Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Comparative case studies in integrated care implementation from across the globe: a quest for action

Authors: Nicole A. Stadnick, Euan Sadler, Jane Sandall, Cristina Fernandez Turienzo, Ian M. Bennett, Jeffrey Borkan, Bibilola Oladeji, Oye Gureje, Gregory A. Aarons, Marisa Sklar

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

Background

Integrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. Furthermore, there is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems.

Methods

Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011), a multiple case study design was used to address two research objectives: 1) To highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and 2) To synthesize the shared and unique challenges and successes across studies using the EPIS framework.

Results

The seven reported case studies represent integrated care implementation efforts from five countries and continents (United States, United Kingdom, Vietnam, Israel, and Nigeria), target a range of clinical populations and care settings, and span all phases of the EPIS framework. Qualitative synthesis of these case studies illuminated common outer context, inner context, bridging and innovation factors that were key drivers of implementation.

Conclusions

We propose an agenda that outlines priority goals and related strategies to advance integrated care implementation research. These goals relate to: 1) the role of funding at multiple levels of implementation, 2) meaningful collaboration with stakeholders across phases of implementation and 3) clear communication to stakeholders about integrated care implementation.

Trial registration

Not applicable.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145–54.PubMedCrossRef
4.
5.
Bolin JN, Gamm L, Vest JR, Edwardson N, Miller TR. Patient-centered medical homes: will health care reform provide new options for rural communities and providers? Fam Community Health. 2011;34(2):93–101.PubMedCrossRef
6.
7.
de Gruy FV, Etz RS. Attending to the whole person in the patient-centered medical home: The case for incorporating mental healthcare, substance abuse care, and health behavior change. Fam Syst Health. 2010;28(4):298.CrossRef
8.
9.
Hunter C, Funderburk J, Polaha J, et al. Primary care behavioral health (PCBH) model research: current state of the science and a call to action. J Clin Psychol Med Setting. 2018;25(2):127–56.CrossRef
10.
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health Ment Health Serv Res. 2011;38(1):4–23.CrossRef
11.
Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):32.PubMedPubMedCentralCrossRef
12.
13.
Ouwens M, Wollersheim H, Hermens R, Hulscher M, Grol R. Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care. 2005;17(2):141–6.PubMedCrossRef
14.
Mur-Veeman I, Hardy B, Steenbergen M, Wistow G. Development of integrated care in England and the Netherlands: managing across public–private boundaries. Health Policy. 2003;65(3):227–41.PubMedCrossRef
15.
Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res. 2018;18(1):350.PubMedPubMedCentralCrossRef
16.
Maruthappu M, Hasan A, Zeltner T. Enablers and barriers in implementing integrated care. Health Syst Reform. 2015;1(4):250–6.PubMedCrossRef
17.
Goodwin N, Smith J, Davies A, Perry C, Rosen R, Dixon A. Integrated care for patients and populations: improving outcomes by working together; 2012.
18.
Moullin J, Dickson K, Stadnick NA, Rabin B, Aarons GA. Systematic review of the exploration, preparation, implementation, Sustainment (EPIS) Framework. Implement Sci. 2019;14(1):1.
19.
Brookman-Frazee L, Stahmer A, Stadnick N, Chlebowski C, Herschell A, Garland AF. Characterizing the use of research-community partnerships in studies of evidence-based interventions in children’s community services. Adm Policy Ment Health Ment Health Serv Res. 2016;43(1):93–104.CrossRef
20.
Greene D, David JL. A research design for generalizing from multiple case studies. Eval Program Plann. 1984;7(1):73–85.CrossRef
21.
Yin RK. Case study research: design and methods. 4th ed. California: Sage Publications; 2009.
22.
Stake RE. Multiple case study analysis. New York: Guilford Press; 2006.
23.
Small ML. ‘How many cases do I need?’: On science and the logic of case selection in field-based research. Ethnography. 2009;10(1):5–38.CrossRef
24.
