of health planning and management 21(1): 75–88, DOI: https://doi.org/10.1002/hpm.826 Epub 2006/04/12.
Goodwin, N (2015). How should integrated care address the challenge of people with complex health and social care needs? Emerging lessons from international case studies. International journal of integrated care 15: e037.DOI: https://doi.org/10.5334/ijic.2254 Epub 2015/11/04.
Ferrer, L and Goodwin, N (2014). What are the principles that underpin integrated care?. International journal of integrated care 14: e037.DOI: https://doi.org/10.5334/ijic.1884 Epub 2014/12/05.
Cloninger, CR Salvador-Carulla, L Kirmayer, LJ Schwartz, MA Appleyard, J Goodwin, N et al. (2014). A Time for Action on Health Inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. International journal of person centered medicine 4(2): 69–89. Epub 2014/01/01.
Goodwin, N (2013). How do you build programmes of integrated care? The need to broaden our conceptual and empirical understanding. International journal of integrated care 13: e040.DOI: https://doi.org/10.5334/ijic.1207 Epub 2013/11/02.
Singer, SJ, Burgers, J, Friedberg, M, Rosenthal, MB, Leape, L and Schneider, E (2011). Defining and measuring integrated patient care: promoting the next frontier in health care delivery. Medical care research and review: MCRR 68(1): 112–27, DOI: https://doi.org/10.1177/1077558710371485 Epub 2010/06/18.
Edgren, L (2008). The meaning of integrated care: a systems approach. International journal of integrated care 8: e68.DOI: https://doi.org/10.5334/ijic.293 Epub 2008/11/15.
Suter, E, Oelke, ND, Adair, CE and Armitage, GD (2009). Ten key principles for successful health systems integration. Healthc Q 13(Spec No): 16–23, DOI: https://doi.org/10.12927/hcq.2009.21092 Epub 2010/01/13.
Armitage, GD, Suter, E, Oelke, ND and Adair, CE (2009). Health systems integration: state of the evidence. International journal of integrated care 9: e82.DOI: https://doi.org/10.5334/ijic.316 Epub 2009/07/11.
Valentijn, PP, Vrijhoef, HJ, Ruwaard, D, Boesveld, I, Arends, RY and Bruijnzeels, MA (2015). Towards an international taxonomy of integrated primary care: a Delphi consensus approach. BMC family practice 16: 64.DOI: https://doi.org/10.1186/s12875-015-0278-x Epub 2015/05/23.
Valentijn, PP Boesveld, IC van der Klauw, DM Ruwaard, D Struijs, JN Molema, JJ et al. (2015). Towards a taxonomy for integrated care: a mixed-methods study. International journal of integrated care 15: e003.DOI: https://doi.org/10.5334/ijic.1513 Epub 2015/03/12.
Valentijn, PP, Schepman, SM, Opheij, W and Bruijnzeels, MA (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International journal of integrated care 13: e010.DOI: https://doi.org/10.5334/ijic.886 Epub 2013/05/21.
Schultz, EM, Pineda, N, Lonhart, J, Davies, SM and McDonald, KM (2013). A systematic review of the care coordination measurement landscape. BMC health services research 13: 119.DOI: https://doi.org/10.1186/1472-6963-13-119 Epub 2013/03/30.
Van Houdt, S, Heyrman, J, Vanhaecht, K, Sermeus, W and De Lepeleire, J (2013). An in-depth analysis of theoretical frameworks for the study of care coordination. International journal of integrated care 13: e024.DOI: https://doi.org/10.5334/ijic.1068 Epub 2013/07/25.
WHO (2015). Global strategy on people-centred and integrated health services In: Geneva: World Health Organization. http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/
Borgermans, L et al. (2017). How to improve integrated care for people with chronic conditions: Key findings from EU FP-7 Project INTEGRATE and beyond. International Journal of Integrated Care 17(5): 2.DOI: https://doi.org/10.5334/ijic.3096 1–12.
Berwick, DM, Nolan, TW and Whittington, J (2008). The triple aim: care, health, and cost. Health Aff (Millwood) 27(3): 759–69, DOI: https://doi.org/10.1377/hlthaff.27.3.759 Epub 2008/05/14.
Stiefel, M and Nolan, K (2012). A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and per Capita Cost In: IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Halthcare Improvement. (Available on: http://www.IHI.org).
