Capturing the Role of Context in Complex System Change: An Application of the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to an Integrated Care Organisation in the UK.

If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influencing the implementation and outcomes of a complex integrated care change programme in Torbay and South Devon (TSD) and, more specifically, in one of five sub-localities, Coastal.

The Generation of Integration: The Early Experience of Implementing Bundled Care in Ontario, Canada

By bundling services and encouraging interprofessional and interorganizational collaboration, integrated health care models counter fragmented health care delivery and rising system costs.
While research has been conducted on the facilitators and challenges of integration, there is less known about how integration is generated. This article explores the generation of integration through the dynamic interplay of contexts and mechanisms and of structures and subjects.

Political struggles for a universal health system in Brazil: successes and limits in the reduction of inequalities

Brazil is a populous high/middle-income country, characterized by deep economic and social inequalities. Like most other Latin American nations, Brazil constructed a health system that included, on the one hand, public health programs and, on the other, social insurance healthcare for those working in the formal sector. This study analyzes the political struggles surrounding the implementation of a universal health system from the mid-1980s to the present, and their effects on selected health indicators, focusing on the relevant international and national contexts, political agendas, government orientations and actors.

Integrated Care Regulation, Assessment, and Inspection – A Collaborative Learning Journey

Over the past ten years, the design and implementation of integrated health and social care organisations and systems has occurred across several continents. These models of care have implied the adoption of new approaches to their organization and governance. As a result, many countries have begun to focus specifically on the regulation, assessment and inspection of integrated care. This editorial argues that there is both an opportunity and a need to share the successes and challenges from these experiences and to promote methods for collaborative learning.

Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program

Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences.

Person-Centered Integrated Care for Chronic Kidney Disease

The effectiveness of person-centered integrated care strategies for CKD is uncertain. This study conducted a systematic review and meta-analysis of randomized, controlled trials to assess the effect of person-centered integrated care for CKD.
It searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (from inception to April of 2016), and selected randomized, controlled trials of person-centered integrated care interventions with a minimum follow-up of 3 months. Random-effects meta-analysis was used to assess the effect of person-centered integrated care.

Health Services Research Spending and Healthcare System Impact

The challenges associated with translating health services and policy research evidence into practice are many and long-standing. Indeed, those challenges have themselves spawned new areas of research, including knowledge translation and implementation science. These sub-disciplines have increase our understanding of the critical success factors associated with the uptake of research evidence into (system) practice. In that regard, building on Canada´s recent Strategy for Patient Oriented Research would seem to offer consideravle promise. The "modest" proposals offered by Thakkar and Sulivan seem less likely to bear fruit. 

Towards Patient-Centered Conflicts of Interest Policy

Financial conflicts of interest exist between industry and physicians, and these relationships have the power to incluence physicians´medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians´reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open Payments Program (OPP) to publicly disclose and bring transparency to the relationships between industry and physicians in the United States. These changes considerably improve transparency and the utility of available data, and caan furthermore enhance professionalism and accountability by encouraging physicians to reflect more actively on their own practices. 

Governing Collaborative Healthcare Improvement: Lessons From an Atlantic Canadian Case

The Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease (AHC) Quality Improvement Collaborative (QIC) in Eastern Canada provided an approach to spur system-level reform across multiple health systems for patients and families living with chronic disease. Developed and led by senior executives with a unique governance approach and involving clinical front-line teams, the AHC serves as a practical example of leadership creating and driving momentum for achieving success in collaborative health system improvements 

The Impact of Integrated Case Management on Health Services Use and Spending Among Nonelderly Adult Medicaid Enrollees

Medicaid plans, whose patients often have complex medical, social, and behavioral needs, seektools to effectively manage enrollees and imprive access to quality care while containing costs. 

The aim of this study is to examine the effects of an integrated case management (ICM) program operated by a Medicaid managed care plan on health service use and spending for nonelderly, non-pregnant adults.