Kirst Maritt, Im Jennifer, Burns Tim, Baker G Ross, Goldhar Jodeme, O'Campo Patricia, Wojtak Anne, Wodchis Walter P
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Canada M5T 3M6.
Department of Psychology, Wilfrid Laurier University, 75 University Ave. West, Waterloo, ON, Canada N2L 3C5.
Int J Qual Health Care. 2017 Oct 1;29(5):612-624. doi: 10.1093/intqhc/mzx095.
A realist review of the evaluative evidence was conducted on integrated care (IC) programs for older adults to identify key processes that lead to the success or failure of these programs in achieving outcomes such as reduced healthcare utilization, improved patient health, and improved patient and caregiver experience.
International academic literature was searched in 12 indexed, electronic databases and gray literature through internet searches, to identify evaluative studies.
Inclusion criteria included evaluative literature on integrated, long-stay health and social care programs, published between January 1980 and July 2015, in English.
Data were extracted on the study purpose, period, setting, design, population, sample size, outcomes, and study results, as well as explanations of mechanisms and contextual factors influencing outcomes.
A total of 65 articles, representing 28 IC programs, were included in the review. Two context-mechanism-outcome configurations (CMOcs) were identified: (i) trusting multidisciplinary team relationships and (ii) provider commitment to and understanding of the model. Contextual factors such as strong leadership that sets clear goals and establishes an organizational culture in support of the program, along with joint governance structures, supported team collaboration and subsequent successful implementation. Furthermore, time to build an infrastructure to implement and flexibility in implementation, emerged as key processes instrumental to success of these programs.
This review included a wide range of international evidence, and identified key processes for successful implementation of IC programs that should be considered by program planners, leaders and evaluators.
对针对老年人的综合护理（IC）项目的评估证据进行了一项现实主义综述，以确定导致这些项目在实现诸如降低医疗保健利用率、改善患者健康状况以及改善患者和护理人员体验等结果方面成败的关键过程。
通过互联网搜索在12个索引电子数据库和灰色文献中检索国际学术文献，以识别评估研究。
纳入标准包括1980年1月至2015年7月期间以英文发表的关于综合长期健康和社会护理项目的评估文献。
提取了关于研究目的、时期、背景、设计、人群、样本量、结果和研究结果的数据，以及影响结果的机制和背景因素的解释。
该综述共纳入65篇文章，代表28个IC项目。确定了两种背景-机制-结果配置（CMOcs）：（i）信任多学科团队关系和（ii）提供者对该模式的承诺和理解。诸如设定明确目标并建立支持该项目的组织文化的强有力领导等背景因素，以及联合治理结构，支持了团队协作和随后的成功实施。此外，建立实施基础设施的时间和实施中的灵活性，成为这些项目成功的关键过程。
本综述纳入了广泛的国际证据，并确定了IC项目成功实施的关键过程，项目规划者、领导者和评估者应予以考虑。