Crabtree B, Miller W. Using codes and code manuals: a template organizing style of interpretation. In: Crabtree B, Miller W, editors. Doing qualitative research. 2nd ed. California: Sage Publications; 1999. p. 163–77.
25.
Palinkas L, Horwitz S, Green C, et al. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health Ment Health Serv Res. 2015;42(5):533–44.CrossRef
26.
27.
28.
29.
Stadnick NA, Brookman-Frazee L, Mandell K, Coleman S, Aarons GA. A mixed methods study to adapt and implement integrated mental healthcare for children with autism spectrum disorder. Pilot Feasib Stud. 2019;5:51.CrossRef
30.
Farmer JE, Clark MJ, Mayfield WA, Cheak-Zamora N, Marvin AR, Law JK, Law PA. The relationship between the medical home and unmet needs for children with autism spectrum disorders. Matern Child Health J. 2014;18:672–80.PubMedCrossRef
31.
American Academy of Pediatrics Medical Home Program Advisory Committee. 2002 policy statement: the medical home. Pediatrics. 2002;113:1545–7.
32.
Fisher J, Tran T, thi La B, Kriitmaa K, Rosenthal D, Tran T. Bulletin of the World Health Organization, vol. 88; 2010. p. 737–45.
33.
34.
Rosen B, Pawlson LG, Nissenholtz R, Benbassat J, Porath A, Chassin MR, Landon BE. What the United States could learn from Israel about improving the quality of health care. Health Aff. 2011;30(4):764–72.CrossRef
35.
36.
Avny O, Teitelbaum T, Simon M, Michnick T, Siman-Tov M. Psychiatric consultation in community clinics: a decade of experience in the community clinics in Jerusalem. Isr J Psychiatry Relat Sci. 2016;53(1):71–5.PubMed
37.
38.
Mansbach-Kleinfeld I, Palti H, Ifrah A, Levinson D, Farbstein I. Missed chances: primary care practitioners' opportunity to identify, treat and refer adolescents with mental disorders. Isr J Psychiatry Relat Sci. 2011;48(3):150–6.PubMed
39.
Petersen I, Lund C, Stein DJ. Optimizing mental health services in low income and middle-income countries. Curr Opin Psychiatry. 2011;24:318–23.PubMedCrossRef
40.
Gureje O, Oladeji BD, Araya R, Montgomery AA, Kola L, Kirmayer L, Zelkowitz P, Groleau D. Expanding care for perinatal women with depression (EXPONATE): study protocol for a randomized controlled trial of an intervention package for perinatal depression in primary care. BMC Psychiatry. 2015;15(1):136.PubMedPubMedCentralCrossRef
41.
Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016;9(4):CD004667.
42.
Curran G, Bauer M, Mittman B, Pyne J, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26.PubMedPubMedCentralCrossRef
43.
Cumberlege J. Better births, improving outcomes of maternity services in England. Natl Matern Rev. 2016;25.
44.
Waltz T, Powell B, Chinman M, et al. Expert recommendations for implementing change (ERIC): protocol for a mixed methods study. Implement Sci. 2014;9(1):39.PubMedPubMedCentralCrossRef
45.
Pines JM, Keyes V, van Hasselt M, McCall N. Emergency department and inpatient hospital use by Medicare beneficiaries in patient-centered medical homes. Ann Emerg Med. 2015;65(6):652–60.PubMedCrossRef
46.
van Hasselt M, McCall N, Keyes V, Wensky SG, Smith KW. Total cost of care lower among medicare fee-for-service beneficiaries receiving care from patient-centered medical homes. Health Serv Res. 2015;50(1):253–72.PubMedCrossRef
47.
DeVries A, Li CH, Sridhar G, Hummel JR, Breidbart S, Barron JJ. Impact of medical homes on quality, healthcare utilization, and costs. Am J Manag Care. 2012;18(9):534–44.PubMed
48.
Gabbay RA, Bailit MH, Mauger DT, Wagner EH, Siminerio L. Multipayer patient-centered medical home implementation guided by the chronic care model. Jt Comm J Qual Patient Saf. 2011;37(6):265–73.PubMedCrossRef
49.
Markovitz AR, Alexander JA, Lantz PM, Paustian ML. Patient-centered medical home implementation and use of preventive services: the role of practice socioeconomic context. JAMA Intern Med. 2015;175(4):598–606.PubMedPubMedCentralCrossRef
50.
51.
52.
Aarons GA, Green AE, Trott E, Willging CE, Torres EM, Ehrhart MG, Roesch SC. The roles of system and organizational leadership in system-wide evidence-based intervention sustainment: a mixed-method study. Adm Policy Ment Health Ment Health Serv Res. 2016;43(6):991–1008.CrossRef
53.
54.
55.
Ehrhart MG, Aarons GA, Farahnak LR. Assessing the organizational context for EBP implementation: the development and validity testing of the implementation climate scale (ICS). Implement Sci. 2014;9(1):157.PubMedPubMedCentralCrossRef
