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Table 4 Statements by experts of international Delphi study 2 on initial descriptions of domains of taxonomy, highlighting main comments and final descriptions

From: Towards an international taxonomy of integrated primary care: a Delphi consensus approach

Initial domains and descriptions# Main comments Adjusted descriptions
1. Clinical integration: The coordination of person-focused care in a single process across time, place and discipline. • Add that integration is needed for a complex (multi-problem) at stake 1. Clinical or service integration: Coordination of person-focused care for a complex need at stake in a single process across time, place and discipline.
• Clinical is too strict for the health and social aspects of health (service delivery)
2. Professional integration: Inter-professional partnerships based on shared competences, roles, responsibilities and accountability to deliver a comprehensive continuum of care to a defined population. • Add shared understanding among professional groups, since this is of crucial importance for professional integration 2. Professional integration: Inter-professional partnerships based on a shared understanding of competences, roles, responsibilities and accountability to deliver a comprehensive continuum of care to a well-described population.
• Rephrase defined into well-described population
3. Organisational integration: Inter-organisational relationships (e.g. contracting, strategic alliances, knowledge networks, mergers), including common governance mechanisms, to deliver comprehensive services to a defined population. • Use the structure of the description of professional integration to describe organisational integration 3. Organisational integration: Inter-organisational partnerships (e.g. agreements, contracting, strategic alliances, knowledge networks, mergers) based on collaborative accountability and shared governance mechanisms, to deliver a comprehensive continuum of care to a well-described population.
• The word integration is problematic, as it is the end of the continuum
• Add collaborative accountability, since this is essential for organisational integration
• Rephrase “well defined” as “well-described”
4. System integration: A horizontal and vertical integrated system, based on a coherent set of (informal and formal) rules and policies between care providers and external stakeholders for the benefit of people and populations. • Remove horizontal and vertical integration because it does not clearly describe and is too complex to understand 4. System integration: Coherent set of (informal and formal) political arrangements to facilitate professionals and organisations to deliver a comprehensive continuum of care for the benefit of people and populations.
• Generally it is difficult to differentiate between organisational and system integration
• Add the political influence in the description, since that is the essence of system integration
• Also add that system integration has to facilitate the other integration mechanisms such as organisational and professional integration
5. Functional integration: Key support functions and activities (i.e. financial, management and information systems) structured around the primary process of service delivery, to coordinate and support accountability and decision making between organisations and professionals to add overall value to the system. • Add that functional integration is the technical enabler for integrated (primary) care 5. Functional integration: Supporting communication mechanisms and tools (i.e. financial, management and information systems) structured around the primary process of service delivery, to provide optimal information as a feedback mechanism for decision support between organisations, professional groups and individuals.
• Add that communication and feedback mechanism is aimed at facilitating decision making
6. Normative integration: The development and maintenance of a common frame of reference (i.e. shared mission, vision, values and culture) between organisations, professional groups and individuals. • Add that normative integration is the cultural enabler for integrated (primary) care 6. Normative integration: Mutually respected cultural frame of reference (i.e. shared mission, vision, values and behaviour) between organisations, professional groups and individuals to achieve shared goals towards person-focused and population based care.
• Add mutual respect of cultural frame of references
• Add that the shared goals should be aimed integrated primary care guiding principles: person-focused and population-based care
7. Person-focused and population based care: Based on the needs and health characteristics of people and populations care is coordinated across professionals, organisations and support systems. • Distinguish between the person-focused and population-based domain within the final taxonomy 7. Person-focused and population based care: Based on the needs of people and populations, care is coordinated across professionals, organisations and support systems in order to achieve the triple aim (improving individual experience of care, the health of the population and reducing the costs per capita)
• Add that the added value is achieving the Triple Aim together
  1. # Initial domains and descriptions are partially adapted from Valentijn et al. [3], and adjusted descriptions are based on the comments from the expert panel of international Delphi study 2