Collective Case Study on Integrated Health and Social Care Within a Canadian Context: Alberta, Ontario and Nova Scotia
Bibliographic record
Abstract
Introduction: Canada’s population is rapidly aging and is putting a strain on Canada’s fragmented welfare system. Integrated health and social care (IHSC) produces positive health and system outcomes. This phenomenon is not fully understood in a Canadian context. A multiple case study of IHSC in Alberta, Ontario and Nova Scotia was undertaken to answer the research questions: What are the factors that support successful services integration among different healthcare and social services organizations serving older adults within a Canadian context? The three cases studied were: geriatric assessment program collaboratory in Alberta; Healthy at Home day program in Ontario, and the Middleton Day Program in Nova Scotia. Theory and Methodology: A collective case study strategy was undertaken and was anchored on a version of the Cheng & Catallo (2020) conceptual framework. This framework identified critical integration factors including leadership, team-based care, communications, information sharing, dedicated resources, inter-organizational culture, performance measurement, accountability agreements and structures, and shared vision and goals. Also, external influencing factors were identified including patient characteristics, geographic setting, government policies and priorities, funding models and governance authorities. Primary data was used and based on key informant interviews of representatives from organizations that comprised each case and focus groups. Within-case analysis and cross-case analysis was undertaken to determine common themes within each case and across the three cases. Results and Discussion: The cross-case analysis revealed that the three cases shared common integration and external influence factors. Many of the integration factors noted in the conceptual framework were present, except for performance measurement and accountability structures and agreements. Role clarity and champions were two new factors that were identified. In addition, the three cases revealed that the external factors in the conceptual framework were present along with three new factors, close sense of community, communities with an aging population and integrating within the not-for-profit sector. Conclusions and Implications: The collective case study revealed that context was important in influencing integration in the three cases. It showed that there are policymaking and practice opportunities for government and service administrators that can improve IHSC for older adults and research opportunities for researchers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.030 | 0.006 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".