title: Indicators and measurement tools for health system integration: a knowledge synthesis protocol.
abstract: BACKGROUND
  Health system integration is a key component of health system reform with the goal of improving outcomes for patients, providers, and the health system. Although health systems continue to strive for better integration, current delivery of health services continues to be fragmented. A key gap in the literature is the lack of information on what successful integration looks like and how to measure achievement towards an integrated system. This multi-site study protocol builds on a prior knowledge synthesis completed by two of the primary investigators which identified 10 key principles that collectively support health system integration. The aim is to answer two research questions: What are appropriate indicators for each of the 10 key integration principles developed in our previous knowledge synthesis and what measurement tools are used to measure these indicators? To enhance generalizability of the findings, a partnership between Canada and Brazil was created as health system integration is a priority in both countries and they share similar contexts.
  
  
  METHODS
  This knowledge synthesis will follow an iterative scoping review process with emerging information from knowledge-user engagement leading to the refinement of research questions and study selection. This paper describes the methods for each phase of the study. Research questions were developed with stakeholder input. Indicator identification and prioritization will utilize a modified Delphi method and patient/user focus groups. Based on priority indicators, a search of the literature will be completed and studies screened for inclusion. Quality appraisal of relevant studies will be completed prior to data extraction. Results will be used to develop recommendations and key messages to be presented through integrated and end-of-grant knowledge translation strategies with researchers and knowledge-users from the three jurisdictions.
  
  
  CONCLUSIONS
  This project will directly benefit policy and decision-makers by providing an easy accessible set of indicators and tools to measure health system integration across different contexts and cultures. Being able to evaluate the success of integration strategies and initiatives will lead to better health system design and improved health outcomes for patients.
authors.affiliation: School of Nursing, University of British Columbia, Okanagan 3333 University Way, Kelowna, British Columbia, V1V 1V7, Canada. nelly.oelke@ubc.ca.
authors.forename: Nelly D
authors.initials: ND
authors.lastname: Oelke
authors.affiliation: Workforce Research & Evaluation, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada. esther.suter@albertahealthservices.ca.
authors.forename: Esther
authors.initials: E
authors.lastname: Suter
authors.affiliation: Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Rua São Manoel, 963, Porto Alegre, Brazil. malice@enf.ufrgs.br.
authors.forename: Maria Alice Dias
authors.initials: MA
authors.lastname: da Silva Lima
authors.affiliation: School of Nursing, University of British Columbia, Okanagan 3333 University Way, Kelowna, British Columbia, V1V 1V7, Canada. cheryl.vvbrown@ubc.ca.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Van Vliet-Brown
mesh_terms: D006801:Humans; D001938:Brazil; D002170:Canada; D003191:Comprehensive Health Care; D003657:Decision Making; D003695:Delivery of Health Care; D006291:Health Policy; D019359:Knowledge; D019984:Quality Indicators, Health Care; D012107:Research Design; D057170:Translational Research, Biomedical; D012196:Review Literature as Topic