Models of Integrated
Delivery System
Conrad Typology of IDS (1996)
1. In traditional stage, care within a given unit is
coordinated for a given condition and is organized
around individual operating units.
2. The transitional stage, sees care coordinated
across operating units for a given stage of illness.
3. In the advanced stage, care is coordinated based
on clinical service lines across all sites within a
given episode of illness such as an acute
cardiovascular event.
4. Final stage is organized around processes and
capabilities to serve multiple needs of populations
and community groups. Health maintenance and
disease prevention are integral aspects of this
stage in order to improve the health of populations
across the continuum of care.
Leutz levels of health services integration
(2005)
1. The least integrated of these dimensions is linkage
which will serve the greatest number of people.
Patients’ needs can be met by identifying their
requirements and providing them with accurate
information and good referrals.
2. Coordination is midway in terms of severity and
number of people who require this level of care.
Formal structures and care managers coordinate
benefits and care across the systems of care.
3. In full health services integration, patients who
require services from two or more systems of care
will benefit from an individual who coordinates
these services; ensures clinical information is
shared among providers in a timely manner; and
provides assistance with transitions between care
settings. This level of health services integration
will be appropriate for a relatively small number of
people, those with the greatest needs.
Team Health Care Practice Models
(Boon 2004)
Fleury (2006) structural forms of
coordination to health services integration.
 This continuum model is based on the
intensity of inter-organizational relations
and organized into three levels:
1. Mutual adjustment (least formal),
2. Alliance,
3. Integration (most formal).
 The model uses five criteria to differentiate the
levels: governance, formalization, sanctions,
scope, and types of problems.
Fleury (2006) structural forms of
coordination to health services integration.
 Governance represents decision making and control
within the system.
 Formalization considers the strategies used (informal e.g.
telephone call vs. extensive e.g. service contract)
amongst the system’s organizations.
 Sanctions indicate the organizations’ accountability (e.g.
oversight by peers, management by objectives).
 The scope encompasses the number of partners, the
different sources of interaction (e.g. financial, clients,
knowledge), and the geographic area or market share
covered by the organizations within the system.
 The type of problem refers to the intensity of care
provided by the system: care that requires little
coordination (e.g. isolated events), services for chronic,
non-complex health problems, and/or care of patients
with complex, chronic health problems.
Program/Service Level Models
 case management
 co-location
 home care
 population health management
 primary care
Case management model
 This model uses a case manager as a facilitator for
achieving the integration of health care services.
 Typically, this individual coordinates the patients’
care for entire period of care.
 Weiss (1998) discussed a prevention-focused model
with a case manager who assisted patients as they
transitioned through the three levels of care:
1. Wellness management which included health
promotion and self-management;
2. Disease management which included risk
reduction, early detection, and intervention of
chronic illness
3. Illness management which comprised
rehabilitation and prevention of recurrence.
Co-location of services and
information
 This model was also easily transferable to a
variety of populations including cancer patients
(O'Connell et al., 2000) and mental health
patients (Wulsin et al., 2006).
 This model depends upon a central location
with a range of health care professionals who
work collaboratively to provide a variety of
services.
 Ideally, these centres also include information
resources such as support meetings, telephone
help lines, and presentations or speakers.
Home care model
 A health services integration model that
focuses on home care after discharge from
hospital was discussed by O’Connell et al.
(2000).
 A team of health care personnel shared the
responsibility for transitioning patients from
hospital to home and was especially effective
for palliative care.
population health management
approach
 A population health management approach was the
cornerstone of the model presented by Byrnes
(1998).
 The proposed model had three components:
1. health status assessment where high risk
groups, conditions and associated costs were
assessed and used for service planning;
2. care management where patient care was
coordinated in a proactive way to enhance
patient satisfaction and outcomes
3. disease management that integrated knowledge
from public health, disease history, health
economics and outcomes research to deliver the
most cost-effective, high quality care.
GP Model of Integration
 Batterham et al. (2002) developed and tested a
model for general medical practitioners’ (GP)
integration through a concept mapping process
and confirmatory factor analysis.
 The model focused on two forms of integration,
patient care and public health, which were
facilitated by various factors: holistic patient
care, GP flexibility, patient information (GP as a
patient’s guide to the health care system),
teamwork, liaison (GP communication on behalf
of patients), care coordination, and hospitals
(GP involvement with patients during
hospitalization).
primary care based models
 Other primary care based models were
discussed by Wulsin et al. (2006) including
those which incorporated behavioral health care
into primary care settings or provided primary
health care in centres which delivered health
care to those requiring psychiatric care. This
later model was especially effective for
individuals with serious behavioral disorders.
Components of Integration and
Examples of Associated Indicators
Components of Integration and Examples
of Associated Indicators
Components of Integration and Examples
of Associated Indicators