Logic and promise of integrated care systems for the frail elderly: International models and outcomes

The frail elderly, for demographic, clinical, and economic reasons, have elevated long term care (LTC) to an issue of special importance in the industrialized world. Despite differences with respect to health and welfare policies, financing arrangements, and service delivery frameworks,developed countries are to varying degrees struggling with concerns related to LTC access, resource allocation, coordination, and spending. The fragmentation of LTC services has emerged, in particular, as a major theme internationally. Integrated care systems for the frail elderly are becoming more and more important in the U.S. and other countries as a comprehensive, holistic approach to these related issues. In addition to examining the logic and conceptual underpinnings of this combined organizational/service delivery strategy, the paper describes and summarizes the models and related evidence of several well-known international examples, including SIPA and PRISMA in Canada, the Rovereto Project in Italy, and Co-ordinated Care Trials in Australia. This review concludes with a summary of the promise and lessons of these unique integrated models, as well as a brief discussion of their implications for LTC in the American context.