Mira, JJ Orozco-Beltran, D Perez-Jover, V Martinez-Jimeno, L Gil-Guillen, VF Carratala-Munuera, C et al. (2013). Physician patient communication failure facilitates medication errors in older polymedicated patients with multiple comorbidities. Family practice 30(1): 56–63, DOI: https://doi.org/10.1093/fampra/cms046 Epub 2012/08/21.
Kuluski, K Hoang, SN Schaink, AK Alvaro, C Lyons, RF Tobias, R et al. (2013). The care delivery experience of hospitalized patients with complex chronic disease. Health expectations: an international journal of public participation in health care and health policy 16(4): e111–23. Epub 2013/05/29.
Rigby, M (2014). The Core vision of Person-Centered Care in a Modern Information-Based Society In: Meyer, I, Muller, S and Kubitschke, L eds. Achieving Effective Integrated E-Care Beyond the Silos. Hershey PA: IGI Global, pp. 1–21.
Onder, G Palmer, K Navickas, R Jureviciene, E Mammarella, F Strandzheva, M et al. (2015). Time to face the challenge of multimorbidity. A European perspective from the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS). European journal of internal medicine 26(3): 157–9, DOI: https://doi.org/10.1016/j.ejim.2015.02.020 Epub 2015/03/24.
Luxford, K, Safran, DG and Delbanco, T (2011). Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. International journal for quality in health care: journal of the International Society for Quality in Health Care/ISQua 23(5): 510–5. Epub 2011/05/19.
Sharfstein, JM (2014). The strange journey of population health. The Milbank quarterly 92(4): 640–3, DOI: https://doi.org/10.1111/1468-0009.12082 Epub 2014/12/11.
Gauld, R Burgers, J Dobrow, M Minhas, R Wendt, C Cohen, AB et al. (2014). Healthcare system performance improvement: a comparison of key policies in seven high-income countries. Journal of health organization and management 28(1): 2–20, DOI: https://doi.org/10.1108/JHOM-03-2013-0057 Epub 2014/05/03.
Bengoa, R (2013). Transforming health care: an approach to system-wide implementation. International journal of integrated care 13: e039.DOI: https://doi.org/10.5334/ijic.1206 Epub 2013/11/02.
Baker, DW, Qaseem, A, Reynolds, PP, Gardner, LA and Schneider, EC (2013). Design and use of performance measures to decrease low-value services and achieve cost-conscious care. Annals of internal medicine 158(1): 55–9, DOI: https://doi.org/10.7326/0003-4819-158-1-201301010-00560 Epub 2012/10/31.
Davies, SL Goodman, C Bunn, F Victor, C Dickinson, A Iliffe, S et al. (2011). A systematic review of integrated working between care homes and health care services. BMC health services research 11: 320.DOI: https://doi.org/10.1186/1472-6963-11-320 Epub 2011/11/26.
Anderson, GF (2011). Leadership in creating accountable care organizations. Journal of general internal medicine 26(11): 1368–70, DOI: https://doi.org/10.1007/s11606-011-1735-4 Epub 2011/05/11.
Belling, R Whittock, M McLaren, S Burns, T Catty, J Jones, IR et al. (2011). Achieving continuity of care: facilitators and barriers in community mental health teams. Implementation science: IS 6: 23.DOI: https://doi.org/10.1186/1748-5908-6-23 Epub 2011/03/23.
Dubuc, N Bonin, L Tourigny, A Mathieu, L Couturier, Y Tousignant, M et al. (2013). Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people. International journal of integrated care 13: e017.DOI: https://doi.org/10.5334/ijic.976 Epub 2013/07/25.
Hesselink, G Schoonhoven, L Barach, P Spijker, A Gademan, P Kalkman, C et al. (2012). Improving patient handovers from hospital to primary care: a systematic review. Annals of internal medicine 157(6): 417–28, DOI: https://doi.org/10.7326/0003-4819-157-6-201209180-00006 Epub 2012/09/19.
Eijkenaar, F, Emmert, M, Scheppach, M and Schoffski, O (2013). Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy 110(2–3): 115–30, DOI: https://doi.org/10.1016/j.healthpol.2013.01.008 Epub 2013/02/06.
Tsiachristas, A, Dikkers, C, Boland, MR and Rutten-van Molken, MP (2013). Exploring payment schemes used to promote integrated chronic care in Europe. Health Policy 113(3): 296–304, DOI: https://doi.org/10.1016/j.healthpol.2013.07.007 Epub 2013/08/14.
