Humphries R. Integrated health and social care in England—Progress and prospects. Health Policy. 2015; 119(7): 856–9. DOI: //doi.org/10.1016/j.healthpol.2015.04.010
Ahgren B, Axelsson R. A decade of integration and collaboration: the development of integrated health care in Sweden 2000–2010. Int J Integr Care. 2011; 11 Spec Ed: e007. DOI: //doi.org/10.5334/ijic.566
Fortin M, Chouinard MC, Bouhali T, Dubois MF, Gagnon C, Belanger M. Evaluating the integration of chronic disease prevention and management services into primary health care. BMC Health Serv Res. 2013; 13: 132. DOI: //doi.org/10.1186/1472-6963-13-132
Oude Wesselink SF, Lingsma HF, Ketelaars CA, Mackenbach JP, Robben PB. Effects of Government Supervision on Quality of Integrated Diabetes Care: A Cluster Randomized Controlled Trial. Med Care. 2015; 53(9): 784–91. DOI: //doi.org/10.1097/MLR.0000000000000399
Barnett K, Mercer S, Norbury M, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet. 2012; 380(9836): 37–43. DOI: //doi.org/10.1016/S0140-6736(12)60240-2
World Health Organization. Global status report on noncommunicable diseases. Switzerland: WHO; 2014. [cited 2019 Dec 12]. Available from: //apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf;jsessionid=6C2829D82B05D70BAA05D9812A4CB41A?sequence=1.
van der Wees PJ, Wammes JJ, Westert GP, Jeurissen PP. The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries. International Journal of Health Policy and Management. 2015; Sep 12; 5(1): 13–22. DOI: //doi.org/10.15171/ijhpm.2015.166
Verma A, Bhatia S. A Policy Framework for Health Systems to Promote Triple Aim Innovation. Healthcare Papers. 2016; 15(3): 9–23.
Mastellos N, Gunn L, Harris M, Majeed A, Car J, Pappas Y. Assessing patients’ experience of integrated care: a survey of patient views in the North West London Integrated Care Pilot. International Journal of Integrated Care. 2014; 14: e015. DOI: //doi.org/10.5334/ijic.1453
World Health Organization. Integrated care models: an overview. Copenhagen, Denmark: WHO Regional Office for Europe. 2016 Oct. [cited 2019 Dec 12]. Available from: //www.euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf.
Foskett-Tharby RC. Coordination of Primary Health Care. [dissertation]. UK: University of Manchester; 2014. [cited 2019 Dec 14]. Available from: //www.research.manchester.ac.uk/portal/files/54556781/FULL_TEXT.PDF.
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press (US); 2011. Available from: //www.ncbi.nlm.nih.gov/books/NBK209880/.
Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. Annals of Family Medicine. 2014; 12(2): 166–71. DOI: //doi.org/10.1370/afm.1616
Kuluski K, Ho JW, Hans PK, Nelson M. Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care. International Journal of Integrated Care. 2017; 17(4): 2. DOI: //doi.org/10.5334/ijic.2944
European Observatory on Health Systems and Policies Series. Primary care in the driver’s seat? Organizational reform in European primary care; 2006. [cited 2019 Dec 13]. Available from: //www.euro.who.int/data/assets/pdf_file/0006/98421/E87932.pdf.
Ehrlich C, Kendall E, Muenchberger H, Armstrong K. Coordinated care: what does that really mean? Health and Social Care in the Community. 2009; 17(6): 619–27. DOI: //doi.org/10.1111/j.1365-2524.2009.00863.x
McDonald KM, Schultz E, Albin L, Pineda N, Lonhart J, Sundaram V, Smith-Spangler C, Brustrom J, Malcolm E. Care Coordination Atlas Version 3 (Prepared by Stanford University under subcontract to Battelle on Contract No. 290-04-0020). AHRQ Publication No. 11-0023-EF. Rockville, MD: Agency for Healthcare Research and Quality. November 2010. [cited 2020 Jan 14]. Available from: //pcmh.ahrq.gov/sites/default/files/attachments/Care%20Coordination%20Measures%20Atlas.pdf.
McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination). Rockville, MD: Agency for Healthcare Research and Quality (US); 2007 Jun. (Technical Reviews, No. 9.7.). [cited 2020 Jan 14]. Available from: //www.ncbi.nlm.nih.gov/books/NBK44015/.
Ross S, Curry N, Goodwin N. Case management what it is and how it can be best implemented. UK: The King’s Fund; 2011. [cited 2020, Sept 29]. Available from: //www.kingsfund.org.uk/sites/default/files/Case-Management-paper-The-Kings-Fund-Paper-November-2011_0.pdf.
Valaitis RK, Carter N, Lam A, Nicholl J, Feather J, Cleghorn L. Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review. BMC Health Services Research. 2017; 17(1): 116. DOI: //doi.org/10.1186/s12913-017-2046-1
Ontario Primary Care Council. Position statement: care coordination in primary care. Ontario; November 2015. [cited 2020, Sept 29]. Available from: //www.afhto.ca/wp-content/uploads/OPCC_Care-Coordination-Position.pdf.
Joo JY, Liu MF. Effectiveness of Nurse-Led Case Management in Cancer Care: Systematic Review. Clinical Nursing Research. 2019; 28(8): 968–91. DOI: //doi.org/10.1177/1054773818773285
Lyon D, Miller J, Pine K. The Castlefields Integrated Care Model: The Evidence Summarised. Journal of Integrated Care. 2006; 14(1): 7–12. DOI: //doi.org/10.1108/14769018200600003
Goodwin JS, Satish S, Anderson ET, Nattinger AB, Freeman JL. Effect of nurse case management on the treatment of older women with breast cancer. Journal of the American Geriatrics Society. 2003; 51(9): 1252–9. DOI: //doi.org/10.1046/j.1532-5415.2003.51409.x
Atherly A, Thorpe KE. Analysis of the treatment effect of Healthways’ Medicare Health Support Phase 1 Pilot on Medicare costs. Population Health Management. 2011; 14(Suppl 1): S23–8. DOI: //doi.org/10.1089/pop.2010.0059
Marek KD, Adams SJ, Stetzer F, Popejoy L, Rantz M. The relationship of community-based nurse care coordination to costs in the Medicare and Medicaid programs. Research in Nursing & Health. 2010; 33(3): 235–42. DOI: //doi.org/10.1002/nur.20378
Rantz MJ, Phillips L, Aud M, Popejoy L, Marek KD, Hicks LL, et al. Evaluation of aging in place model with home care services and registered nurse care coordination in senior housing. Nursing Outlook. 2011; 59(1): 37–46. DOI: //doi.org/10.1016/j.outlook.2010.08.004
Laughlin CB, Beisel M. Evolution of the chronic care role of the registered nurse in primary care. Nursing Economics. 2010; 28(6): 409–14.
Coleman EA, Parry C, Chalmers S, Min S. The Care Transitions Intervention: Results of a Randomized Controlled Trial. Archives of Internal Medicine. 2006; 166(17): 1822–8. DOI: //doi.org/10.1001/archinte.166.17.1822
Egan E, Clavarino A, Burridge L, Teuwen M, White E. A randomized control trial of nursing-based case management for patients with chronic obstructive pulmonary disease. Lippincott’s Case Management: managing the process of patient care. 2002; 7(5): 170–9. DOI: //doi.org/10.1097/00129234-200209000-00002S
Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The Importance Of Transitional Care In Achieving Health Reform. Health Affairs. 2011; 30(4): 746–54. DOI: //doi.org/10.1377/hlthaff.2011.0041
Boyd CM, Boult C, Shadmi E, Leff B, Brager R, Dunbar L, et al. Guided care for multimorbid older adults. Gerontologist. 2007; 47(5): 697–704. DOI: //doi.org/10.1093/geront/47.5.697geront/47.5.697
Coburn KD, Marcantonio S, Lazansky R, Keller M, Davis N. Effect of a community-based nursing intervention on mortality in chronically ill older adults: A randomized controlled trial. PLoS Medicine. 2012; 9(7). DOI: //doi.org/10.1371/journal.pmed.1001265
Hudon C, Chouinard MC, Dubois MF, Roberge P, Loignon C, Tchouaket E, et al. Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study. Annals of Family Medicine. 2018; 16(3): 232–9. DOI: //doi.org/10.1370/afm.2233
American Nurses Association. Position statements: Care Coordination and Registered Nurses’ Essential Role. Jun 2012. [cited 2020 Jan 14]. Available from: //www.nursingworld.org/~4afbf2/globalassets/practiceandpolicy/health-policy/cnpe-care-coord-position-statement-final--draft-6-12-2012.pdf.
