title: Measuring healthcare integration: Operationalization of a framework for a systems evaluation of palliative care structures, processes, and outcomes.
abstract: Healthcare integration is a priority in many countries, yet there remains little direction on how to systematically evaluate this construct to inform further development. The examination of community-based palliative care networks provides an ideal opportunity for the advancement of integration measures, in consideration of how fundamental provider cohesion is to effective care at end of life.
  
  
  
  This article presents a variable-oriented analysis from a theory-based case study of a palliative care network to help bridge the knowledge gap in integration measurement.
  
  
  
  Data from a mixed-methods case study were mapped to a conceptual framework for evaluating integrated palliative care and a visual array depicting the extent of key factors in the represented palliative care network was formulated.
  
  
  
  The study included data from 21 palliative care network administrators, 86 healthcare professionals, and 111 family caregivers, all from an established palliative care network in Ontario, Canada.
  
  
  
  The framework used to guide this research proved useful in assessing qualities of integration and functioning in the palliative care network. The resulting visual array of elements illustrates that while this network performed relatively well at the multiple levels considered, room for improvement exists, particularly in terms of interventions that could facilitate the sharing of information.
  
  
  
  This study, along with the other evaluative examples mentioned, represents important initial attempts at empirically and comprehensively examining network-integrated palliative care and healthcare integration in general.
authors.affiliation: Department of Oncology, McMaster University, Hamilton, ON, Canada bainbridgd@hhsc.ca.
authors.forename: Daryl
authors.initials: D
authors.lastname: Bainbridge
authors.affiliation: School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.affiliation: School of Nursing, McMaster University, Hamilton, ON, Canada Department of Health, Aging & Society, McMaster University, Hamilton, ON, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Krueger
authors.affiliation: Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Taniguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010166:Palliative Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*
keywords: Integrated healthcare systems; community networks; evaluation studies; palliative care