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The purpose of this paper is to identify and describe the international and New Zealand (NZ) evidence for models of integrated ambulatory care and describe key implementation issues and lessons learnt.

A scoping review was conducted for published and grey literature on integrated care. Publications from 2000 to February 2019 that described integrated ambulatory care were included.

A total of 34 articles were included. Internationally and in NZ, the most common models of integrated care found were: transfer, relocation and joint working. The international literature showed that transferring care from hospitals to community and other integrated models of care between the primary–specialist interface increased access and convenience for patients. However, there was insufficient evidence of clinical and economic outcomes. Very few NZ-based studies reported on effectiveness of models of care. Key implementation issues were: no viable and sustainable funding, lack of infrastructure, lack of confidence, trust and communication between providers, increased workload and time and knowledge and skills gap to perform new roles. The NZ literature highlighted the need for an appropriate location for services, committed leadership, development of a governance group representing different provider groups, strong communication mechanisms, new workforce skills and overall change management.

The review provides an overview of key components of integrated care models in ambulatory settings and identifies some common elements across the models of care. The findings can inform the design and implementation of integrated ambulatory care in health systems.

Integrating health, social and informal care and seeking for new effective collaborations is a major topic in many countries, and requires innovation and improvement in current practices. Conceptual quality management models can facilitate practice improvement. However, a generic quality management model for integrated care was lacking. The purpose of this paper is to describe the results of multiple studies that resulted in a validated generic quality management model for integrated care. The Development Model for Integrated Care (DMIC) is the basis for a digital tool for self-evaluation and is being used in multiple ways in a large number of integrated care settings.

A literature review, a Delphi study and concept mapping study were executed to identify the essential ingredients of integrated care. A next step was an expert study on the development process of integrated care over time. Lastly, a survey study in 84 integrated care networks was performed to empirically validate the model. Based on the model, a digital self-assessment tool was created to apply the model in practice.

The studies showed that integrated care is a complex and multi-component concept but generic elements can be assessed. The literature and expert study resulted in a set of 89 elements of integrated care. The elements were grouped in nine clusters; “quality care”, “performance management”, “inter-professional teamwork”, “delivery system”, “roles and tasks”, “patient-centredness”, “commitment”, “transparent entrepreneurship” and “result-focused learning”. Four developmental phases named “the initiative and design phase”, “the experimental and execution phase”, “the expansion and monitoring phase” and “the consolidation and transformation phase” were found. The findings showed that the model is applicable for multiple integrated care settings.

The DMIC has the potential to serve as a research framework for integrated care, and the use as an evaluation tool on multiple levels. Further research is suggested about more explicitly involving the perspectives of clients, research on the involvement of multiple stakeholders and their professional backgrounds and the use of the model in other countries.

The DMIC is the basis of a digital web-based assessment tool, which is being used in the Netherlands in multiple integrated care settings. Applying the tool helps in assessing the current state of integrated care practice and defining suggestions for further improvement and development. It is also being used to benchmark multiple settings and is adopted in guidelines or care standards for integrated care.

A generic conceptual and validated model that can be supportive for integrated care practices, policy and research was lacking. The results of the summarized studies in this paper present such a conceptual model for integrated care and gives suggestions for further use in an international audience. Results in a Canadian study showed that the model can also be used in other settings and countries. This contributes to the opportunities for use of the model in integrated care practice, policy and research also in other countries.

Although a large amount of literature about the levels, aims, and relevance of integrated care is present, to realise change in practice knowledge about the implementation and development process of integrated care is also crucial. Instruments such as quality management models can facilitate improvement, but are not frequently used in integrated care practice. The purpose of this paper, therefore, is to present further insight into these models and into the related literature about network and organisational development.

An overview of the recent literature is presented.

The improvement of integrated care is complex and there is no consensus about a set of relevant elements for integrated care. Available quality management models vary in their underlying evidence and do not have integrated care as their central focus or are aimed at specific patient groups such as the chronically ill. The lack of a consistent set of elements and the need for a generic, evidence‐based quality management model for integrated care is important for integrated care improvement. It can be assumed that, as described in the literature about networks and organisations, dynamic stages or phases could be relevant for integrated care. These issues raise important next questions for further research and for facilitating organisational change.

The paper presents a current overview of the available literature about the concept of integrated care, with a special focus on integrated care improvement and its dynamics. It raises the relevant questions and challenges for the further expansion of knowledge about these topics, which will be addressed in a second article in a later issue of Journal of Integrated Care.

It is suggested that a common understanding of integrated care between multi‐professional staff is vital to prevent barriers to unification and quality of care. This paper examines qualitative data from PROCARE, a recently completed European project on integrated care for older people, to put forward an interpretation of what integrated care means to staff. Through thematic analysis, four main clusters were identified. The paper suggests that, while the analysis revealed a common and inter‐related European interpretation that was somewhat idealised and moralistic, this was countered by challenges to its implementation that were inseparable from the rhetoric. The paper suggests that a collective, morally strong understanding is unable to prevent barriers to integrated care, and that tensions between services remain a prominent impediment.

