Good team dynamics and worker flexibility can ensure older adults get the most from integrated care

Kirst M, Im J, Burns T, et al. What works in implementation of integrated care programs for older adults with complex needs? A realist review International journal for quality in healthcare. 2017;29(5):612-624.

Review Question

• What are the qualities of integrated care programs for older adults that reduce healthcare use, and improve patient health as well as patient and caregiver experience?

Background

• Older adults with chronic conditions have growing healthcare needs, and can suffer from poor health outcomes, experience long wait times, and contribute to increased healthcare costs if systems are not set up to address their needs.
• Programs that integrate various aspects of care try to reduce healthcare costs and increase coordination across sectors, such as by prioritizing increased community and home-care services. However, current research does not describe how such programs improve health and in which situations they are most successful.
• Identifying the specific qualities of successful programs is important for developing future programs to meet the many needs of older adults.

How the review was done

• A detailed search of a number of electronic databases for studies published from 1980 to 2015 was conducted. Studies that focused on evaluating long-term integrated programs and services, included a focus on multidisciplinary teams, and targeted older adults with complex needs were included in the review.
• A total of 3,921 studies were identified in searches, and 65 were included in the review after assessments for eligibility.
• This review was funded by the Health System Performance Research Network and the Ontario Ministry of Health and Long-Term Care.

What the researchers found

• Integrated care programs were found to reduce healthcare use and improve health when they included multidisciplinary teams that shared patient information, and involved health workers with clear roles who trusted each other with their responsibilities.
• The review found that programs were more likely to succeed when organizations used money to reward health workers who participated in activities and meetings with a mix of health professionals, and when they were given enough time to establish positive relationships and shared goals with their team.
• Studies that described aspects of unsuccessful programs showed that they did not clearly describe how health workers should perform tasks, and did not allow enough time for teams to build relationships and develop collaboration skills.

Conclusions

• This review found that successful integrated care programs for older adults used teams with a mix of health professionals who shared goals and understood their roles. Organizations that were successful with these programs invested in understanding their structure, and provided carers with flexibility and monetary rewards that encouraged team collaboration.