Value-based integrated (renal) care: setting a development agenda for research and implementation strategies

Abstract

Background: Integrated care services are considered a vital strategy for improving the Triple Aim values for people with chronic kidney disease. However, a solid scholarly explanation of how to develop, implement and evaluate such value-based integrated renal care services is limited. The aim of this study was to develop a framework to identify the strategies and outcomes for the implementation of value-based integrated renal care.

Methods: First, the theoretical foundations of the Rainbow Model of Integrated Care and the Triple Aim were united into one overarching framework through an iterative process of key-informant consultations. Second, a rapid review approach was conducted to identify the published research on integrated renal care, and the Cochrane Library, Medline, Scopus, and Business Source Premier databases were searched for pertinent articles published between 2000 and 2015. Based on the framework, a coding schema was developed to synthesis the included articles.

Results: The overarching framework distinguishes the integrated care domains: 1) type of integration, 2) enablers of integration and the interrelated outcome domains, 3) experience of care, 4) population health and 5) costs. The literature synthesis indicated that integrated renal care implementation strategies have particularly focused on micro clinical processes and physical outcomes, while little emphasis has been placed on meso organisational as well as macro system integration processes. In addition, evidence regarding patients' perceived outcomes and economic outcomes has been weak.

Conclusion: These results underscore that the future challenge for researchers is to explore which integrated care implementation strategies achieve better health and improved experience of care at a lower cost within a specific context. For this purpose, this study's framework and evidence synthesis have set a developmental agenda for both integrated renal care practice and research. Accordingly, we plan further work to develop an implementation model for value-based integrated renal services.

Keywords: Chronic kidney disease; Coordination of care; Delivery of care; Economics; Integrated care; Nephrology; Organization models; Quality improvement; Renal disease; Review.

Fig. 1

The Rainbow Model of Integrated Care: A multi-perspective on value creation through integration of care. Legend: Schematic representation of value-based integrated care. Adapted from “Rainbow of Chaos: A study into the Theory and Practice” by P.P. Valentijn, 2015, Ede, Print Service Ede. Copyright 2015 by Pim P. Valentijn. Adapted with permission