Integrated care models: an overview - WHO/Europe

1 Integrated care models: an overview working document Integrated care models: an overview working document October 2016 Health Services Delivery Programme Division of Health Systems and Public Health Abstract Over the past decade many definitions, concepts and theories have emerged explaining and defining what Integrated care is and what the main building blocks for the successful integration of services are. By means of a scoping literature review, this document aims to provide conceptual clarity and consolidate the current understanding of Integrated care models.

2 In light of the current implementation of the European Framework for Action on Integrated Health Services Delivery, this document provides a cross-cutting analysis of components that challenge or support Integrated care , and delivers an output of generic considerations when designing and implementing Integrated care models. Keywords DELIVERY OF HEALTHCARE, Integrated HEALTH care SYSTEMS HEALTH SERVICES Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen , Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website ( ).

3 World Health Organization 2016 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

4 Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication.

5 However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Table of contents List of figures .. iv List of tables .. iv List of abbreviations.

6 V Acknowledgements .. vi Preface .. vii About this document .. 1 Purpose and rationale .. 1 Methods and sources of evidence .. 1 overview of sections .. 2 Sectione one: Integrated care as a multifaceted concept .. 3 Definition of Integrated care .. 3 Taxonomies of integration .. 5 Sectione two: Models of Integrated care .. 7 Individual models of Integrated care .. 7 Group- and disease-specific models .. 10 Population-based models .. 15 Section three: Synthesis of evidence .. 18 Final 21 References.

7 21 Annexes .. 26 Integrated care models: an overview Page iv List of figures Fig. 1. Perspectives shaping Integrated care .. 3 Fig. 2. overview of PCMH attributes delivered at Bend Memorial Clinic, 9 Fig. 3. The Chronic care model .. 10 Fig. 4. The Innovative care for Chronic Conditions model .. 12 Fig. 5. The PRISMA model of Integrated Service Delivery System .. 13 Fig. 6. Extended Kaiser Pyramid .. 15 List of tables Table 1. Typologies of integration .. 5 Table 2. Key components and strategies of CCM.

8 11 Table 3. Example measures within VA performance monitoring 16 Integrated care models: an overview Page v List of abbreviations AHRQ Agency for Healthcare Research and Quality AQuA Advanced Quality Alliance CCM Chronic care model CCU Continuity of care Units EFFA IHSD European Framework for Action on Integrated Health Services Delivery GP general practitioner IHO Integrated healthcare organizations IHSD Integrated health services delivery KP Kaiser Permanente PAHO Pan-American Health Organisation PCMH Patient-Centred Medical Home VA Veterans Health Administration

9 USA United States of America Integrated care models: an overview Page vi Acknowledgements A first draft of this document was prepared by Nick Goodwin, International Foundation for Integrated care . Viktoria Stein, International Foundation for Integrated care , contributed to advance the document. The final document was developed by Altynai Satylganova and reviewed by Juan Tello and Erica Barbazza, WHO Regional Office for Europe. The work reflects the concepts underpinning activities of the Health Services Delivery Programme, together with its office, the WHO European Centre for Primary Health care in Almaty, Kazakhstan.

10 The Programme is a technical unit within the Division of Health Systems and Public Health. The work has benefitted from the expert input of Lourdes Ferrer, International Foundation for Integrated care , Nicki McNaney and Elizabeth Bradbury, Advancing Quality Alliance (AQuA). All figures are reproduced with the permission of authors. Integrated care models: an overview Page vii Preface In 2012, Member States of the WHO European Region endorsed the European health policy Health 2020, recognizing health system strengthening as one of four priority action areas in setting out a course of action for achieving the Region s greatest health potential by year 2020 (1).