Agency for Healthcare Research and Quality. Chapter 3. Care Coordination Measurement Framework. Content last reviewed June 2014. Rockville, MD: Agency for Healthcare Research and Quality. [cited 2020 Sept 14]. Available from: //www.ahrq.gov/ncepcr/care/coordination/atlas/chapter3.html.
American Nurses Association. Framework for measuring Nurses’ Contributions to Care Coordination. Oct 2013. [cited 2020 Jan 14]. Available from: //www.nursingworld.org/~4afbd6/globalassets/practiceandpolicy/health-policy/framework-for-measuring-nurses-contributions-to-care-coordination.pdf.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005; 8(1). DOI: //doi.org/10.1080/1364557032000119616
Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implementation Science. 2010; 5: 69. DOI: //doi.org/10.1186/1748-5908-5-69
Garcia ME, Uratsu CS, Sandoval-Perry J, Grant RW. Which Complex Patients Should Be Referred for Intensive Care Management? A Mixed-Methods Analysis. Journal of General Internal Medicine. 2018; 33(9): 1454–60. DOI: //doi.org/10.1007/s11606-018-4488-5
Fereday J, Muir-Cochrane E. Demonstrating Rigor Using Thematic Analysis: A Hybrid Approach of Inductive and Deductive Coding and Theme Development. International Journal of Qualitative Methods. 2006; 5(1): 80–92. DOI: //doi.org/10.1177/160940690600500107
Grembowski D, Schaefer J, Johnson KE, Fischer H, Moore SL, Tai-Seale M, et al. A conceptual model of the role of complexity in the care of patients with multiple chronic conditions. Medical Care. 2014; 52(Suppl 3): S7–s14. DOI: //doi.org/10.1097/MLR.0000000000000045
Aragonès E, Lluís Piñol J, Caballero A, López-Cortacans G, Casaus P, Maria Hernández J, et al. Effectiveness of a multi-component programme for managing depression in primary care: A cluster randomized trial. The INDI project. Journal of Affective Disorders. 2012; 142(1–3): 297–305. DOI: //doi.org/10.1016/j.jad.2012.05.020
Berra K, Ma J, Klieman L, Hyde S, Monti V, Guardado A, et al. Implementing cardiac risk-factor case management: Lessons learned in a county health system. Critical Pathways in Cardiology. 2007; 6(4): 173–9. DOI: //doi.org/10.1097/HPC.0b013e31815b5609
Gabbay RA, Anel-Tiangco RM, Dellasega C, Mauger DT, Adelman A, Van Horn DH. Diabetes nurse case management and motivational interviewing for change (DYNAMIC): results of a 2-year randomized controlled pragmatic trial. Journal of Diabetes. 2013; 5(3): 349–57. DOI: //doi.org/10.1111/1753-0407.12030
Hudon C, Chouinard MC, Diadiou F, Lambert M, Bouliane D. Case management in primary care for frequent users of health care services with chronic diseases: A qualitative study of patient and family experience. Annals of Family Medicine. 2015; 13(6): 523–8. DOI: //doi.org/10.1370/afm.1867
Jansen APD, van Hout HPJ, Nijpels G, Rijmen F, Dröes RM, Pot AM, et al. Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: A randomized clinical trial. International Journal of Nursing Studies. 2011; 48(8): 933–43. DOI: //doi.org/10.1016/j.ijnurstu.2011.02.004
Newcomer R, Maravilla V, Faculjak P, Graves MT. Outcomes of preventive case management among high-risk elderly in three medical groups: A randomized clinical trial. Evaluation and the Health Professions. 2004; 27(4): 323–48. DOI: //doi.org/10.1177/0163278704270011
Ruikes FGH, Zuidema SU, Akkermans RP, Assendelft WJJ, Schers HJ, Koopmans RTCM. Multicomponent program to reduce functional decline in frail elderly people: A cluster controlled trial. Journal of the American Board of Family Medicine. 2016; 29(2): 209–17. DOI: //doi.org/10.3122/jabfm.2016.02.150214
Schraeder C, Fraser CW, Clark I, Long B, Shelton P, Waldschmidt V, et al. Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people. Journal of Clinical Nursing. 2008; 17(11C): 407–17. DOI: //doi.org/10.1111/j.1365-2702.2008.02578.x
Metzelthin SF, Daniels R, Rossum Ev, Cox K, Habets H, de Witte LP, et al. A nurse-led interdisciplinary primary care approach to prevent disability among community-dwelling frail older people: A large-scale process evaluation. International Journal of Nursing Studies. 2013; 50(9): 1184–96. DOI: //doi.org/10.1016/j.ijnurstu.2012.12.016
Ekers D, Wilson R. Depression case management by practice nurses in primary care: an audit. Mental Health in Family Medicine. 2008; 5(2): 111–9.
