Shifting paradigms: Developmental milestones for integrated care

James Shaw; Jennifer Gutberg; Paul Wankah; Mudathira Kadu; Carolyn Steele Gray; Ann McKillop; G Ross Baker; Mylaine Breton; Walter P Wodchis

doi:10.1016/j.socscimed.2022.114975

Shifting paradigms: Developmental milestones for integrated care

Soc Sci Med. 2022 May:301:114975. doi: 10.1016/j.socscimed.2022.114975. Epub 2022 Apr 14.

Authors

James Shaw¹, Jennifer Gutberg², Paul Wankah³, Mudathira Kadu², Carolyn Steele Gray⁴, Ann McKillop⁵, G Ross Baker², Mylaine Breton³, Walter P Wodchis⁶

Affiliations

¹ Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada. Electronic address: Jay.shaw@utoronto.ca.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
³ Department of Community Health, University of Sherbrooke, Canada.
⁴ Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Canada.
⁵ School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Research Chair Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Canada.

PMID: 35461081
DOI: 10.1016/j.socscimed.2022.114975

Abstract

Frameworks for understanding integrated care risk underemphasizing the complexities of the development of integrated care in a local context. The objectives of this article are to (1) present a novel strategy for conceptualizing integrated care as developing through a series of milestones at the organizational level, and (2) present a typology of milestones empirically generated through the analysis of four cases of integrated community-based primary health care (ICBPHC) in Canada and New Zealand. Our paper reports on an analysis of 4 specific organizational case studies within a large dataset generated for an international multiple case study project of exemplar models of ICBPHC. Drawing on earlier analyses of 359 qualitative interviews with patients, caregivers, health care providers, managers, and policymakers, in this article we present a detailed analysis of 28 interviews with managers and leaders of local models of integrated care. We generated a detailed timeline of the development of integrated care as expressed by each participant, and synthesized themes across timelines within each case to identify specific milestone events. We then synthesized across cases to generate the broader milestone categories to which each event belongs. We generated 5 milestone categories containing 12 more specific milestone events. The milestone categories include (1) strategic relational, (2) strategic process change, (3) internal structural, (4) inter-organizational structural, and (5) external milestones. We propose a comprehensive framework of developmental milestones for integrated care. Milestones represent a compelling strategy for conceptualizing the development of integrated care. Practically, policymakers and health care leaders can support the implementation of integrated care by examining the history and context of a given model of care and identifying strategies to achieve milestones that will accelerate integrated care. Further research should document additional milestone events and advance the development of dynamic frameworks for integrated care.

Keywords: Canada; Health policy; Health systems; Implementation science; Integrated delivery systems; Integrated health care systems; New Zealand.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Community Health Services*
Delivery of Health Care, Integrated*
Humans
New Zealand
Organizational Case Studies

Grants and funding

TTF-128263/CIHR/Canada