Kindig, D and Stoddart, G (2003). What is population health?. American journal of public health 93(3): 380–3, DOI: https://doi.org/10.2105/AJPH.93.3.380 Epub 2003/02/27.
Maddux, FW, McMurray, S and Nissenson, AR (2013). Toward population management in an integrated care model. Clinical journal of the American Society of Nephrology: CJASN 8(4): 694–700, DOI: https://doi.org/10.2215/CJN.09050912 Epub 2013/03/30.
Hibbard, JH, Greene, J, Sacks, RM, Overton, V and Parrotta, C (2016). Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease. Health services research, Epub 2016/08/23.
Ellis, G, Whitehead, MA, Robinson, D, O’Neill, D and Langhorne, P (2011). Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 343: d6553.DOI: https://doi.org/10.1136/bmj.d6553 Epub 2011/10/29.
Young, AS Chaney, E Shoai, R Bonner, L Cohen, AN Doebbeling, B et al. (2007). Information technology to support improved care for chronic illness. Journal of general internal medicine 22(Suppl 3): 425–30, DOI: https://doi.org/10.1007/s11606-007-0303-4 Epub 2007/12/06.
Bruun Larsen, L, Soendergaard, J, Halling, A, Thilsing, T and Thomsen, JL (2016). A novel approach to population-based risk stratification, comprising individualized lifestyle intervention in Danish general practice to prevent chronic diseases: Results from a feasibility study. Health Informatics J, May 31 2016DOI: https://doi.org/10.1177/1460458216645149
Dinov, ID Heavner, B Tang, M Glusman, G Chard, K Darcy, M et al. (2016). Predictive Big Data Analytics: A Study of Parkinson’s Disease Using Large, Complex, Heterogeneous, Incongruent, Multi-Source and Incomplete Observations. PloS one 11(8): e0157077.DOI: https://doi.org/10.1371/journal.pone.0157077 Epub 2016/08/06.
Fullerton, CA, Henke, RM, Crable, E, Hohlbauch, A and Cummings, N (2016). The Impact Of Medicare ACOs On Improving Integration And Coordination Of Physical And Behavioral Health Care. Health Aff (Millwood) 35(7): 1257–65, DOI: https://doi.org/10.1377/hlthaff.2016.0019 Epub 2016/07/08.
Pershing, S and Fuchs, VR (2013). Restructuring medical education to meet current and future health care needs. Academic medicine: journal of the Association of American Medical Colleges 88(12): 1798–801. Epub 2013/10/17.
Vachon, B Desorcy, B Camirand, M Rodrigue, J Quesnel, L Guimond, C et al. (2013). Engaging primary care practitioners in quality improvement: making explicit the program theory of an interprofessional education intervention. BMC health services research 13: 106.DOI: https://doi.org/10.1186/1472-6963-13-106 Epub 2013/03/22.
van Dijk-de Vries, A, Moser, A, Mertens, VC, van der Linden, J, van der Weijden, T and van Eijk, JT (2012). The ideal of biopsychosocial chronic care: how to make it real? A qualitative study among Dutch stakeholders. BMC family practice 13: 14.DOI: https://doi.org/10.1186/1471-2296-13-14 Epub 2012/03/13.
Chung, VC, Ma, PH, Hong, LC and Griffiths, SM (2012). Organizational determinants of interprofessional collaboration in integrative health care: systematic review of qualitative studies. PloS one 7(11): e50022.DOI: https://doi.org/10.1371/journal.pone.0050022 Epub 2012/12/05.
Weiner, SJ Kelly, B Ashley, N Binns-Calvey, A Sharma, G Schwartz, A et al. (2014). Content coding for contextualization of care: evaluating physician performance at patient-centered decision making. Medical decision making: an international journal of the Society for Medical Decision Making 34(1): 97–106. Epub 2013/06/21.
Weiner, SJ Schwartz, A Sharma, G Binns-Calvey, A Ashley, N Kelly, B et al. (2013). Patient-centered decision making and health care outcomes: an observational study. Annals of internal medicine 158(8): 573–9, DOI: https://doi.org/10.7326/0003-4819-158-8-201304160-00001 Epub 2013/04/17.
Hastings, SE, Armitage, GD, Mallinson, S, Jackson, K and Suter, E (2014). Exploring the relationship between governance mechanisms in healthcare and health workforce outcomes: a systematic review. BMC health services research 14: 479.DOI: https://doi.org/10.1186/1472-6963-14-479 Epub 2014/10/05.
