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All Together Now: A Conceptual Exploration of Integrated Care

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Kodner, Dennis·2009·Healthcare Quarterly

DOI 10.12927/hcq.2009.21091

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Abstract

Integrated care is a key strategy in reforming health systems around the world. Despite its importance, the concept's polymorphous nature and lack of specificity and clarity significantly hamper systematic understanding, successful application and meaningful evaluation. This article explores the many definitions, concepts, logics and methods found in health system and service integration. In addition to framing this evolving, albeit imprecise field, the article summarizes the main elements or building blocks of integrated care and suggests a way to address its various complexities and unknowns in a real-world sense.

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Integrating Health and Social Care for Community-Dwelling Older Adults: A Description of 16 Canadian Programs
Stewart, T. L., Dionne, É., Urquhart, R., Oelke, N. D., Couturier, Y., Scott, C. M., & Haggerty, J. L. (2023) · Healthcare policy · doi:10.12927/hcpol.2023.27177 · Cited by 6
The INTERLINKS framework for long‐term care of older people in Europe
Billings, J. R. (2013) · Journal of Integrated Care · doi:10.1108/jica-02-2013-0007 · Cited by 6
Inter-Organizational Coordination to Improve Patient Outcomes in Multimorbid Older Patients Following Hospital Discharge – a Systematic Review
Linder, W., Ssegonja, R., Feldman, I., Kristiansson, R. S., Marchi, J., & Winblad, U. (2025) · International Journal of Integrated Care · doi:10.5334/ijic.9018 · Cited by 9
Factors that influence inter-organisational integration: a qualitative exploration of service providers’ perspectives from an integrated care initiative
Liapi, F., Chater, A., Randhawa, G., Stephenson, A., & Pappas, Y. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13051-7 · Cited by 7
“…at the same stage in the process of service delivery are joined together (e.g. mergers of acute hospitals) or vertical integration, when different organisations at different levels of care (e.g., primary, secondary, and tertiary) are combined under one management umbrella [24–26, 28, 29].”
The Long-Term Impacts of an Integrated Care Programme on Hospital Utilisation among Older Adults in the South of England: A Synthetic Control Study
Seamer, P., Lloyd, T., Conti, S., & O’Neill, S. (2023) · International Journal of Integrated Care · doi:10.5334/ijic.6475 · Cited by 5
International experiments with different models of allocating funds to facilitate integrated care: a scoping review protocol
Khayatzadeh‐Mahani, A., Nolte, E., Sutherland, J. M., & Forest, P. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-021374 · Cited by 5
Exploring Intra and Interorganizational Integration Efforts Involving the Primary Care Sector – A Case Study from Ontario
Khan, A. I., Harris, J. K., Barnsley, J. M., & Wodchis, W. P. (2022) · International Journal of Integrated Care · doi:10.5334/ijic.5541 · Cited by 5
“…professional integration or interprofessional collaboration within a defined organizational structure, which refers to collaboration between professionals based on shared competences, roles, responsibilities and accountability to deliver a comprehensive and coordinated continuum of care [11, 12].”
Integrated care initiatives in the Spanish Health System/Experiencias de integración asistencial en el Sistema Nacional de Salud de España
Nuño-Solínis, R., Arce, R. S., & Toro, N. (2012) · International Journal of Integrated Care · doi:10.5334/ijic.881 · Cited by 5
“Por ello, puede decirse que una atención integrada es especialmente relevante para los pacientes crónicos y pluripatológicos, que son los que más sufren los problemas de acceso, continuidad, fragmentación y calidad, presentes en todos los sistemas sanitarios [1].”
Background
Inter-organisational collaboration in palliative care trajectories for nursing home residents: A nation-wide mixed methods study among key persons
Hermans, S., Sevenants, A., Declercq, A., Broeck, N. V., Deliëns, L., Cohen, J., & Audenhove, C. V. (2019) · International Journal of Care Coordination · doi:10.1177/2053434519857352 · Cited by 5
“A network, which is a specific form of interorganisational collaboration in which three or more organisations work together towards a common goal, is a type of strategy directed at realising integrated care on an organisational level.(24,25) Palliative care networks, which include palliative care teams, home care orga…”
Background
Macro and meso level influences on distributed integrated COPD care delivery: a social network perspective
Hartford, W., Asgarova, S., Macdonald, G., Berger, M., Cristancho, S., & Nimmon, L. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06532-y · Cited by 5
“managed care, continuity of care, patient-centered care, and or integrated delivery systems [7, 8].”
Background
Public Policy Issues Affecting Integrated Health Care: Challenges, Opportunities, and Implications for Clinical Mental Health Counselors
Kaur, V., Lindinger‐Sternart, S., & Grey, B. (2022) · Journal of Mental Health Counseling · doi:10.17744/mehc.44.1.05 · Cited by 5
Priorización de herramientas para la integración entre atención primaria y hospitalaria: encuesta sobre expectativas y creencias de los profesionales
Corral-Gudino, L., Arroyo, L. A. R., & Sánchez, L. M. Z.-V. (2018) · Medicina de Familia SEMERGEN · doi:10.1016/j.semerg.2018.09.004 · Cited by 5
Programmes to support transitions in care for children and youth with complex care needs and their families: a scoping review protocol
Doucet, S. A., Curran, J., Breneol, S., Luke, A., Dionne, É., Azar, R., Reid, A., McKibbon, S., Horsman, A. R., & Binns, K. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-033978 · Cited by 5
