Is health systems integration being advanced through Local Health District planning?Carla Saunders A B and David J. Carter A
A Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Jones Street, Ultimo, NSW 2007 (PO Box 222), Australia. Email: firstname.lastname@example.org
B Corresponding author. Email: email@example.com
Australian Health Review - http://dx.doi.org/10.1071/AH15191
Submitted: 14 October 2015 Accepted: 8 March 2015 Published online: 21 April 2016
Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned.
Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans.
Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care.
Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW.
What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems.
What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services.
What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.
References Australian Institute of Health and Welfare. Chronic diseases. Available at: http://www.aihw.gov.au/chronic-diseases/ [verified 9 October 2015].
 NSW Ministry of Health. Integrated care. Available at: http://www.health.nsw.gov.au/integratedcare/Pages/objectives-and-benefits.aspx [verified 9 October 2015].
 Sherwood PR, Given CW, Given BA, Von Eye A. Caregiver burden and depressive symptoms analysis of common outcomes in caregivers of elderly patients. J Aging Health 2005; 17 125–47.
| Caregiver burden and depressive symptoms analysis of common outcomes in caregivers of elderly patients.CrossRef | 15750048PubMed |
 Uphold CR. Transitional care for older adults: the need for new approaches to support family caregivers. J Gerontol Geriatr Res 2012; 1 e107
| Transitional care for older adults: the need for new approaches to support family caregivers.CrossRef |
 Burton AM, Sautter JM, Tulsky JA, Lindquist JH, Hays JC, Olsen MK, Zimmerman SI, Steinhauser KE. Burden and well-being among a diverse sample of cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers. J Pain Symptom Manage 2012; 44 410–20.
| Burden and well-being among a diverse sample of cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers.CrossRef | 22727950PubMed |
 Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009; 4 50–65.
| Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.CrossRef | 19664226PubMed |
 Stevens S, Scott I, Von Hellens L, Iselin G. ‘Closing the loop’: the role of health care leaders in integrating research and practice. Aust Health Rev 2004; 27 56–64.
| ‘Closing the loop’: the role of health care leaders in integrating research and practice.CrossRef | 15362297PubMed |
 NSW Ministry of Health. Integrated care. Available at: http://www.health.nsw.gov.au/integratedcare/pages/default.aspx [verified 9 October 2015].
 NSW Government. Local Health Districts and Specialty Networks. Available at: http://www.health.nsw.gov.au/lhd/pages/default.aspx [verified 9 October 2015].
 NSW Ministry of Health. Service agreement. An agreement between: Secretary NSW Health and South Eastern Sydney Local Health District 1 July 2015–30 June 2016. Available at: http://www.seslhd.health.nsw.gov.au/docs/201516ServiceLevelAgreement.PDF [verified 9 October 2015].
 Eagar K, Garrett P, Lin V. Health planning: Australian perspectives. Sydney: Allen & Unwin; 2001.
 Queensland Government. Queensland health guide to health service planning. Brisbane: Queensland Health; 2012.
 Nicholson C, Jackson C, Marley J. A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review. BMC Health Serv Res 2013; 13 528–36.
| 24359610PubMed |
 Downe-Wamboldt B. Content analysis: method, applications, and issues. Health Care Women Int 1992; 13 313–21.
| Content analysis: method, applications, and issues.CrossRef | 1:STN:280:DyaK3s%2FhsFaqtQ%3D%3D&md5=97f8363d7f8afda1b28c691a6b3f3839CAS | 1399871PubMed |
 NSW Ministry of Health. Chronic disease management program. Available at: http://www.health.nsw.gov.au/cdm/pages/default.aspx [verified 30 September 2015].
 NSW Health. State-wide evaluation NSW Health Chronic Disease Management Program. Final report October 2014. George Institute for Global Health, Centre for Primary Health Care and Equity University of New South Wales and the Centre for Health Economics Research and Evaluation at the University of Technology Sydney. 2014. Available at: http://www.health.nsw.gov.au/cdm/Documents/CDMP-Evaluation-Report-2014.pdf [verified September 2015].
 NSW Government. Integrated care strategy NSW. Available at: http://www.health.nsw.gov.au/integratedcare/Pages/Integrated-Care-Strategy.aspx [verified 9 October 2015].
