A quality management model for integrated care: results of a Delphi and Concept Mapping study

Int J Qual Health Care. 2009 Feb;21(1):66-75. doi: 10.1093/intqhc/mzn048. Epub 2008 Oct 22.


Objective: The objective of this study is to identify the elements and clusters of a quality management model for integrated care.

Design: In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts commented and prioritized 175 elements in three rounds. During a half-a-day session with the expert panel, Concept Mapping was used to cluster the elements, position them on a map and analyse their content. Multi-dimensional statistical analyses were applied to design the model.

Participants: Thirty-one experts, with an average of 8.9 years of experience working in research, managing improvement projects or running integrated care programmes.

Results: The literature study resulted in 101 elements of integrated care. Based on criteria for inclusion and exclusion, 89 unique elements were determined after the three Delphi rounds. By using Concept Mapping the 89 elements were grouped into nine clusters. The clusters were labelled as: 'Quality care', 'Performance management', 'Interprofessional teamwork', 'Delivery system', 'Roles and tasks', 'Patient-centeredness', 'Commitment', 'Transparent entrepreneurship' and 'Result-focused learning'.

Conclusion: The identified elements and clusters provide a basis for a comprehensive quality management model for integrated care. This model differs from other quality management models with respect to its general approach to multiple patient categories, its broad definition of integrated care and its specification into nine different clusters. The model furthermore accentuates conditions for effective collaboration such as commitment, clear roles and tasks and entrepreneurship. The model could serve evaluation and improvement purposes in integrated care practice. To improve external validity, replication of the study in other countries is recommended.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Concept Formation*
  • Delivery of Health Care, Integrated / standards*
  • Delphi Technique*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Organizational*
  • Quality Assurance, Health Care*