Nancarrow, SA (2015). Six principles to enhance health workforce flexibility. Human resources for health 13: 9.DOI: https://doi.org/10.1186/1478-4491-13-9 Epub 2015/08/13.
Bitton, A Ellner, A Pabo, E Stout, S Sugarman, JR Sevin, C et al. (2014). The Harvard Medical School Academic Innovations Collaborative: transforming primary care practice and education. Academic medicine: journal of the Association of American Medical Colleges 89(9): 1239–44. Epub 2014/07/10.
Dieleman, M, Shaw, DM and Zwanikken, P (2011). Improving the implementation of health workforce policies through governance: a review of case studies. Human resources for health 9: 10.DOI: https://doi.org/10.1186/1478-4491-9-10 Epub 2011/04/14.
DiGioia, AM 3rd, Greenhouse, PK, Chermak, T and Hayden, MA (2015). A case for integrating the Patient and Family Centered Care Methodology and Practice in Lean healthcare organizations. Healthc (Amst) 3(4): 225–30, DOI: https://doi.org/10.1016/j.hjdsi.2015.03.001 Epub 2015/12/25.
U.S. Department of Health and Human Services (2000). Healthy People 2010 In: Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden, CR, Zorn, M, Ratzan, SC and Parker, RM, (eds.), NLM Pub. No. CBM 2000-1. Bethesda, MD:: National Institutes of Health, U.S. Department of Health and Human Services.
Carman, KL Dardess, P Maurer, M Sofaer, S Adams, K Bechtel, C et al. (2013). Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood) 32(2): 223–31, DOI: https://doi.org/10.1377/hlthaff.2012.1133 Epub 2013/02/06.
WHO (2013). Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases: formal meeting of Member States to conclude the work on the comprehensive global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of noncommunicable diseases In: Geneva: World Health Organization. (A66/8; http://apps.who.int/iris/handle/10665/105633).
Armstrong, MJ, Mottershead, TA, Ronksley, PE, Sigal, RJ, Campbell, TS and Hemmelgarn, BR (2011). Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obesity reviews: an official journal of the International Association for the Study of Obesity 12(9): 709–23. Epub 2011/06/23.
Friedman, AJ, Cosby, R, Boyko, S, Hatton-Bauer, J and Turnbull, G (2011). Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations. Journal of cancer education: the official journal of the American Association for Cancer Education 26(1): 12–21. Epub 2010/12/17.
van Het Bolscher-Niehuis, MJ, den Ouden, ME, de Vocht, HM and Francke, AL (2016). Effects of self-management support programmes on activities of daily living of older adults: A systematic review. International journal of nursing studies 61: 230–47, DOI: https://doi.org/10.1016/j.ijnurstu.2016.06.014 Epub 2016/07/12.
Coulter, A, Entwistle, VA, Eccles, A, Ryan, S, Shepperd, S and Perera, R (2015). Personalised care planning for adults with chronic or long-term health conditions. The Cochrane database of systematic reviews 3: CD010523.DOI: https://doi.org/10.1002/14651858.CD010523.pub2 Epub 2015/03/04.
Horner, K Ludman, EJ McCorkle, R Canfield, E Flaherty, L Min, J et al. (2013). An oncology nurse navigator program designed to eliminate gaps in early cancer care. Clinical journal of oncology nursing 17(1): 43–8, DOI: https://doi.org/10.1188/13.CJON.43-48 Epub 2013/02/02.
Manderson, B, McMurray, J, Piraino, E and Stolee, P (2012). Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature. Health & social care in the community 20(2): 113–27, DOI: https://doi.org/10.1111/j.1365-2524.2011.01032.x Epub 2011/10/15.
Huntley, AL Thomas, R Mann, M Huws, D Elwyn, G Paranjothy, S et al. (2013). Is case management effective in reducing the risk of unplanned hospital admissions for older people? A systematic review and meta-analysis. Family practice 30(3): 266–75, DOI: https://doi.org/10.1093/fampra/cms081 Epub 2013/01/15.
Kumar, GS and Klein, R (2013). Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: a systematic review. The Journal of emergency medicine 44(3): 717–29, DOI: https://doi.org/10.1016/j.jemermed.2012.08.035 Epub 2012/12/04.
Natale-Pereira, A, Enard, KR, Nevarez, L and Jones, LA (2011). The role of patient navigators in eliminating health disparities. Cancer 117(15 Suppl): 3543–52, DOI: https://doi.org/10.1002/cncr.26264 Epub 2011/08/04.