Remote patient monitoring (RPM) and virtual visits have the potential to transform care delivery and outcomes but require intentional planning around how these technologies contribute to integrated care. Since maturity models are useful frameworks for understanding current performance and motivating progress, the authors developed a model describing the features of RPM that can advance integrated care.

This work was led by St. Joseph's Health System Centre for Integrated Care in collaboration with clinical and programme leads and frontline staff offering RPM services as part of Connected Health Hamilton in Ontario, Canada. Development of the maturity model was informed by a review of existing telehealth maturity models, online stakeholder meetings, and online interviews with clinical leads, programme leads, and staff.

The maturity model comprises 4 maturity levels and 17 sub-domains organised into 5 domains: Technology, Team Organisation, Programme Support, Integrated Information Systems, and Performance and Quality. An implementation pillars checklist identifies additional considerations for sustaining programmes at any maturity level. Finally, the authors apply one of Connected Health Hamilton's RPM programmes to the Team Organisation domain as an example of the maturity model in action.

This work extends previous telehealth maturity models by focussing on the arrangement of resources, teams, and processes needed to support the delivery of integrated care. Although the model is inspired by local programmes, the model is highly transferable to other RPM programmes.

This study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising diabetic patient health outcomes and improving healthcare systems in low and middle-income countries.

Peer-reviewed literature that analysed the integration of health services regarding dental and medical services were reviewed. The articles were identified using the Academic Search Complete, Business Source Complete, CINAHL Complete, Google Scholar and MEDLINE databases and screened using the PRISMA guidelines.

A total of 40 full-text articles were examined for eligibility out of which 26 were selected for analysis. Diabetes was shown to contribute significantly to the global disease burden and this is also reflected in most low and middle-income countries. It is found that the integration of medical and dental services could help alleviate this burden. Hence, locally adapted Rainbow-Modified Integrated Care model is proposed to fill this integration gap.

The integration of dental and medical services has been proven to be useful in improving diabetic patient outcomes. Hence, the need to facilitate cross-professional collaboration between dentists and physicians cannot be overemphasised and this can be extended and locally adapted by different health systems across the world.

The integration of dental and diabetic services using models such as the Rainbow Model of Integrated Care is recommended to optimise health outcomes of diabetic patients and enhancing service delivery, especially in resource-poor healthcare systems.

It seems impossible to create a comprehensive evaluation model which fully takes into account the multi‐dimensional context of integrated health and social care. Clinical integration, as a prerequisite for efficient outcomes of integration, must nonetheless get special attention. For more extensive evaluations, a quality chain matrix, including co‐operating acts by different providers, has proven to be useful. Examples of evaluated services in Sweden are given, and the management benefits of the use of evaluation data are highlighted.

Design, implementation, and evaluation are all important for integrated care. However, they miss one critical factor: education. The authors define “integrated care education” as meaningful learning that purposefully supports collaboration and the development of adaptive expertise in integrated care. The ECHO (Extensions for Community Health Outcomes) model is a novel digital health solution that uses technology-enabled learning (TEL) to facilitate, support, and model integrated care education. Using ECHO Concussion as a case study, the authors describe the effects of technology-enabled integrated care education on the micro-, meso-, and macro-dimensions of integrated care.

This case study was constructed using data extracted from ECHO Concussion from video-archived sessions, participant observation, and internal program evaluation memos. The research team met regularly to discuss the development of relevant themes to the dimensions of integrated care.

On the micro-level, clinical integration occurs through case-based learning and the development of adaptive expertise. On the meso-level, professional integration is achieved through the development of the “specialist generalist,” professional networks and empathy. Finally, on the macro-level, ECHO Concussion and the ECHO model achieve vertical and horizontal system integration in the delivery of integrated care. Vertical integration is achieved through ECHO by educating and connecting providers across sectors from primary to quaternary levels of care. Horizontal integration is achieved through the establishment of lateral peer-based networks across sectors as a result of participation in ECHO sessions with a focus on population-level health.

This case study examines the role of education in the delivery of integrated care through one program, ECHO Concussion. Using the three dimensions of integrated care on the micro-, meso-, and macro-levels, this case study is the first explicit operationalization of ECHO as a means of delivering integrated care education and supporting integrated care delivery.

Integrated care is gaining popularity in Australian public policy as an acceptable means to address the needs of the unwell aged. The purpose of this paper is to investigate contemporary models of integrated care for community dwelling older persons in Australia and discuss how public policy has been interpreted at the service delivery level to improve the quality of care for the older person.

A scoping review was conducted for peer-reviewed and grey literature on integrated care for the older person in Australia. Publications from 2007 to present that described community-based enablement models were included.

Care co-ordination is popular in assisting the older person to bridge the gap between existing, disparate health and social care services. The role of primary care is respected but communication with the general practitioner and introduction of new roles into an existing system is challenging. Older persons value the role of the care co-ordinator and while robust model evaluation is rare, there is evidence of integrated care reducing emergency department presentations and stabilising quality of life of participants. Technology is an underutilised facilitator of integration in Australia. Innovative funding solutions and a long-term commitment to health system redesign is required for integrated care to extend beyond care co-ordination.

This scoping review summarises the contemporary evidence base for integrated care for the community dwelling older person in Australia and proposes the barriers and enablers for consideration of implementation of any such model within this health system.