From: Indicators and measurement tools for health system integration: a knowledge synthesis protocol
Key principle | Description of the principle | Sample indicators |
---|---|---|
1. Comprehensive services across the care continuum | • Cooperation between health and social care organizations • Access to care continuum with multiple points of access • Emphasis on wellness, health promotion, and primary care | • Coordinated transitions in care across services [23] • Shared programs across sectors/services [24] • Third next available appointment [25] • Emergency department average LOS registration to discharge; registration to admission (QPSD 23) [26] • Measure wait time for referral to treatment by provider type (QPSD 20) [26] • Proportion of patients with health outcomes which are avoidable given the current state of medical knowledge and access to appropriate care [27] • Tobacco screening [28] |
2. Patient focus | • Patient-centred philosophy; focusing on patients’ needs • Patient engagement and participation • Population-based needs for assessment; focus on defined population | • Involvement in care planning for chronic disease/complex care [29] • Evidence of a population-based needs assessment [30, 31] |
3. Geographic coverage and rostering | • Maximize patient accessibility and minimize duplication of services • Roster: responsibility for identified population; right of patient to choose and exit | • Existence of primary care network structures (e.g. family health teams, primary care networks, GP Divisions, inner city primary health care clinics) [30] |
4. Standardized care delivery through interprofessional teams | • Interprofessional teams across the continuum of care • Provider-developed, evidence-based care guidelines and protocols to enforce one standard of care, regardless of where patients are treated | • Team effectiveness [32] • Using a shared clinical pathway across care sectors (e.g. diabetes care, asthma care) [33] |
5. Performance management | • Committed to quality of services, evaluation, and continuous care • Diagnosis, treatment, and care interventions linked to clinical outcomes | • Performance measurement indicators and tools are in place and being used regularly [34] • Clinical outcomes being measured [35] |
6. Information systems | • State-of-the-art information systems to collect, track, and report activities • Efficient information systems that enhance communication and information flow across the continuum of care | |
7. Organizational culture and leadership | • Organizational support with demonstration of commitment • Leaders with vision who are able to instil a strong, cohesive culture | • Extent to which organizational goals and objectives are aligned across care sectors [36] |
8. Physician integration | • Physicians are the gateway to integrated health care delivery systems • Pivotal in the creation and maintenance of a single-point-of-entry or universal electronic patient record • Engage physicians in leading role, participation on Board to promote buy-in | • Physician integration within care teams and across care sectors [10, 36, 38] • Practitioner payment models that support integration [37] |
9. Governance structure | • Strong, focused, diverse governance represented by a comprehensive membership from all stakeholder groups • Organizational structure that promotes coordination across settings and levels of care | • Existence of interagency agreements, service delivery team coalitions [39] • Governance model that includes representation of communities served [30] • Evidence of governance in monitoring and evaluation of health system [40] |
10. Financial management | • Aligning service funding to ensure equitable funding distribution for different services or levels of services • Funding mechanisms must promote interprofessional teamwork and health promotion • Sufficient funding to ensure adequate resources for sustainable change | • Extent to which financial management is coordinated across care units and sectors [36] |
11. Overall integration |  | • Degree of integration within the health system and across sectors [41, 42] |