Comparing (and learning from) integrated care initiatives: an analytical framework

Purpose – Care integration has been the hallmark of most proposed solutions to current and prospective challenges of health systems. However, it is an imprecise umbrella term encompassing heterogeneous models and little substantive knowledge exists on the basic mechanisms leading to positive outcomes. This study aims to address this gap by identifying the environmental conditions and the configurations of factors associated with service delivery success in integrated care initiatives. Design/methodology/approach – On the basis of an extensive literature review, an analytical framework aimed at structuring and interpreting the relations between contextual, cultural and organizational factors and the outcomes of integrated care initiatives is proposed. The framework is applied to four successful cases of care integration in the USA, Canada, Italy and Switzerland. Findings – The results suggest that positive outcomes mainly depend on the correct matching of macro-level factors with a balanced mix of operating means at the micro-level, rather than on the intense focus on any one element of the framework. Research limitations/implications – The analysis infers, from a small-purposive sample, that successful initiatives are a matter of appropriate configuration of contextual, organizational and technical factors. Generalizability of results would benefit from additional international cases and using the framework on decentralized health systems. Originality/value – This framework can guide future research efforts in the field as it is adaptable and relatively easy to operationalize. It can also be a useful tool for practitioners and policy-makers, to bring structure and reduce the complexity of efforts aimed to design, evaluate and improve integrated care initiatives.