Table 1
Mapping goal-oriented care to integrated care.
| Rainbow Model of Integrated Care Dimensions | Definition [32] | Goal-Oriented Care Approach |
|---|---|---|
| Micro level – clinical integration | “The coordination of person-focused care in a single process across time, place and discipline” | GOC operationalizes a person-focused approach in a clinical encounter by calibrating care plans to person-identified goals and priorities, rather than working towards goals related to a specific disease, profession or setting. |
| Meso level – professional integration | “Interprofessional partnerships based on shared competencies, roles, responsibilities and accountability to deliver a comprehensive continuum of care to a defined population” | Goals are often diverse and complex, requiring support from different health and social care professionals. All team members need to understand and agree to focus on common goals (specifically, the patient’s), which can support the transcending of differences between disciplines and lead to clarification of roles and responsibilities in delivery of care. |
| Meso level – organizational integration | “Inter-organizational relationships (e.g. contracting, strategic alliances, knowledge networks, mergers) including common governance mechanisms, to deliver comprehensive services to a defined population” | Services required to meet diverse patient goals are likely to come from multiple organizations. Working towards common patient-prioritized goals can help establish a shared language and vision for professionals working together across organizational boundaries. Organizations can look beyond their siloed approaches to establish a shared vision and aligned governance structures. |
| Macro level – system integration | “A horizontal and vertical integrated system, based on a coherent set of (informal and formal) rules and policies between care providers and external stakeholders for the benefit of people and populations.” | When adopted across a wide region or network, GOC can be used to drive the structure of partnerships to better align with person-centred needs. For example, pay-for-performance systems need to attend to relevant and appropriate outcomes in order to be successful in integrated care [35]. Focusing too much on biomedical targets can have deleterious effects particularly for multi-morbid complex patients [36]. Goal-attainment has been argued to be a more appropriate outcome for multi-morbid patients [16]. |
| Mechanisms linking micro, meso and macro | ||
| Functional integration | “Key support functions and activities (i.e. financial, management and information systems) structured around the primary process of service delivery to coordinate and support accountability and decision-making between organisations and professionals in order to add overall value to the system.” | GOC creates a unifying process of care delivery that can inform the structure of coordinating activities (e.g., referral pathways) and information sharing (e.g., shared electronic medical records). For example, information sharing platforms can highlight person-centred goals, and indicate different providers and organizations that need to be involved in addressing the identified goals. |
| Normative integration | “The development and maintenance of a common frame of reference (i.e. shared mission, vision, values and culture) between organisations, professional groups and individuals.” | GOC can serve as a common philosophy, and a building block towards shared values of person-centeredness to align disparate professional and organizational groups that need to work together in an integrated model. |