Developing an Action Model for Integration of Health System Response to HIV/AIDS and Noncommunicable Diseases (NCDs) in Developing Countries
Haregu, T., Setswe, G., Elliott, J., & Oldenburg, B. F. (2013) · Global Journal of Health Science · doi:10.5539/gjhs.v6n1p9 · Cited by 5
“Integration is a means to an end rather than an end by itself (D.L. Kodner, 2009).”
Background
Integrated care: What policies support and influence integration in health care across New Zealand, England, Canada and the United States?
Oliver-Baxter, J., Bywood, P. T., & Brown, L. J. (2013) · Flinders Academic Commons (Flinders University) · Cited by 5
Improving care for victims: a study protocol of the evaluation of a centre for sexual and family violence
Zijlstra, E., LoFoWong, S., Hutschemaekers, G. J. M., & Lagro‐Janssen, A. L. M. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011545 · Cited by 5
“13 Fragmentation of care leads to suboptimal care and higher costs.(14) Besides, victims might be treated negatively by the police and/or healthcare professionals and do not always receive the medical care they need, such as pregnancy counselling or safety assessment.”
Background
Integrated care: What strategies and other arrangements support and influence integration at the meso/organisational level?
Oliver-Baxter, J., Brown, L. J., & Bywood, P. T. (2013) · Flinders Academic Commons (Flinders University) · Cited by 5
Mapping the concept of health care integration: A lexicographic analysis of scientific literature
Urionagüena, A., Piquer‐Martinez, C., Benrimoj, S. I., Calvo, B., García‐Cárdenas, V., Gastelurrutia, M. Á., Martínez, F. M., & Fernández-Llimós, F. (2024) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2024.01.013 · Cited by 4
Development of indicators for integrated antenatal care service provision: a feasibility study in Burkina Faso, Kenya, Malawi, Senegal and Sierra Leone
Sheffel, A., Tampe, T., Katwan, E., & Moran, A. C. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-065358 · Cited by 4
Integrated maternity care: A concept analysis
Cellissen, E., Zelm, R. V., Hendrix, M. J. C., Wildschut, H. I. J., & Nieuwenhuijze, M. J. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306979 · Cited by 4
Improving the integration of care for trans adults: ICTA a mixed-methods study
Holti, R., Callahan, E., Fletcher, J., Hope, S., Moller, N. P., Vincent, B., & Walley, P. (2024) · Health and Social Care Delivery Research · doi:10.3310/ewta4502 · Cited by 5
THE INTEGRATION OF HEALTH SERVICES. HEALTH NETWORKS
Botezat, D., Oprea, L., & Gavrilovici, C. (2013) · Social Research Reports · Cited by 4
La gestion de cas en gérontologie
Corvol, A., Moutel, G., & Somme, D. (2012) · médecine/sciences · doi:10.1051/medsci/2012283022 · Cited by 4
One Client, One Team
Daub, S., Goldhar, J., & Purbhoo, D. (2016) · Healthcare Management Forum · doi:10.1177/0840470416644930 · Cited by 4
“Based on global best practices, TC CCAC identified two pivotal drivers for engaging health system partners: (1) the CCAC care coordinators who provided intensive case coordination across the continuum and (2) primary care.”
Background
A Nonclinical Competency Model for Case Managers
Hausdorf, P. A., & Swanson, S. (2014) · Home Health Care Management & Practice · doi:10.1177/1084822314521209 · Cited by 4
Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study
Thomas, K., Bendtsen, P., & Krevers, B. (2015) · International Journal of Integrated Care · doi:10.5334/ijic.1741 · Cited by 4
“Coordinated care has been found to improve continuity of care, reduce mortality, reduce inappropriate hospital admissions, improve quality of services and reduce costs in mental health and diabetes care [12,13].”
Background
An Introduction to Integrated Care and Diabetes Integrated Care
Wenzel, H., & Simmons, D. S. (2016) · Springer eBooks · doi:10.1007/978-3-319-13389-8_1 · Cited by 4
Modeling service organization integration: a social networks perspective
Fares, J. (2025) · Management Research Review · doi:10.1108/mrr-10-2023-0743 · Cited by 3
Organising maternal and newborn care in high-income countries: a scoping review of organisational elements and their association with outcomes
Liebregts, J., Goodarzi, B., Valentijn, P., Downe, S. M., Erwich, J. J., Burchell, G. L., Batenburg, R. S., de Jonge, A., & Verhoeven, C. J. M. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-107624 · Cited by 3
Use of the International Classification of Functioning, Disability and Health (ICF) in integrated care for people with disabilities: A scoping review using the SELFIE framework
Kim, H.-J., Choi, B., Choi, E., Kim, H., Jang, S., Lim, J., Bulkeley, K., & Smith‐Merry, J. (2025) · Disability and health journal · doi:10.1016/j.dhjo.2025.101854 · Cited by 3
Health Systems Integration: Competing or Shared Mental Models?
Evans, J. M. (2014) · International Journal of Integrated Care · doi:10.5334/ijic.1578 · Cited by 4
“The diversity in terminology and approaches – what Kodner (2009) refers to as an “imprecise hodgepodge” – indicates a lack of clarity on the concept of integration (p.”
BackgroundInfluential
Améliorer la santé mentale des populations par l’intégration des soins de santé mentale aux soins primaires
Menear, M., Gilbert, M., & Fleury, M. (2017) · Santé mentale au Québec · doi:10.7202/1040253ar · Cited by 3
“Le processus de sélection des initiatives visant l’intégration des services de santé mentale aux soins primaires a compris trois étapes.”
Background
Can a case lead approach deliver the “craft and graft” of integration?
Bailey, D., & Mutale, G. J. (2020) · Journal of Integrated Care · doi:10.1108/jica-11-2019-0046 · Cited by 3
Mental Health Task-Shifting in Community-Based Organizations: Implementation, Impact, and Cost — Evaluation of the Connections to Care Program
Ayer, L. A., Schultz, D. J., Abbott, M. M., Barnes‐Proby, D., Chan, W. Y., Dunbar, M. S., Hoch, E., Liu, H., Martineau, M., Ohana, E., et al. (2020) · RAND Corporation eBooks · doi:10.7249/rr3083 · Cited by 3

