title: How do integrative practices influence patient-centered care?: An exploratory study comparing diabetes and mental health care.
abstract: BACKGROUND
  Integration between organizational units to achieve common goals has been of interest to health systems because of the potential to improve patient-centered care. However, the means by which integrative practices actually influence patient-centered care remain unclear. Whereas many studies claim a positive association between implementation of integrative practices and patient-centered care, others raise concerns that integrative practices may not necessarily improve patient-centered care.
  
  
  OBJECTIVE
  The aim of this study was to explore the mechanism by which integrative practices influence patient-centered care and to suggest a systematic approach for effective integration.
  
  
  METHODS
  We conducted a qualitative study comparing diabetes and mental health services through focus groups with 60 staff members from one health maintenance organization. We developed quantitative indicators to support the suggested model.
  
  
  RESULTS
  We identified a five-category framework of integrative practices that each directly and distinctively influences patient-centered care. Moreover, our findings suggest that integrative practices influence patient-centered care indirectly through creation of interdependent treatment competence, which enables providers to repeatedly deliver interdependent treatment in a flexible and adaptive way.
  
  
  CONCLUSIONS
  Providers should carefully implement integrative practices considering patient and disease characteristics, as our findings suggest that more implementation of integrative practices is not necessarily better for patient-centered care. Specifically, optimal implementation refers to the collective implementation of different integrative practices and thus encompasses both the extent (i.e., the amount of currently implemented practices out of those considered important to implement) and the extensiveness (i.e., the amount relative to the implementation of other practices) that may lead to interdependent treatment competence and higher patient-centered care. We suggest a creative measurement method of comparing the relative implementation of integrative practices that may assist managers and policy makers in developing interdependent treatment competence.
authors.affiliation: Zhanna Novikov, MSc, is PhD Candidate, William Davidson Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa. E-mail: zhannano@technion.ac.il. Wiljeana J. Glover, PhD, is Assistant Professor, Technology, Operations, and Information Management Division, Babson College, Massachusetts. Paula C. Trepman, BSc, is Medical Student, Stanford University School of Medicine, California. Eitan Naveh, DSc, is Associate Professor, William Davidson Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa. Margalit Goldfracht, MD, is Director of Quality Improvement Department, Medicine Section, Community Division Headquarters, Clalit Health Services, Tel-Aviv, Israel, and Associate Professor, Department of Family Health Care, The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa.
authors.forename: Zhanna
authors.initials: Z
authors.lastname: Novikov
authors.forename: Wiljeana J
authors.initials: WJ
authors.lastname: Glover
authors.forename: Paula C
authors.initials: PC
authors.lastname: Trepman
authors.forename: Eitan
authors.initials: E
authors.lastname: Naveh
authors.forename: Margalit
authors.initials: M
authors.lastname: Goldfracht
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D055815:Young Adult