Katon W, Russo J, Lin EHB, Schmittdiel J, Ciechanowski P, Ludman E, et al. Cost-effectiveness of a multicondition collaborative care intervention. Archives of General Psychiatry. 2012; 69(5): 506–14. DOI: //doi.org/10.1001/archgenpsychiatry.2011.1548
Trehearne B, Fishman P, Lin EHB. Role of the Nurse in Chronic Illness Management: Making The Medical Home More Effective. Nursing Economics. 2014; 32(4): 178–84.
Mastal MF, Reardon ME, English M. Innovations in disability care coordination organizations: integrating primary care and behavioral health clinical systems. Professional Case Management. 2007; 12(1): 27–36. DOI: //doi.org/10.1097/01269241-200701000-00007
Roth CP, Ganz DA, Nickels L, Martin D, Beckman R, Wenger NS. Nurse care manager contribution to quality of care in a dual-eligible special needs plan. Journal of Gerontological Nursing. 2012; 38(7): 44–54. DOI: //doi.org/10.3928/00989134-20120606-10
Thyrian JR, Hertel J, Wucherer D, Eichler T, Michalowsky B, Dreier-Wolfgramm A, et al. Effectiveness and safety of dementia care management in primary care: A randomized clinical trial. JAMA Psychiatry. 2017; 74(10): 996–1004. DOI: //doi.org/10.1001/jamapsychiatry.2017.2124
Unützer J, Hantke M, Powers D, Higa L, Lin E, Vannoy SD, et al. Care management for depression and osteoarthritis pain in older primary care patients: a pilot study. International Journal of Geriatric Psychiatry. 2008; 23(11): 1166–71. DOI: //doi.org/10.1002/gps.2048
Friedman B, Wamsley BR, Liebel DV, Saad ZB, Eggert GM. Patient satisfaction, empowerment, and health and disability status effects of a disease management-health promotion nurse intervention among medicare beneficiaries with disabilities. Gerontologist. 2009; 49(6): 778–92. DOI: //doi.org/10.1093/geront/gnp090
Meng H, Friedman B, Dick AW, Liebel D, Wamsley BR, Eggert GM, et al. Impact of a disease management-health promotion nurse intervention on personal assistance use and expenditures. Home Health Care Services Quarterly. 2009; 28(4): 113–29. DOI: //doi.org/10.1080/01621420903579669
Yuille L, Bryant-Lukosius D, Valaitis R, Dolovich L. Optimizing Registered Nurse Roles in the Delivery of Cancer Survivorship Care within Primary Care Settings. Nursing Leadership (Tor Ont). 2016; 29(4): 46–58. DOI: //doi.org/10.12927/cjnl.2016.24984
Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. Journal of General Internal Medicine. 2008; 23(5): 536–42. DOI: //doi.org/10.1007/s11606-008-0529-9
Boult C, Reider L, Frey K, Leff B, Boyd CM, Wolff JL, et al. Early effects of “Guided Care” on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2008; 63(3): 321–7. DOI: //doi.org/10.1093/gerona/63.3.321
Boult C, Reider L, Leff B, Frick KD, Boyd CM, Wolff JL, et al. The effect of guided care teams on the use of health services: Results from a cluster-randomized controlled trial. Archives of Internal Medicine. 2011; 171(5): 460–6. DOI: //doi.org/10.1001/archinternmed.2010.540
Boult C, Leff B, Boyd CM, Wolff JL, Marsteller JA, Frick KD, et al. A matched-pair cluster-randomized trial of guided care for high-risk older patients. Journal of General Internal Medicine. 2013; 28(5): 612–21. DOI: //doi.org/10.1007/s11606-012-2287-y
McNab J, Gillespie JA. Bridging the chronic care gap: Healthone Mt Druitt, Australia. International Journal of Integrated Care. 2015; e015. DOI: //doi.org/10.5334/ijic.2243
McNab J, Paterson J, Fernyhough J, Hughes R. Role of the GP liaison nurse in a community health program to improve integration and coordination of services for the chronically ill. Australian Journal of Primary Health. 2016; 22(2): 123–7. DOI: //doi.org/10.1071/PY14089