Authors: Kodner, D.
Affiliations: American Medical Association (US)
Corresponding author: Kodner, Dennis
Venue: Healthcare Quarterly
Publisher: Longwoods Publishing
Published: 2009-10-16
Volume: 13
Issue: sp
Pages: 6-15
ISSN: 1710-2774 (ISSN-L)
1929-6347
DOI: 10.12927/hcq.2009.21091
OpenAlex: W2138401727
Cited by: 434
References: 40
Citations by year: 2026: 8 · 2025: 26 · 2024: 23 · 2023: 24 · 2022: 31 · 2021: 42 · 2020: 30 · 2019: 22 · 2018: 36 · 2017: 33 · 2016: 38 · 2015: 29 · 2014: 25 · 2013: 29 · 2012: 19
FWCI: 2.20
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Healthcare Quarterly (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Practices
Keywords: integrated care, health care reform, service integration, conceptual definitions, health system integration, care coordination
MeSH terms: Canada, Continuity of Patient Care, Decision Support Techniques, Humans, Managed Care Programs, Models, Theoretical, Operations Research, Philosophy, Medical, United States, Models, Organizational, Practice Guidelines as Topic, Health Care Reform, Systems Integration, Delivery of Health Care, Integrated, Case Management, Critical Pathways, Disease Management

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All Together Now: A Conceptual Exploration of Integrated Care

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