Grant: Travel Awards - Institute Community Support

Integrated care programs aim to reduce health system fragmentation and high healthcare costs through community-based interventions for older adults with complex needs such as those who have multiple chronic conditions. These models aim to improve coordination in the health care system and the care experience of patients and caregivers. These models have been evaluated but have returned mixed results. Furthermore, the mechanisms and the contextual factors of these programs have not yet been systematically established. In this realist review, we systematically assessed the evaluative evidence on integrated care programs for older adults with complex needs to understand what are the program mechanisms that lead to success, how they work, for whom, and under what context. The review included 65 articles that represent 28 integrated care programs from 13 countries. The review emphasizes the importance of trusting multidisciplinary team relationships for effective communication and information sharing. Contextual factors such as strong leadership that establish goals and an organizational culture that support the program, joint governance structures, and team collaboration, all support successful implementations of programs. Furthermore, provider commitment to and understanding of the model, as fostered by strong leadership, clear governance, time to build infrastructure needed for implementation, and flexibility during implementation, proved instrumental to the success of programs. The review includes international evidence and identifies key processes to be considered by program planners, leaders and in evaluations for future implementations of integrated care programs