Van Leeuwen KM, Bosmans JE, Jansen APD, Hoogendijk EO, Muntinga ME, Van Hout HPJ, et al. Cost-Effectiveness of a Chronic Care Model for Frail Older Adults in Primary Care: Economic Evaluation Alongside a Stepped-Wedge Cluster-Randomized Trial. Journal of the American Geriatrics Society. 2015; 63(12): 2494–504. DOI: //doi.org/10.1111/jgs.13834
Scrymgeour G, Forrest R, Marshall B. Implementing a continuity of cancer care nursing role into a New Zealand primary health organisation-The patient’s perspective. Journal of Primary Health Care. 2013; 5(4): 322–9. DOI: //doi.org/10.1071/HC13322
Spencer E. Management and Support of Uninsured Patients with Diabetes Type II within a Nurse Managed Clinic [dissertation]. Ann Arbor: University of Missouri - Saint Louis. 2019. [cited 2019 Dec 14]. Available from: //irl.umsl.edu/dissertation/858/.
Suijker JJ, Van Rijn M, Buurman BM, Riet GT, Van Moll Charante EP, De Rooij SE. Effects of nurse-led multifactorial care to prevent disability in community-living older people: Cluster randomized trial. PLoS ONE. 2016; 11(7). DOI: //doi.org/10.1371/journal.pone.0158714
Bleijenberg N, Drubbel I, Schuurmans MJ, Dam HT, Zuithoff NPA, Numans ME, et al. Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial. Journal of the American Geriatrics Society. 2016; 64(9): 1779–88. DOI: //doi.org/10.1111/jgs.14325
Bleijenberg N, ten Dam VH, Drubbel I, Numans ME, de Wit NJ, Schuurmans MJ. Development of a proactive care program (U-CARE) to preserve physical functioning of frail older people in primary care. Journal of Nursing Scholarship. 2013; 45(3): 230–7. DOI: //doi.org/10.1111/jnu.12023
Mastal MF, Reardon ME. Innovations in disability care coordination organizations: integrating primary care and behavioral health clinical systems. Professional Case Management. 2007; 12(1): 27–36. DOI: //doi.org/10.1097/01269241-200701000-00007
Graffigna G, Barello S, Bonanomi A. The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model. PLoS ONE. 2017; 12(6): e0179865. DOI: //doi.org/10.1371/journal.pone.0179865
Finset A. Patient Participation, Engagement and Activation: Increased emphasis on the role of patients in healthcare. Patient Education and Counseling. 2017; 100(7): 1245–6. DOI: //doi.org/10.1016/j.pec.2017.05.011
Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Services Research. 2004; 39(4 Pt 1): 1005–26. DOI: //doi.org/10.1111/j.1475-6773.2004.00269.x
Popejoy LL, Jaddoo J, Sherman J, Howk C, Nguyen R, Parker JC. Monitoring resource utilization in a health care coordination program. Professional Case Management. 2015; 20(6): 310–20. DOI: //doi.org/10.1097/NCM.0000000000000120
Busetto L, Luijkx K, Vrijhoef HJM. Development of the COMIC Model for the comprehensive evaluation of integrated care interventions. International Journal of Care Coordination. 2016; 19(1–2): 47–58. DOI: //doi.org/10.1177/2053434516661700
Gonzalez-Ortiz LG, Calciolari S, Goodwin N, Stein V. The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care. International Journal of Integrated Care. 2018; 18(3): 10. DOI: //doi.org/10.5334/ijic.4198
Goodman C, Drennan V, Davies S, Masey H, Gage H, Scott C, Manthorpe J, Brearley S, Iliffe S. 2010. Nurses as Case Managers in Primary Care: The contribution to chronic disease management. Report for the National Institute for Health Research Service Delivery and Organisation programme. NIHR SDO website. [cited 2020 Sept 24]. Available from: www.sdo.nihr.ac.uk/projdetails.php?ref=08-1605-122.
