title: The evolution of integrated health care strategies.
abstract: OBJECTIVE
  To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature.
  
  
  METHODS
  A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration.
  
  
  RESULTS
  Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS).
  
  
  CONCLUSIONS
  This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.
authors.forename: Jenna M
authors.initials: JM
authors.lastname: Evans
authors.forename: G Ross
authors.initials: GR
authors.lastname: Baker
authors.forename: Whitney
authors.initials: W
authors.lastname: Berta
authors.forename: Jan
authors.initials: J
authors.lastname: Barnsley
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D006284:Health Plan Implementation; D006801:Humans; D007373:Interinstitutional Relations; D017146:Models, Organizational; D015279:Organizational Culture; D009936:Organizational Innovation