From micro to macro: assessing implementation of integrated care in Australia
Lisa Angus A E and Pim P. Valentijn B C DA 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.
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