Couet, N Desroches, S Robitaille, H Vaillancourt, H Leblanc, A Turcotte, S et al. (2013). Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health expectations: an international journal of public participation in health care and health policy, Epub 2013/03/05.
Duncan, E, Best, C and Hagen, S (2010). Shared decision making interventions for people with mental health conditions. The Cochrane database of systematic reviews 1: CD007297.DOI: https://doi.org/10.1002/14651858.CD007297.pub2 Epub 2010/01/22.
Dwamena, F Holmes-Rovner, M Gaulden, CM Jorgenson, S Sadigh, G Sikorskii, A et al. (2012). Interventions for providers to promote a patient-centred approach in clinical consultations. The Cochrane database of systematic reviews 12: CD003267.DOI: https://doi.org/10.1002/14651858.CD003267.pub2 Epub 2012/12/14.
Calvillo, J, Roman, I and Roa, LM (2013). How technology is empowering patients? A literature review. Health expectations: an international journal of public participation in health care and health policy, Epub 2013/05/29.
Etter, JF and Schmid, F (2016). Effects of Large Financial Incentives for Long-Term Smoking Cessation: A Randomized Trial. Journal of the American College of Cardiology 68(8): 777–85, DOI: https://doi.org/10.1016/j.jacc.2016.04.066 Epub 2016/08/20.
Maniglio, R (2010). Child sexual abuse in the etiology of depression: A systematic review of reviews. Depression and anxiety 27(7): 631–42, DOI: https://doi.org/10.1002/da.20687 Epub 2010/03/26.
Infurna, MR, Reichl, C, Parzer, P, Schimmenti, A, Bifulco, A and Kaess, M (2016). Associations between depression and specific childhood experiences of abuse and neglect: A meta-analysis. Journal of affective disorders 190: 47–55, DOI: https://doi.org/10.1016/j.jad.2015.09.006 Epub 2015/10/20.
Danese, A and Tan, M (2014). Childhood maltreatment and obesity: systematic review and meta-analysis. Molecular psychiatry 19(5): 544–54, DOI: https://doi.org/10.1038/mp.2013.54 Epub 2013/05/22.
Devries, KM Mak, JY Child, JC Falder, G Bacchus, LJ Astbury, J et al. (2014). Childhood sexual abuse and suicidal behavior: a meta-analysis. Pediatrics 133(5): e1331–44, DOI: https://doi.org/10.1542/peds.2013-2166 Epub 2014/04/16.
Carr, CP, Martins, CM, Stingel, AM, Lemgruber, VB and Juruena, MF (2013). The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes. The Journal of nervous and mental disease 201(12): 1007–20, DOI: https://doi.org/10.1097/NMD.0000000000000049 Epub 2013/11/29.
Kalmakis, KA and Chandler, GE (2015). Health consequences of adverse childhood experiences: a systematic review. Journal of the American Association of Nurse Practitioners 27(8): 457–65, DOI: https://doi.org/10.1002/2327-6924.12215 Epub 2015/03/11.
Tamayo, T, Christian, H and Rathmann, W (2010). Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review. BMC public health 10(525)DOI: https://doi.org/10.1186/1471-2458-10-525 Epub 2010/09/03.
Goodman, A, Joyce, R and Smith, JP (2011). The long shadow cast by childhood physical and mental problems on adult life. Proceedings of the National Academy of Sciences of the United States of America. 108(15): 6032–7, DOI: https://doi.org/10.1073/pnas.1016970108 Epub 2011/03/30.
Furlong, M, McGilloway, S, Bywater, T, Hutchings, J, Smith, SM and Donnelly, M (2012). Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. The Cochrane database of systematic reviews 2: CD008225.DOI: https://doi.org/10.4073/csr.2012.12 Epub 2012/02/18.
Cruden, G, Kelleher, K, Kellam, S and Brown, CH (2016). Increasing the Delivery of Preventive Health Services in Public Education. American journal of preventive medicine, DOI: https://doi.org/10.1016/j.amepre.2016.07.002 Epub 2016/08/21.
Rodriguez, CM, Smith, TL and Silvia, PJ (2016). Multimethod prediction of physical parent-child aggression risk in expectant mothers and fathers with Social Information Processing theory. Child abuse & neglect 51: 106–19, DOI: https://doi.org/10.1016/j.chiabu.2015.10.028 Epub 2015/12/04.