title: Identification of mechanisms enabling integrated care for patients with chronic diseases: a literature review.
abstract: BACKGROUND
  Notwithstanding care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of integrated care lacks specificity and clarity. This article presents a literature review to identify mechanisms for achieving integrated care objectives.
  
  
  METHODS
  Existing models often present a large variety of dimensions, archetypes and categories of integration without specifying them. Models and programmes describing integrated care for chronic diseases were reviewed. Data were extracted related to objectives and clusters of mechanisms of integration.
  
  
  RESULTS
  Thirty-four studies presented four objectives: functional, organisational, professional and service integration. We categorised approaches and interventions to achieve these objectives by strategy and clusters of 'mechanisms of integration': degree, patient centredness and normative aspects.
  
  
  CONCLUSIONS
  The clarification of mechanisms to achieve objectives of integrated care as presented may be used as starting point for the development and refinement of integrated care programmes, including methodological grounding of their evaluation. Given that most studies reviewed lack both empirical data and descriptions of the methods used, future research needs to close these gaps. Validation of the findings by a large panel of experts is suggested as recommendation to work towards a grounded framework.
authors.affiliation: TNO, P.O. 3005, 2301 DA Leiden, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: van der Klauw
authors.affiliation: TNO, P.O. 3005, 2301 DA Leiden, The Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Molema
authors.affiliation: TNO, P.O. 3005, 2301 DA Leiden, The Netherlands.
authors.forename: Liset
authors.initials: L
authors.lastname: Grooten
authors.affiliation: MD3, National University of Singapore, 16 Medical Drive, 117597 Singapore.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Vrijhoef
keywords: classification; delivery of health care; health-care reform; integrated; integrated health-care systems; literature review; models organisational
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