title: Health systems integration: state of the evidence.
abstract: BACKGROUND
  Integrated health systems are considered a solution to the challenge of maintaining the accessibility and integrity of healthcare in numerous jurisdictions worldwide. However, decision makers in a Canadian health region indicated they were challenged to find evidence-based information to assist with the planning and implementation of integrated healthcare systems.
  
  
  METHODS
  A systematic literature review of peer-reviewed literature from health sciences and business databases, and targeted grey literature sources.
  
  
  RESULTS
  Despite the large number of articles discussing integration, significant gaps in the research literature exist. There was a lack of high quality, empirical studies providing evidence on how health systems can improve service delivery and population health. No universal definition or concept of integration was found and multiple integration models from both the healthcare and business literature were proposed in the literature. The review also revealed a lack of standardized, validated tools that have been systematically used to evaluate integration outcomes. This makes measuring and comparing the impact of integration on system, provider and patient level challenging.
  
  
  CONCLUSIONS
  Healthcare is likely too complex for a one-size-fits-all integration solution. It is important for decision makers and planners to choose a set of complementary models, structures and processes to create an integrated health system that fits the needs of the population across the continuum of care. However, in order to have evidence available, decision makers and planners should include evaluation for accountability purposes and to ensure a better understanding of the effectiveness and impact of health systems integration.
authors: Health Systems and Workforce Research Unit, Alberta Health Services - Calgary (formerly Calgary Health Region), 10301 Southport Lane SW, Calgary, Alberta, Canada T2W 1S7.
authors: Gail D
authors: GD
authors: Armitage
authors: Esther
authors: E
authors: Suter
authors: Nelly D
authors: ND
authors: Oelke
authors: Carol E
authors: CE
authors: Adair