Planning the scale-up of integrated care programs: A qualitative multiple-case study of case management for adults...

Adults with complex needs require health and social services from a variety of providers. Appropriate care for these people calls for integrated care. However, few studies have assessed the organizational conditions conducive to implementing integrated care programs in preparation for scale-up.

This study aimed to 1) implement a case management program as part of an integrated care program initiative for adults with complex needs in health and social services organizations and primary care clinics, 2) evaluate the organizational factors influencing implementation, and 3) share recommendations from key stakeholders to facilitate scale-up.

A qualitative multiple-case study was conducted in two health and social services organizations and five primary care clinics in Quebec, Canada. We collected data through participant observation, semi-structured interviews, and focus groups with stakeholders. The data were analyzed using deductive (RE-AIM framework) and inductive thematic analysis. Case stories were developed and then compared.

Identifying patients targeted by the program was challenging. Better access to health information technology for case-finding was strongly recommended. Remuneration methods compatible with family physicians' expected levels of commitment to the program were needed to promote their engagement. Appropriate change management was also important to promote implementation and ensure sustainability of the program over time.

This study may inform stakeholders interested in scaling up integrated care programs for adults with complex needs.