Integrated care for older people or people living with frailty and waiting times/lists: a mixed methods rapid review

Integrated care can be defined as the joining up of different health and/or social services to deliver care that meets individuals needs in an efficient way. There is limited clarity about the effectiveness of integrated care interventions in improving the timeliness of health and social care delivery. To address this gap, a rapid review was conducted, incorporating both quantitative and qualitative perspectives that evaluate the impact of integrated care interventions on waiting times and waiting lists. The review included studies published between 2015 and 2024. Sixty-one studies were identified out of which 30 reported integrated care interventions operating across two or more services. Studies were conducted in a number of different countries. Study population included older people (over the age of 65) with various injuries and diseases, and aged care or palliative care needs. The interventions involved integration across different services, with most covering both health and social care. All interventions were multifaceted. Weak quantitative evidence from multiple studies suggests that integrated care interventions including multidisciplinary team (MDT) working, pathways/ protocols and/or care coordination as their main element may help reduce various waiting times, for example time to admission and/or time to surgery in older people with hip fracture. Strong quantitative evidence from two studies shows that a multidisciplinary assessment for older people presenting at an emergency department (ED) for various reasons, is effective in reducing time spent in the ED. Qualitative studies mainly investigated waiting times from healthcare professionals perspectives. The findings suggest that integrated care interventions could support early assessment and diagnosis of dementia and complex chronic geriatric conditions; enable more timely symptom management and care planning in nursing homes; reduce processing time of aged care referrals in primary and community care; help streamline inpatient care for ageing associated diseases; and reduce delays for hip fracture care. One study explored older peoples and their relatives experiences and findings suggest that an ED avoidance service for older adults with urgent but non-emergency needs may help reduce emergency waiting times. There is a need for high quality research including studies i) investigating the effect of integrated care on waiting times, ii) evaluating the effectiveness of organisational integration on waiting times, iii) exploring older peoples experiences with waiting times in relation to integrated care. Policy and Practice Implications: There is some evidence that MDTs, integrated care pathways, and care coordination may improve inpatient waiting times to surgery, and emergency waiting times in an ED. Thus, initiatives supporting the development and implementation of these integrated care interventions is crucial. Funding statementThe authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government]