The reimagination of sustainable integrated care in Ontario, Canada

• Published in: Health policy (Amsterdam) 2021-01, Vol.125 (1), p.83-89
• Main Authors: Embuldeniya, Gayathri, Gutberg, Jennifer, Wodchis, Walter P.
• Format: Article
• Language: English
• Subjects: Accountability; Acute services; Bundled care; Chronic illnesses; Community health care; Concept formation; Coordination; Decision making; Health administration; Health service delivery; Integrated care; Integrated funding models; Interviews; Policy making; Sustainability; Uncertainty
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2020.11.001

•Integrating care across sectors was challenging for chronic disease programs.•Participants adopted creative sustainability strategies, unique to each program.•Their designs transcended policymakers’ original conceptualization of integration.•Fostering accountability and patient-centred care was key to sustainability for program stakeholders.•Differences in policymakers’ and program implementers’ understanding of integrated care are indicated. To encourage clinical and financial efficiency, the Canadian province of Ontario initiated an integrated care program – Integrated Funding Models (IFMs) that required collaboration and coordination across acute and post-acute care sectors. This research shows how program implementers went beyond policy-makers’ original designs, to make integrated care sustainable for chronic diseases. Forty-five interviews were conducted with program participants at three chronic disease programs, as well as with policymakers. Interviews were conducted over two phases; during early implementation in 2016, and as programs matured in 2018. Data were analyzed through a cultural constructivist lens to understand how participants shaped programs. Participants desired greater accountability and control. Participants in the first program wanted localized control over decision-making. In the second, participants initiated greater control over financial uncertainty. In the third program, hospital participants sought greater control over community care. Participants across programs simultaneously wanted integrated care to be expanded holistically, spatially, and temporally for patients, extending the length of care, and expanding the spaces in which care was provided. Findings also suggest a gap between program implementers’ and policymakers’ conceptualizations of integrated care. This work shows how IFMs were reimagined in ways that transcended their original conceptualization as spatially and temporally delimited initiatives aimed at improving coordination and efficiency. It has practical implications for those facing sustainability challenges in other contexts.