Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

From micro to macro: assessing implementation of integrated care in Australia

Lisa Angus A E and Pim P. Valentijn B C D
+ Author Affiliations
- Author Affiliations

A Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.

B Department of Patient and Care, Maastricht University Medical Center, Plein Debyelaan 25, NL-6202 AZ Maastricht, Netherlands.

C Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, NL-6229 GT Maastricht, Netherlands.

D Present address: Integrated Care Evaluation, Essenburgh, Zuiderzeestraatweg 199, NL-3849AE Hierden, Netherlands.

E Corresponding author. Present address: Providence Center for Outcomes Research & Education (CORE), 5211 NE Glisan Street, Portland, OR 97213, USA. Email: lisa.angus@gmail.com

Australian Journal of Primary Health 24(1) 59-65 https://doi.org/10.1071/PY17024
Submitted: 24 February 2017  Accepted: 29 August 2017   Published: 14 November 2017

Abstract

Many countries and health systems are pursuing integrated care as a means of achieving better outcomes. However, no standard approaches exist for comparing integration approaches across models or settings, and for evaluating whether the key components of integrated care are present in different initiatives. This study sheds light on how integrated care is being implemented in Australia, using a new tool to characterise and compare integration strategies at micro, meso and macro levels. In total, 114 staff from a purposive sample of 38 integrated care projects completed a survey based on the Rainbow Model of Integrated Care. Ten key informants gave follow-up interviews. Participating projects reported using multiple strategies to implement integrated care, but descriptions of implementation were often inconsistent. Micro-level strategies, including clinical–professional service coordination and person-centred care, were most commonly reported. A common vision was often described as an essential foundation for joint work. However, performance feedback appeared under-utilised, as did strategies requiring macro-level action such as data linkages or payment reform. The results suggest that current integrated care efforts are unevenly weighted towards micro-level strategies. Increased attention to macro-level strategies may be warranted in order to accelerate progress and sustain integrated care in Australia.

Additional keywords: delivery of health care – integrated, patient-centred care, primary care, health services – administration.


References

Department of Health (2017) Health care homes: reform of the primary health care system. Available at http://www.health.gov.au//internet/main/publishing.nsf/Content/health-care-homes [Verified 18 May 2017]

Dutton P (2014) Primary health networks to drive better primary health care. Media release from the former Minister for Health & Minister for Sport. Available at http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2014-dutton085.htm [Verified 18 May 2017]

Goodwin N (2016) Understanding and evaluating the implementation of integrated care: a ‘three pipe’ problem. International Journal of Integrated Care 16, 19
Understanding and evaluating the implementation of integrated care: a ‘three pipe’ problem.CrossRef |

Ham C, Walsh N (2013) ‘Making Integrated Care Happen at Scale and Pace.’ (The King’s Fund: London, UK)

Kodner DL (2009) All together now: a conceptual exploration of integrated care. Healthcare Quarterly 13, 6–15.
All together now: a conceptual exploration of integrated care.CrossRef |

LeBreton JM, Senter JL (2008) Answers to 20 questions about interrater reliability and interrater agreement. Organizational Research Methods 11, 815–852.
Answers to 20 questions about interrater reliability and interrater agreement.CrossRef |

Lyngsø AM, Godtfredsen NS, Host D, Frolick A (2014) Instruments to assess integrated care: a systematic review. International Journal of Integrated Care 14, e027
Instruments to assess integrated care: a systematic review.CrossRef |

Martínez-González NA, Berchtold P, Ullman K, Busato A, Egger M (2014) Integrated care programmes for adults with chronic conditions: a meta-review. International Journal for Quality in Health Care 26, 561–570.
Integrated care programmes for adults with chronic conditions: a meta-review.CrossRef |

McDonald J, Lane R, Kearns R, Ward B, Powell Davies G, Fuller J, Dennis S, Spooner C, Walker C, Russell G (2015) ‘Emerging Models of Integrated Primary Health Care Centres: How they Optimise Access and Integration and the Influence of Characteristics and Organisational Factors.’ (Centre for Primary Health Care and Equity UNSW and Australian Primary Health Care Research Institute: Sydney, NSW, Australia)

Mitchell GK, Burridge L, Zhang J, Donald M, Scott IA, Dart J, Jackson C (2015) Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness? Australian Journal of Primary Health 21, 391–408.
Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?CrossRef |

New South Wales Health (2016) NSW Integrated Care Strategy. Available at http://www.health.nsw.gov.au/integratedcare/Pages/integrated-care-strategy.aspx [Verified 18 May 2016]

Nicholson C, Jackson CL, Marley JE (2014) Best-practice integrated health care governance – applying evidence to Australia’s health reform agenda. The Medical Journal of Australia 201, 64–66.
Best-practice integrated health care governance – applying evidence to Australia’s health reform agenda.CrossRef |

Powell Davies G, Williams AM, Larsen K, Perkins D, Roland M, Harris MF (2008) Coordinating primary health care: an analysis of the outcomes of a systematic review. The Medical Journal of Australia 188, S65–S68.

Suter E, Oelke ND, Adair CE, Armitage GD (2009) Ten key principles for successful health systems integration. Healthcare Quarterly 13, 16–23.
Ten key principles for successful health systems integration.CrossRef |

Valentijn PP (2016) Rainbow of chaos: a study into the theory and practice of integrated primary care. International Journal of Integrated Care 16, 3
Rainbow of chaos: a study into the theory and practice of integrated primary care.CrossRef |

Valentijn PP, Schepman SM, Opheij W, 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
Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.CrossRef |

Valentijn PP, Vrijhoef HJM, Ruwaard D, Boesveld I, Arends RY, Bruijnzeels MA (2015) Towards an international taxonomy of integrated primary care: a Delphi consensus approach. BMC Family Practice 16, 64–78.
Towards an international taxonomy of integrated primary care: a Delphi consensus approach.CrossRef |

Valentijn PP, Angus LA, Boesveld IC, Nurjono M, Ruwaard D, Vrijhoef HJM (2016) Validating the Rainbow Model of Integrated Care Measurement Tool: results from three pilot studies in the Netherlands, Singapore and Australia. In ‘4th World Congress on Integrated Care’, 23–25 November 2016, Wellington, New Zealand. (International Foundation for Integrated Care) Available at https://www.dropbox.com/sh/r7dhhl0f1za189t/AADrDRNCUHoRyGkh5uqeA8mza/5.4%20Validating%20the%20Rainbow%20Model%20of%20Integrated%20Care%20Measurement%20-%20Pim%20Valentijn.pdf?dl=0 [Verified 25 September 2017]



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