 Commonwealth Department of Health. Primary Health Networks (PHNs). Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/primary_health_networks [verified 9 October 2015].
 Bootha M, Hilla G, Mooreb MJ, Dallab D, Moorec MG, Messengerd A. The new Australian Primary Health Networks: how will they integrate public health and primary care? Public Health Res Pract 2016; 26 1
 Munn P. Factors influencing service coordination in rural South Australia. Aust Soc Work 2003; 56 305–17.
| Factors influencing service coordination in rural South Australia.CrossRef |
 Barraclough F, Longman J, Barclay L. Integration in a nurse practitioner-led mental health service in rural Australia. Aust J Rural Health 2015;
| Integration in a nurse practitioner-led mental health service in rural Australia.CrossRef | 26311391PubMed |
 Platt V, O’Connor K, Coleman R. Improving regional and rural cancer services in Western Australia. Aust J Rural Health 2015; 23 32–9.
| Improving regional and rural cancer services in Western Australia.CrossRef | 25689381PubMed |
 NSW Agency for Clinical Innovation. Models of care. Available at: http://www.aci.health.nsw.gov.au/resources/models-of-care [verified 9 October 2015].
 Wiseman V, Mooney G, Berry G, Tang KC. Involving the general public in priority setting: experiences from Australia. Soc Sci Med 2003; 56 1001–12.
| Involving the general public in priority setting: experiences from Australia.CrossRef | 1:STN:280:DC%2BD3s%2FotlegtQ%3D%3D&md5=2146d7426d166c2dae82e41e24409e64CAS | 12593873PubMed |
 Abelson J, Forest PG, Casebeer A, Mackean G, The Effective Public Consultation Project Team Will it make a difference if I show up and share? A citizen’s perspective on improving public involvement processes for health system decision-making. J Health Serv Res Policy 2004; 9 205–12.
| Will it make a difference if I show up and share? A citizen’s perspective on improving public involvement processes for health system decision-making.CrossRef | 15526385PubMed |
 Gagliardi AR, Lemieux-Charles L, Brown AD, Sullivan T, Goel V. Barriers to patient involvement in health service planning and evaluation: an exploratory study. Patient Educ Couns 2008; 70 234–41.
| Barriers to patient involvement in health service planning and evaluation: an exploratory study.CrossRef | 18023129PubMed |
 NSW Clinical Excellence Commission. Partnering with patients program. Available at: http://www.cec.health.nsw.gov.au/programs/partnering-with-patients [verified 9 October 2015].
 Suter E, Oelke ND, Adair CE, Armitage GD. Ten key principles for successful health systems integration. Healthc Q 2009; 13 16–23.
| Ten key principles for successful health systems integration.CrossRef | 20057244PubMed |
 Oelke ND, Cunning L, Andrews K, Martin D, MacKay A, Kuschminder K, Congdon V. Organizing care across the continuum: primary care, specialty services, acute and long-term care. Healthc Q 2009; 13 75–9.
| Organizing care across the continuum: primary care, specialty services, acute and long-term care.CrossRef | 20057254PubMed |
 Fortin M, Chouinard MC, Bouhali T, Dubois MF, Gagnon C, Bélanger M. Evaluating the integration of chronic disease prevention and management services into primary health care. BMC Health Serv Res 2013; 13 132
| Evaluating the integration of chronic disease prevention and management services into primary health care.CrossRef | 23565674PubMed |
 Thielke S, Vannoy S, Unützer J. Integrating mental health and primary care. Prim Care 2007; 34 571–92.
| Integrating mental health and primary care.CrossRef | 17868760PubMed |
 Letourneau S. Health Link Alberta: a model for successful health service integration. Healthc Q 2009; 13 56–60.
| Health Link Alberta: a model for successful health service integration.CrossRef | 20057251PubMed |
 Bichel A, Erfle S, Wiebe V, Axelrod D, Conly J. Improving patient access to medical services: preventing the patient from being lost in translation. Healthc Q 2009; 13 61–8.
| Improving patient access to medical services: preventing the patient from being lost in translation.CrossRef | 20057252PubMed |
 Brailer DJ. Interoperability: the key to the future health care system. Health Affairs 2005; 24 W5