Table 1
Types of care integration strategies and definitions.
| TYPE OF STRATEGY | DEFINITION |
|---|---|
| Organisational integration strategies | Strategies aimed at achieving coordination of care through inter-organisational relationships (e.g., contracting, strategic alliances, knowledge networks, mergers) [17, 20, 21]. |
| Functional integration strategies | Strategies aimed at integrating non-clinical support and back-office functions, for example, through the use of shared electronic medical records and shared financing and management [17, 20, 21]. |
| Service/professional integration strategies | Strategies aimed at creating new inter-professional partnerships and ways of interaction based on shared competencies, roles, responsibilities, and accountability (e.g., multidisciplinary teams, periodic meetings between interrelated professional groups or departments) [20]. |
| Clinical integration strategies | Strategies aimed at achieving coordination of care through understanding it as a single process that crosses intra- and inter-professional boundaries and organisational boundaries (e.g., shared clinical practice guidelines and pathways) [20, 21, 22]. |
| Normative integration strategies | Strategies aimed at achieving coordination of care between organisations, professional groups, and individuals through a common frame of reference (i.e., shared mission, vision, values, and culture)[20, 21, 22]. |
| Systemic integration strategies | Strategies aimed at Integrating care through coherent rules and policies at various levels of organisations [17, 21]. |
Table 2
Organisational outcomes and definitions.
| ORGANISATIONAL OUTCOME | DEFINITION |
|---|---|
| Coordination of the care process | Refers to a process in which team members make concrete agreements, team members are familiar with the various steps in the care process, and there is an optimum timing of activities within the care process [24]. |
| Patient-focused organisation of care | Refers to having the patient’s needs and preferences at the centre of the process of organising care [24]. |
| Follow-up of the care process | Refers to monitoring variances, risks of complications, and outcomes – including patient satisfaction - throughout the complete care process [24]. |
| Communication with patients and family | Refers to a process in which time is provided explicitly to listen and provide information to patients and family members. Furthermore, patients are asked explicitly for their consent regarding the proposed care [24]. |
| Inter-organisational collaboration | The successful cooperation among different organisations that makes task achievement possible through united effort. A critical subtype of inter-organisational collaboration is collaboration with primary care. This type of inter-organisational collaboration refers to care processes in which centres which provide highly complex health care provision consider primary care to be an equal partner, and good cooperation exists between different levels of care [25]. |
| Interprofessional collaboration | Defined as “the process by which different health and social care professional groups work together to positively impact care. Interprofessional collaboration involves regular negotiation and interaction between professionals, which values the expertise and contributions that various healthcare professionals bring to patient care” [26]. |
Figure 1
PRISMA diagram.
Table 3
Organisational integration strategies.
| REFERENCE | COUNTRY | NAME | STRATEGY DESCRIPTION | OUTCOME |
|---|---|---|---|---|
| Dillip et al. [43] | Tanzania | Training in Kibaha district | Joint training to link health workers | Increased inter-organisational collaboration Increased collaboration with primary care |
| Kalita et al. [44] | India | Integrating health and nutrition programs in Chhattisgarh, India | Merger between health programmes | Improved coordination of care |
| Kearns et al. [45] | Bangladesh | The Manoshi Project | Building a direct referral system | Increased collaboration with primary care Increased inter-organisational collaboration |
| Kenya | Jacaranda Health | Assessment of availability and capabilities of facilities for referral | Increased collaboration with primary care Increased inter-organisational collaboration | |
| Lhamsuren et al. [46] | Mongolia | Reaching Every District | Partnership through referrals from one organisation to another | Increased inter-organisational collaboration |
Table 4
Service/professional integration strategies.
| REFERENCE | COUNTRY | NAME | STRATEGY DESCRIPTION | OUTCOME |
|---|---|---|---|---|
| Jiang et al. [47] | China | Safe motherhood program in rural Guangxi Zhuang Autonomous | Traditional birth attendants as liaisons | Improvement of follow-up |
| Kearns et al. [45] | Ethiopia | Health extension worker (HEW) programme | Community health workers as liaisons | Increased collaboration with primary care |
| Pakistan | Lady Health Worker | Community health workers as liaisons | Increased collaboration with primary care | |
| Mwaniki et al. [48] | Kenya | The Kenya Kwale district improvement collaborative | Traditional birth attendants as liaisons | Increased collaboration with primary care Improvement of follow-up |
| Orya et al. [49] | Somalia and Sierra Leone | Improving the reproductive and sexual health of internally displaced people, Maroodi Jeex, Somaliland. Building capacity for the improvement of infant and maternal health in northern Bombali, Sierra Leone | Traditional birth attendants as liaisons | Improvement of follow-up. Making care more patient-centred |
Table 5
Clinical integration strategies.
| REFERENCE | COUNTRY | NAME | STRATEGY DESCRIPTION | OUTCOME |
|---|---|---|---|---|
| Carmichael et al. [50] Balakrishnan et al. [51] Borkum et al. [52] | India | Information communication Technology Continuum of Care Service | Mobile technology tool for frontline workers | Improved coordination of the care process Improved interprofessional collaboration Improved follow-up of the care process |
| Graven et al. [53] | Belize | Belize Integrated Patient-centred Country Wide Health Information System (BHIS) | Country-wide health information system with an embedded maternal care program management algorithm | Improved follow-up of care |
| Osaki et al. [54] | Indonesia | Maternal and child health handbook | Home-based record | Improved follow-up of the care process |
Table 6
Functional integration strategies.
| REFERENCE | COUNTRY | NAME | STRATEGY DESCRIPTION | OUTCOME |
|---|---|---|---|---|
| Jalloh-Vos et al. [55] | Sierra Leone | Mobile communication strategies | Establishing a virtual private network (VPN) and distributing mobile phones, SIM cards, and prepaid phone credit | Improved communication with patients and family Increased interprofessional collaboration Increased collaboration with primary care |
| Meyer et al. [56] | South Africa | AitaHealth ™ | Home-based and facility-based healthcare mobile information system | Improved follow-up of the care process |
Table 7
Effect of each type of maternal care integration strategy on organisational outcomes.
| TYPE OF INTEGRATION STRATEGY | OUTCOME | |||||
|---|---|---|---|---|---|---|
| INTER- ORGANISATIONAL COLLABORATION | FOLLOW-UP OF THE CARE PROCESS | PATIENT-CENTRED CARE | COMMUNICATION WITH PATIENTS AND FAMILY | COORDINATION OF CARE PROCESS | INTER- PROFESSIONAL COLLABORATION | |
| Organisational | + | NI | NI | NI | + | NI |
| Service/ professional | + | + | + | NI | NI | NI |
| Functional | + | + | + | + | NI | NI |
| Clinical plus functional | NI | + | NI | NI | + | + |
[i] +: type of strategy listed in the corresponding line influenced the organisational outcome listed in the column. NI: effects of type of strategy listed on the line not identified for the type of outcome listed in the corresponding column.