56.
Klein KJ, Conn AB, Sorra JS. Implementing computerized technology: an organizational analysis. J Appl Psychol. 2001;86(5):811.CrossRefPubMed
57.
Williams NJ, Ehrhart MG, Aarons GA, Marcus SC, Beidas RS. Linking molar organizational climate and strategic implementation climate to clinicians’ use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study. Implement Sci. 2018;13(1):85.PubMedPubMedCentralCrossRef
58.
Bonham CA, Sommerfeld D, Willging C, Aarons GA. Organizational factors influencing implementation of evidence-based practices for integrated treatment in behavioral health agencies. Psychiatry J. 2014;2014:802983.PubMedPubMedCentral
59.
Jacobs JA, Dodson EA, Baker EA, Deshpande AD, Brownson RC. Barriers to evidence-based decision making in public health: a national survey of chronic disease practitioners. Public Health Rep. 2010;125(5):736–42.PubMedPubMedCentralCrossRef
60.
Holtrop JS, Hall TL, Rubinson C, Dickinson LM, Glasgow RE. What makes for successful registry implementation: a qualitative comparative analysis. J Am Board Fam Med. 2017;30(5):657–65.PubMedCrossRef
61.
Drahota AM, Meza RD, Brikho B, Naaf M, Estabillo JA, Gomez ED, et al. Community-academic partnerships: a systematic review of the state of the literature and recommendations for future research. Milbank Q. 2016;94(1):163–214.PubMedPubMedCentralCrossRef
62.
Aarons GA, Green AE, Palinkas LA, Self-Brown S, Whitaker DJ, Lutzker JR, et al. Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implement Sci. 2012;7(1):32.PubMedPubMedCentralCrossRef
63.
64.
Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, et al. Engaging patients to improve quality of care: a systematic review. Implement Sci. 2018;13(1):98.PubMedPubMedCentralCrossRef
65.
Aarons GA, Ehrhart MG, Farahnak LR. The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership. Implement Sci. 2014;9(1):45.PubMedPubMedCentralCrossRef
66.
Aarons GA, Ehrhart MG, Moullin JC, Torres EM, Green AE. Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol. Implement Sci. 2017;12(1):29.PubMedPubMedCentralCrossRef
67.
Joshi G, Petty C, Wozniak J, Henin A, Fried R, Galdo M, et al. The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. J Autism Dev Disord. 2010;40(11):1361–70.PubMedCrossRef
68.
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Policy Mental Health Mental Health Serv Res. 2011;38(2):65–76.CrossRef
69.
Kates N. Services and trends in Israel's mental health system. Hosp Community Psychiatry. 1994;45(5):480–4.PubMed
70.
71.
72.
Rosser WW, Colwill JM, Kasperski J, Wilson L. Progress of Ontario’s family health team model: a patient-centered medical home. Annf Family Medic. 2011;9(2):165–71.CrossRef
73.
Crabtree BF, Nutting PA, Miller WL, Stange KC, Stewart EE, Jaén CR. Summary of the National Demonstration Project and recommendations for the patient-centered medical home. Annf Family Med. 2010;8(Suppl 1):S80–90.CrossRef
74.
Stange KC, Nutting PA, Miller WL, Jaén CR, Crabtree BF, Flocke SA, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25(6):601–12.PubMedPubMedCentralCrossRef
75.
Klein KJ, Sorra JS. The challenge of innovation implementation. Acad Manage Rev. 1996;21(4):1055–80.CrossRef
Metadata
Title
Comparative case studies in integrated care implementation from across the globe: a quest for action
Authors
Nicole A. Stadnick
Euan Sadler
Jane Sandall
Cristina Fernandez Turienzo
Ian M. Bennett
Jeffrey Borkan
Bibilola Oladeji
Oye Gureje
Gregory A. Aarons
Marisa Sklar
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4661-5

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue

Research article

A conceptual model of urgent care sense-making and help-seeking: a qualitative interview study of urgent care users in England

Research article

Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment

Research article

Implementing eScreening technology in four VA clinics: a mixed-method study

Research article

What do patients really want? An in-depth examination of patient experience in four Australian hospitals

Research article

Effectiveness of health literacy intervention on cardiovascular diseases among university students of Pakistan

Research article

What helped and hindered implementation of an intervention package to reduce smoking in pregnancy: process evaluation guided by normalization process theory