Examining the Influence of Integrated Home and Community Care Programs on Quadruple Aim and Health Equity Outcomes Across the Health Care System: A Scoping Review

TL;DR

This study reviews how integrated home and community care programs affect healthcare quality, costs, and equity for aging populations.

Contribution

The study identifies gaps in research on health equity and system-level impacts of integrated care models.

Findings

Most studies focused on cost and hospital outcomes, with limited attention to health equity and population health.

Only 11 of 47 studies evaluated system-level influence, highlighting a need for broader research.

Integrated palliative care was the most studied program type, with 23 included studies.

Abstract

Integrated approaches have been promoted as a solution to challenges in delivering high-quality care for aging populations. Despite their theorized benefits, the system-wide influence of integrated home and community care models remains poorly understood.

We systematically searched MEDLINE (Ovid), CINAHL (EBSCO) and AgeLine (EBSCO) for studies examining the influence of integrated home and community care programs on outcomes aligned with the Quadruple Aim and Health Equity framework.

Forty-seven peer-reviewed articles were included, representing five program types: comprehensive coordinated care (n = 6), integrated palliative care (n = 23), preventative care (n = 4), restorative care (n = 3), and transitional care (n = 11). Most studies focused on value outcomes, particularly in hospital (n = 36) and emergency services (n = 22). Patient and caregiver experience was assessed in 11 studies, while provider experience (n = 1), health equity (n = 2) and population health (n = 0) were rarely examined. Eleven studies evaluated system-level influence; 23 focused on community-dwelling care recipients.

The emphasis on cost-related outcomes reflects prevailing austerity and value-based rhetoric, which may shape research funding, priorities and attention.

Future research should adopt a balanced approach, incorporating all Quadruple Aim and Health Equity domains. A learning health system model, linking data, knowledge and practice, is recommended to enable continuous improvement and resource alignment.

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