Exploring Intra and Interorganizational Integration Efforts Involving the Primary Care Sector - A Case Study from Ontario

Anum Irfan Khan; Jenine K Harris; Jan Barnsley; Walter Wodchis

doi:10.5334/ijic.5541

Exploring Intra and Interorganizational Integration Efforts Involving the Primary Care Sector - A Case Study from Ontario

Int J Integr Care. 2022 Sep 8;22(3):15. doi: 10.5334/ijic.5541. eCollection 2022 Jul-Sep.

Authors

Anum Irfan Khan¹, Jenine K Harris², Jan Barnsley¹, Walter Wodchis¹

Affiliations

¹ University of Toronto, Canada.
² Washington University in St Louis, USA.

Abstract

Background: The primary care sector is uniquely positioned to lead the coordination of providers and organizations across health and social care sectors. This study explores whether intraorganizational (professional) integration within a primary care team might be related to interorganizational integration between primary care and other community partners involved in caring for complex patients.

Methods: Two care coordination initiatives (Health Links) were selected - one led by a primary care team with a high level of intraorganizational integration as assessed by the Collaborative Practice Assessment Tool (CPAT), and the other led by a primary care team with a low level of intraorganizational integration. A case study design involving a social network approach was used to assess interorganizational integration across six types of relationships including regular contact, perceived level of integration, referrals, information sharing, joint care planning, and shared resources.

Results: Compared to the high-CPAT led case, the low-CPAT led case had higher density (more ties among organizations) in terms of regular contact, integration, and sharing of resources, whereas the opposite was true for the referral, information sharing, and joint care planning networks. Network centralization (extent to which network activity is influenced by one or a group of organizations) was higher for the high-CPAT case compared to the low-CPAT case in the integration, referrals, and joint care planning networks, while the low-CPAT case had higher centralization with regard to regular contact, information sharing, and shared resources.

Conclusion: The interplay between intra and interorganizational integration remains unclear. We found no consistent differences in the patterns of ties across the six types of networks examined between the two cases. Assessing changes in network metrics for different organizations in each case over time, and supplementing network findings through in-depth interviews with network members are key next steps to consider.

Keywords: case study; interorganizational collaboration; multimorbidity; network analysis; primary care.

Grants and funding

This work was supported by research grants to the Health System Performance Research Network from the Ontario Ministry of Health and Long Term Care (Grant # 06034) and the Ontario SPOR Support Unit, as well as funding from the Canadian Institutes for Health Research (Funding Reference Number TTF-128263). No endorsement by the funding sources is intended or should be inferred. The funding sources for this study had no role in study design, data collection, analysis, or interpretation of data, nor in the writing of the manuscript.