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Reading: Scaling-up strategies of integrated care initiatives: a systematic literature review


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Scaling-up strategies of integrated care initiatives: a systematic literature review


Liset Grooten ,

Vrije Universiteit Brussel, BE
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Hubertus Johannes Maria Vrijhoef

Vrije Universiteit Brussel, Belgium; Maastricht University Medical Center; Panaxe, NL
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Introduction: To make effective use of integrated initiatives and rapidly increase their wide-scale impact to benefit more people on a lasting basis, large-scale implementation is desirable. However, an understanding of what elements are related with successful implementation of integrated care initiatives on a larger scale remains largely unknown. WHO/ExpandNet argue that ‘’strategic planning for the expansion and institutionalization of successfully tested health systems innovations is essential’’[1]. Flexible, but intentional, scale-up strategies can help guide system changes [2].

This literature review aims to explore what scaling-up strategies for integrated care initiatives are described in literature, to describe to what extent these are theory-based, and how they match the framework for scaling-up, as defined by WHO [3].

Methods: PubMed Medline and Web of Science were consulted to collect data. A combination of three concepts are used as search strategy: 1 search terms describing “integrated care”; 2 search terms related to “scaling-up”; and 3 search terms related to “strategy”. Papers focusing on scaling-up and/or expansion of integrated care initiatives and reporting a strategy for expansion between January 2007 and December 2017 are identified. After the articles are retrieved, the framework for scaling-up, as defined by WHO, is used as a guide to extract the data. The guide includes the types of scaling-up i.e. vertical; horizontal; diversification; spontaneous, the steps for developing a scaling-up strategy for integrated care i.e. scalability; capacity of user organization; environment and planning actions; capacity of resource team; choices for vertical scaling-up; choices for horizontal scaling-up; role of diversification; actions for spontaneous scaling-up; and identification of next steps including the strategic choices made i.e. dissemination and advocacy; organizational process; costs/ resource mobilization; monitoring and evaluation.

Results: A number of 6,222 articles were identified in the two databases, after removing duplicates, a total of 5,568 potentially relevant articles have been reviewed based on title. After papers are included based on the title selection, the abstracts will be reviewed. Next, the included papers will be up for full text review. The reference lists of the full papers will also be checked to include additional relevant papers for final review. The data-analysis is ongoing at this moment Dec 2017.

Discussion: The framework for scaling-up does not specifically focus on scaling-up integrated care initiatives, however, since it is widely used and one of the few available comprehensive frameworks in scaling-up health interventions it has huge promise for the field of integrated care. We hypothesize to find a blend of types, strategic choices and steps for the scaling-up of integrated care.

Conclusion: This literature review will yield information around scaling-up strategies aimed at the transfer and scaling-up of successful integrated care initiatives. The insights on the usage of and potential gaps in scaling-up strategies will be useful to guide the further development, implementation and evaluation of scaling-up strategies.

The literature search is currently being undertaken, therefore, it is too early to report on lessons learned, these will be presented at the conference.

Limitations: This review will select English articles which may result in language bias. 

How to Cite: Grooten L, Vrijhoef HJM. Scaling-up strategies of integrated care initiatives: a systematic literature review. International Journal of Integrated Care. 2018;18(s2):252. DOI:
Published on 23 Oct 2018.


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