Leutz WN. Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. The Milbank Quarterly. 1999; 77(1): 77–110, iv–v. DOI: //doi.org/10.1111/1468-0009.00125
Kodner DL, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care. 2002; 2: e12. DOI: //doi.org/10.5334/ijic.67
Carter N, Valaitis RK, Lam A, Feather J, Nicholl J, Cleghorn L. Navigation delivery models and roles of navigators in primary care: a scoping literature review. BMC Health Services Research. 2018; 18(1): 96. DOI: //doi.org/10.1186/s12913-018-2889-0
Kelly KJ, Doucet S, Luke A. Exploring the roles, functions, and background of patient navigators and case managers: A scoping review. International Journal of Nursing Studies. 2019; 98: 27–47. DOI: //doi.org/10.1016/j.ijnurstu.2019.05.016
Lukewich J, Taylor S, Poitras ME, Martin-Misener R. Advancing Family Practice Nursing in Canada: An Environmental Scan of International Literature and National Efforts towards Competency Development. Nursing Leadership (Toronto, Ont). 2018; 31(2): 66–78. DOI: //doi.org/10.12927/cjnl.2018.25602
Schraeder C, Shelton P. Effective care coordination models. In Lamb G (eds.), Care coordination: the game changer. How nursing is revolutionizing quality care. Silver Spring, Maryland: American Nurses Association. 2014; 57–79.
Brown RS, Ghosh A, Schraeder C, Shelton P. Promising practices in acute/primary care. In Shraeder C, Shelton P (eds.), Comprehensive care coordination for chronically ill adults. West Sussex: UK: John Wiley & Sons. 2011; 39–64. DOI: //doi.org/10.1002/9781118785775.ch3
Wodchis WP, Dixon A, Anderson GM, Goodwin N. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis. International Journal of Integrated Care. 2015; 15: e021. DOI: //doi.org/10.5334/ijic.2249
Gray DP, Evans P, Sweeney K, Lings P, Seamark D, Seamark C, et al. Towards a theory of continuity of care. Journal of the Royal Society of Medicine. 2003; 96(4): 160–6. DOI: //doi.org/10.1258/jrsm.96.4.160
Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Annals of Family Medicine. 2005; 3(2): 159–66. DOI: //doi.org/10.1370/afm.285
Morales-Asencio JM, Gonzalo-Jiménez E, Martin-Santos FJ, Morilla-Herrera JC, Celdráan-Mãas M, Carrasco AM, et al. Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study. BMC Health Services Research. 2008; 8. DOI: //doi.org/10.1186/1472-6963-8-193
Given BA, Given CW, Sherwood P. Chapter 26 – Caregiver Burden. In: Management of Cancer in the Older Patient. Philadelphia: W.B. Saunders. 2012; 241–8. DOI: //doi.org/10.1016/B978-1-4377-1398-5.10026-8
Izumi S, Barfield PA, Basin B, Mood L, Neunzert C, Tadesse R, et al. Care coordination: Identifying and connecting the most appropriate care to the patients. Research in Nursing and Health. 2018; 41(1): 49–56. DOI: //doi.org/10.1002/nur.21843