What Works in Integrated Care Programs for Older Adults with Complex Needs? A Realist Review

Key Questions Answered
  • What factors lead to successful integrated care programs?
  • What is the evidence supporting these factors?
Key Themes and Takeaways

This resource offers a rigorous review of the literature to identify the relationship between context, mechanism, and outcome in integrated care programs for older adults with multiple chronic conditions. The review included a total of 65 articles, representing 28 programs, and identified two important context-mechanism-outcome configurations: 

  • Trusting multidisciplinary team relationships. In successful programs, cross-sector multidisciplinary teams, spanning different organizations, trusted each other and had clearly defined roles. These teams collaborated closely and communicated effectively, which enhanced continuity and coordination of care.
  • Provider commitment to and understanding of the program model. Providers’ commitment to and belief in the model as a means to improve patient health were particularly important to motivate providers to invest the effort to change their work practices and to work in a multi-disciplinary way.
Maritt Kirst
Jennifer Im
Tim Burns
G. Ross Baker
Jodeme Goldhar
Patricia O’Campo
Ann Wojtak
Walter P. Wodchis
Population Addressed
People with Multiple Chronic Conditions
Level of Evidence (OBSOLETE)
Strong Evidence
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