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Introduction: Research plays an important role in supporting integrated care (IC). However, IC networks may lack the capacity to leverage research. Moreover, many health system organizations (HSOs) struggle to identify and implement relevant research in a timely fashion. Embedded research is a promising strategy to align data with system priorities, increase the relevance and timeliness of evidence, and build capacity to conduct and use research. This study reviews two Canadian postdoctoral training programs that embed researchers in HSOs. We describe the programs, report on early lessons learned, and discuss implications for IC. Background: •IC is a priority in many Canadian jurisdictions. For example, Ontario Health Teams (OHTs) were introduced in 2019 to organize care in a more integrated way. •Embedded research requires different skills than traditional research. In response, new training programs have developed such as the Health System Impact Fellowship (HSIF) and the OHT Impact Fellows (OHTIF) programs. Aims: This paper describes the HSIF and OHTIF models and presents early lessons learned. Through surveys, program data, and interviews with participants, we identify key challenges and opportunities. Combined with insights from program leads, we provide an in-depth look at the design and implementation of these programs and how embedded research can support IC initiatives. Highlights: The HSIF program was launched in 2017 and has embedded more than 200 fellows in over 100 HSOs across Canada. Host organizations determine research priorities and are matched with fellows. Distinctive features include a focus on impact-oriented research, co-supervision with health system and academic leaders, professional development, protected time for academic research, and a national cohort that fosters networking and collaboration. Promising outcomes include advancement of HSO goals, increased system capacity for research, and enhanced leadership skills and early career success among fellows. The OHTIF program is modeled on HSIF and places researchers directly in OHTs where they support local projects and learning across organizations. Launched in 2021, the program saw strong demand from OHTs and trainees interested in IC research. Distinctive features include its focus on IC, intensive training activities, and ongoing mentorship for fellows. Early feedback is promising but also suggests areas for attention, including the unique needs of rural and remote regions and the multiple, often competing demands that fellows encounter. Both programs involve patients and caregivers on their advisory panels and offer training in patient engagement. Conclusions: Embedded research is a promising strategy to support IC and health system research. Data from two Canadian training programs show strong interest from HSOs keen to embed research talent within their teams, and from applicants interested in using their research skills to address real-world challenges. Early evidence also highlights the importance of matching, onboarding, and ongoing training for fellows, mentors, and host organizations to build a highperforming embedded research workforce. Implications: Our experience suggests embedded research programs provide important benefits both in augmenting the research and evidence translation capabilities of HSOs and in providing valuable training experiences for fellows, augmenting the research and evaluation skills gained in their graduate education. [ABSTRACT FROM AUTHOR]

In Canada, the average costs to treat mental illness varies greatly depending upon the type of disorder. In 2012, the total direct cost of treating psychotic disorders to the Ministry of Health in Ontario, Canada was around 2.1 billion Canadian dollars. Psychiatric hospitalizations, followed by long-term care needs, contributed to the high cost of care. As of 2017-2018 schizophrenia and psychotic disorders were costliest to treat, with an estimated average cost of 12,971 Canadian dollars per hospital stay (CIHI, 2019). Bundled care models refer to a single payment for a full scope of care, are based on timely and highest quality of care, within an integrated care pathway provided to a patient during a defined episode of care. The results are a seamless transition experience and consistency in care for patients across providers and care settings. Bundled care models have been successfully created and implemented in other acute episodes of care, however within mental health and addictions and specifically within the specialized psychiatric setting are relatively new, as defining and articulating the episode of care across the chronicity of one's lifetime has proven challenging. In this paper, we describe our experiences with designing a proof-ofconcept bundled care model for patients with schizophrenia, implementing the model in the hospital setting, measuring adherence, and calculating the accompanying financial model. The comprehensive, evidenced based care elements that comprise optimal care for those with schizophrenia (in accordance with best practices and Health Quality Ontario's Quality Standards) were mapped into a 61-day proof of concept pathway by taking into consideration - (a) daily nursing care activities (b) clinical care and treatment activities reflective of Quality Ontario's governed quality standards for schizophrenia care (i.e. access to Family Intervention Therapy [FIT] and cognitive behavior therapy for psychosis [CBTp]) and (c) identification of exceptions to care. The financial model leveraged data retrieved from the electronic health record on a sample of 142 inpatients with a diagnosis of schizophrenia and reflective of the resources required to deliver the care elements and activities. Statistical analysis were conducted to identify areas of opportunity to standardize practice and align practices in quality improvement initiatives to increase adherence to the proof-of-concept model and pathway. Initial learnings included the identification of the variable risk factors that impact complexity and care. Next steps in this work include the definition and design of risk-adjusted, personalized pathways to further refine the model and reflect personalized care. By taking into consideration the complexity factors, both from a treatment perspective and population health focus with the social determinants of health, personalized pathways can be identified to ensure timely, quality, evidence-based and efficient care during the course of admission. Work is currently underway to develop formalized partnerships across care settings (acute care, specialized mental health care and community settings) to further broaden the model and support a seamless experience across care settings. Further learnings from this work have funding model implications and will inform mental health bundled care policies to support similar mental health clinical pathways. [ABSTRACT FROM AUTHOR]

Introduction: Discussions of integrated care have ranged in focus from large-scale health system transformations, to discrete interventions intended to enhance local continuity of care. Beyond these variations in scale and focus, literature on integrated care has used a variety of conceptual frameworks to explain various activities and elements necessary to achieve integrated care. Existing frameworks have helped to advance research and practice; yet the complexity of changing practice required to achieve integrated care across the policy, organizational, and clinical levels complicates efforts to represent or implement these innovations in straightforward ways. Aims Objectives Theory or Methods: In this paper, we present a novel strategy for conceptualizing integrated care as developing through a series of milestones observable at the organizational level. Based on analysis of four integrated care organizational case studies in Canada and New Zealand, we outline how this approach to conceptualizing integrated care both resolves the tension of crossing the macro, meso, and micro levels of analysis, and generates new practical insights to guide policy and practice. Methods consist of qualitative interviews, observation, and document analysis across cases, and qualitative data were analyzed temporally to identify milestones as indicated by participants over time. Highlights or Results or Key Findings: We define a milestone as the occurrence of a salient event that is perceived by respondents to facilitate or disrupt efforts towards the development of integrated care. We synthesize these events at the organizational level, suggesting that the organizational level of analysis is the most appropriate level to represent the significance of these milestones. Our analysis identified six categories of milestone: (1) Strategic relational milestones, referring to building relationships between stakeholders. (2) Strategic process change milestones, referring to efforts to improve quality in practice. (3) Structural (intra-organizational) milestones, referring to changes in organizational structure. (4) Structural (inter-organizational) milestones, referring to changes in the legal, operational, or leadership structures that facilitate relationships between organizations. (5) Environmental milestones, referring to changes in the social or natural environment. (6) Political milestones, referring to changes in the control and allocation of resources. Conclusions: Our results generate a new conceptual framework for understanding the achievement of integrated care as occurring through a series of milestones. This approach enhances the focus on achieving integrated care "in the wild", in the actual environments in which leaders, clinicians, policymakers, patients, and caregivers work to implement integrated care. Implications for applicability/transferability sustainability and limitations: Our model emphasizes two practical points. First, that there is no single series of sequential steps that must be taken to achieve integrated care. Second, that policy efforts to support integrated care ought to encourage organizations and their collaborators to work toward milestones that facilitate the development of integrated care. [ABSTRACT FROM AUTHOR]