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

Maritt Kirst
Jennifer Im
Tim Burns
G. Ross Baker
Jodeme Goldhar
Patricia O’Campo
Ann Wojtak
Walter P. Wodchis
Peer-Reviewed Article
October 2017

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.
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