What works in implementation of integrated care programs for older adults with complex needs? A realist review.
Purpose
A realist review of the evaluative evidence was conducted on integrated care (IC) programs for older adults to identify key processes that lead to the success or failure of these programs in achieving outcomes such as reduced healthcare utilization, improved patient health, and improved patient and caregiver experience.


Data sources
International academic literature was searched in 12 indexed, electronic databases and gray literature through internet searches, to identify evaluative studies.


Study selection
Inclusion criteria included evaluative literature on integrated, long-stay health and social care programs, published between January 1980 and July 2015, in English.


Data extraction
Data were extracted on the study purpose, period, setting, design, population, sample size, outcomes, and study results, as well as explanations of mechanisms and contextual factors influencing outcomes.


Results of data synthesis
A total of 65 articles, representing 28 IC programs, were included in the review. Two context-mechanism-outcome configurations (CMOcs) were identified: (i) trusting multidisciplinary team relationships and (ii) provider commitment to and understanding of the model. Contextual factors such as strong leadership that sets clear goals and establishes an organizational culture in support of the program, along with joint governance structures, supported team collaboration and subsequent successful implementation. Furthermore, time to build an infrastructure to implement and flexibility in implementation, emerged as key processes instrumental to success of these programs.


Conclusions
This review included a wide range of international evidence, and identified key processes for successful implementation of IC programs that should be considered by program planners, leaders and evaluators.
['Kirst|Maritt|M|', 'Im|Jennifer|J|', 'Burns|Tim|T|', 'Baker|G Ross|GR|', 'Goldhar|Jodeme|J|', "O'Campo|Patricia|P|", 'Wojtak|Anne|A|', 'Wodchis|Walter P|WP|']
D000368:Aged D000369:Aged, 80 and over D019033:Delivery of Health Care, Integrated D006299:Health Services for the Aged D006801:Humans D008605:Mental Health Services D015279:Organizational Culture
integrated care older adults care coordination health and social care services