Table 2.

Characteristics of studies included in this systematic review.

Author, year	Country	Study design	Study subjects	Length of follow-up	Integrated care programme	Outcomes reported
Atherly et al. 2004	USA	survey	n = 402 community-dwellers; n = 235 enrolled to the Program for All-Inclusive Care of the Elderly (PACE) and n = 167 non-PACE community-dwellers	18 months	PACE (The Program for All-Inclusive Care of the Elderly) involves comprehensive integration of medical and social services and care including care planning with family members.	Patient satisfaction
Beland et al. 2006	Canada	RCT	n = 1297 community-dwellers aged >64 years with moderate or severe functional problems (assessed using the Functional Autonomy Measurement System) of which n = 606 assigned to SIPA and n = 624 assigned to the usual services available	22 months	SIPA (System of Integrated Care for Older Persons) a publicly managed and funded system of community-based multidisciplinary teams with full clinical responsibility for delivering integrated care through the provision of community health and social services and the coordination of hospital and nursing home care.	Hospital admission, patient satisfaction, mortality
Bernabei et al. 1998	Italy	RCT	n = 200 community-dwellers aged ≥65 years with frailty based on their physical, mental and cognitive health identified through existing home health services or home assistance programmes; n = 100 intervention and n = 100 controls who received care as usual	12 months	Intervention involving case management and care planning by the community geriatric evaluation unit consisting of 2 case managers (performing assessments, monitoring the provision of services), 1 social worker, 1 geriatrician, nurses and general practitioners.	Hospital admission, length of stay, mortality
Brown et al. 2003	UK	mixed-methods	n = 393 community-dwellers aged >64 years; n = 195 integrated care, n = 198 care as usual	18 months	Joint working primary and social care consisting of two co-located integrated teams, one based in a general practice and the other in a health centre attached to a general practice.	Patient satisfaction
Ham et al. 2003	USA, England	comparative study	Data from medical records presented in numbers per 100 000 population consisting of people aged ≥65 years	n/a	Kaiser-Permanente: a medical care program that involves voluntary enrolment, prepayment for services, comprehensive benefits, preventive medical care, integrated hospital-based health care facilities, and provision of physician services through group medical practice vs NHS (National Health Service): the universal and free healthcare programme in England.	Hospital admission, length of stay
Hebert et al. 2010	Canada	quasi-experimental	n = 920 community-dwellers aged ≥75 years at risk of functional decline (assessed using the Functional Autonomy Measurement System); n = 501 assigned to PRISMA and n = 419 controls receiving care as usual	4 years	PRISMA (Program of Research to Integrate Services for the Maintenance of Autonomy) an embedded model with a single entry point using all the public, private, or voluntary health and social service organisations involved in caring for older people in a given area where every organisation keeps its own structure but agrees to participate under an umbrella system and to adapt its operations and resources to the agreed requirements and processes. Case manager included in PRISMA could be any clinical healthcare professional and is responsible for conducting a thorough assessment of the patient’s needs, planning the required services, arranging patient admission to these services, etc.	Hospital admission, patient satisfaction, length of stay, readmission, mortality
Landi et al. 1999	Italy	quasi-experimental	n = 115 community-dwellers, mean age 77.5 years (+/– 11.7) assessed pre/post intervention	6 months	Case managers and the geriatric evaluation unit designed and implemented individualised care plans in agreement with general practitioners, and determined the services for which patients were eligible. The approved services were then provided by multidisciplinary teams, with the case manager coordinating the delivery and facilitating the integration process between social and healthcare professionals.	Hospital admission, length of stay
Landi et al. 2001	Italy	quasi-experimental	n = 1204 community-dwellers, mean age 77.4 years (+/– 9.7) assessed pre/post intervention	12 months	National model that integrates all the community-based services provided either by the health agency or by the municipality into one “single enter” centre.	Hospital admission, length of stay
Looman et al. 2014	The Netherlands	quasi-experimental	n = 417 community-dwellers aged ≥75 years who were frail (assessed with the Groningen Frailty Indicator); n = 205 assigned to WICM and n = 212 received care as usual	3 months	WICM (Walcheren Integrated Care Model) includes a single entry point system through the general practice known for patient data being shared across teams and focus on prevention. Case managers organise admittance to the required services, the planning and co-ordination of care delivery and periodical evaluation and monitoring of the treatment plan in cooperation with multidisciplinary teams.	Patient satisfaction
Schiotz et al. 2011	USA, Denmark	comparison study	Data from medical records of people aged ≥65 years with one or more of the following 5 chronic conditions: angina, heart failure, COPD, hypertension and diabetes.	n/a	Kaiser-Permanente: a medical care programme that involves voluntary enrolment, prepayment for services, comprehensive benefits, preventive medical care, integrated hospital-based health care facilities, and provision of physician services through group medical practice vs Danish Healthcare system (DHS): the universal and free healthcare programme in Denmark.	Hospital admission, length of stay, readmission, mortality
de Stampa et al. 2014	France	quasi-experimental	n = 428 community-dwellers aged >64 years classified as very frail (assessed using Katz ADL, Lawton IADL, the cognitive performance scale, the depression rating scale, etc.); n = 105 assigned to COPA intervention and n = 323 received care as usual	12 months	COPA (Coordination of care for the elderly) single entry point system connecting primary care and hospital care, home-based geriatric assessment, individualised care plan, interdisciplinary protocols, case manager organises planned hospital visits.	Hospital admission
Tourigny et al. 2004	Canada	quasi-experimental	n = 482 people aged ≥75 years (2/3 living in own home, 1/3 in private seniors’ residence) reporting functional decline (based on Katz ADL, Lawton IADL, etc.); n = 272 in geographical area where ISD is provided and n = 210 in different geographical area where there was no ISD network	5 years	ISD (Integrated service delivery) network of health and social services is a single entry service designed to manage both home and institutional care that involves exchange of clinical information across institutions. The service is run by case managers who develop individual service plans for enrolled patients.	Hospital admission, length of stay, readmission, mortality