Care integration within and outside health system boundaries

Health Serv Res. 2020 Dec;55 Suppl 3(Suppl 3):1033-1048. doi: 10.1111/1475-6773.13578.


Objective: Examine care integration-efforts to unify disparate parts of health care organizations to generate synergy across activities occurring within and between them-to understand whether and at which organizational level health systems impact care quality and staff experience.

Data sources: Surveys administered to one practice manager (56/59) and up to 26 staff (828/1360) in 59 practice sites within 24 physician organizations within 17 health systems in four states (2017-2019).

Study design: We developed manager and staff surveys to collect data on organizational, social, and clinical process integration, at four organizational levels: practice site, physician organization, health system, and outside health systems. We analyzed data using descriptive statistics and regression.

Principal findings: Managers and staff perceived opportunity for improvement across most types of care integration and organizational levels. Managers/staff perceived little variation in care integration across health systems. They perceived better care integration within practice sites than within physician organizations, health systems, and outside health systems-up to 38 percentage points (pp) lower (P < .001) outside health systems compared to within practice sites. Of nine clinical process integration measures, one standard deviation (SD) (7.2-pp) increase in use of evidence-based care related to 6.4-pp and 8.9-pp increases in perceived quality of care by practice sites and health systems, respectively, and a 4.5-pp increase in staff job satisfaction; one SD (9.7-pp) increase in integration of social services and community resources related to a 7.0-pp increase in perceived quality of care by health systems; one SD (6.9-pp) increase in patient engagement related to a 6.4-pp increase in job satisfaction and a 4.6-pp decrease in burnout; and one SD (10.6-pp) increase in integration of diabetic eye examinations related to a 5.5-pp increase in job satisfaction (all P < .05).

Conclusions: Measures of clinical process integration related to higher staff ratings of quality and experience. Action is needed to improve care integration within and outside health systems.

Keywords: health care organizations and systems; integrated delivery systems; quality of care/patient safety (measurement); survey research and questionnaire design.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Continuity of Patient Care / organization & administration
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / standards
  • Efficiency, Organizational*
  • Electronic Health Records / organization & administration
  • Health Services Research
  • Humans
  • Job Satisfaction
  • Male
  • Middle Aged
  • Models, Organizational
  • Organizational Objectives
  • Quality of Health Care / standards
  • Systems Integration*
  • United States