Values underpinning integrated care: a systematic review

摘要

Introduction : The last decade Integrated Care research has mainly focused on implementation, measurement and funding. Also studies on ‘generic ingredients’ have been published, resulting in valuable conceptual models. These models have to be tailored to specific local contexts. If we want to take integrated care forward, a deeper understanding of the essence of integrated care and it’s underlying values is necessary [1]. Underlying values can help to understand behavior and align collaboration as crucial ingredient. In collaboration with IFIC [2], the WHO published a first set of guiding principles for integrated care [3]. This study builds upon this knowledge, following a more systematic approach. The main research question is: What values underpin integrated care in the existing literature, and how can these values be described based on the existing literature? Methods : A systematic search in three databases and a secondary comprehensive search identified 926 articles. 475 records remained after removing duplicates. 62 full-text articles were assessed for eligibility and subsequently 22 records were included in the content analysis. Two researchers independently coded the articles, and all coded fragments were sorted and categorized. Results : The analyzed articles have been published between January 2006 and July 2017, in the US (48%), Europe (29%) or Canada (23%). In total 23 different values of integrated care with descriptions were identified, for instant ‘holistic’, ‘trustful and ‘co-produced’. Discussion and conclusions : Because the 23 values transcend specific situations, they seem to be applicable in multiple settings and on multiple organizational levels. However, some values seem to be more relevant on specific levels. Also a certain connectedness between the values is visible. It is interesting to discuss whether these 23 values really characterize integrated care, and how these values can be used in integrated care practice and governance. Lessons learned : So far integrated care literature focuses on the role and description of value, whereas values are a driver for behavior. This approach appears to be quite new and adds to the existing body of knowledge. In our session we will discuss the identified values and their applicability. Limitations : The literature shows a lack in studies that describe values from a users’ point of view. We want to discuss how to gain more insight into this perspective. Suggestions for future research : To further sharpen this first set of values and to gain insight into their organizational levels, an international Delphi study is carried out - in collaboration with IFIC's SIG on values. The expert panel consists of 33 experts from 13 different countries. On ICIC18 we will give an impression of its first results.