title: Instruments to assess integrated care: a systematic review.
abstract: BACKGROUND
  Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified.
  
  
  METHODS
  An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected abstracts were independently reviewed by two investigators.
  
  
  RESULTS
  We identified 23 measurement instruments and, within these, eight organisational elements were found. No measurement instrument covered all organisational elements, but almost all studies include well-defined structural and process aspects and six include cultural aspects; 14 explicitly stated using a theoretical framework.
  
  
  CONCLUSIONS
  This review did not identify any measurement instrument covering all aspects of integrated care. Further, a lack of uniform use of the eight organisational elements across the studies was prevalent. It is uncertain whether development of a single 'all-inclusive' model for assessing integrated care is desirable. We emphasise the continuing need for validated instruments embedded in theoretical contexts.
authors.affiliation: Department of Integrated Healthcare, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lyngsø
authors.affiliation: Department of Respiratory Medicine, Hvidovre University Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark.
authors.forename: Nina Skavlan
authors.initials: NS
authors.lastname: Godtfredsen
authors.affiliation: Department of Integrated Healthcare, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Høst
authors.affiliation: Department of Integrated Healthcare, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Frølich
keywords: integrated care; measurement instruments; organisational elements; systematic literature review