International research priorities for integrated care and cross-boundary working: an electronic Delphi study

Integrated care can be broadly defined as the delivery of high-quality and safe care for patients as they cross organizational boundaries or when care is delivered with multiple health care teams, professions, or organizations. Successful integration of care services is contingent on multiple and complex factors across macro, meso, and micro levels of health and social care systems in lower-, middle-, and higher-income countries. Previous priorities for the future development of integrated care have focused on designing and implementing models or approaches to integrated care rather than establishing the research needed to underpin them. This study aimed to address this evidence gap by developing a consensus on international research priorities related to integration of care and cross-boundary working.

We conducted a sequential electronic Delphi (eDelphi) study from September 2023 to December 2023. The eDelphi process consisted of initial priority generation followed by two rounds of consensus development via an online survey. Sixty-six priorities were generated by 19 delegates at an international conference workshop titled, 'Priority setting for future research on integration of care and cross-boundary working'. Workshop delegates then identified other experts in integrated care and cross-boundary working from their networks. In each eDelphi round, participants then provided item-by-item responses using a seven-point Likert scale, with consensus defined a priori as ≥80% agreement (strongly agree or agree). Priorities that reached consensus were conceptually grouped into topics.

Twenty-five of 66 unique (37.9%) research priorities achieved consensus after two eDelphi rounds. In Round 1, 63/85 (74.1%) experts from 10 countries across 4 continents achieved consensus on 12/66 (18.2%) priorities. In Round 2, 51/63 (81.0%) experts achieved consensus on a further 13/54 (24.1%) priorities. From the 25 priorities, we derived six conceptual groupings that represent broad topics for future research on integrated care and cross-boundary working: (i) access to care, (ii) data sharing and technology, (iii) measurement of care quality, (iv) patient experience and satisfaction, (v) service design, integration and governance, and (vi) teamwork and leadership.

Integrating care services and improving cross-boundary working is important for improving the quality of care provided to patients, regardless of country. Therefore, the conceptual topics and individual priorities identified in this study can inform policymakers, practitioners, and researchers when designing or evaluating integrated care services across the world in pursuit of improved integrated care systems.