“We warmly welcome you to the Project INTEGRATE website. The ageing population and increased prevalence of chronic diseases require a strong re-orientation away from the current emphasis on acute care in hospitals towards prevention, self-care, more consistent standards of primary care, and care that is well coordinated and integrated.
However, as we start shifting care from a monolithic hospital-based perspective to a more transversal integrated care approach, the resulting picture becomes increasingly blurred. Integrated care services are complex interventions. They are the result of many components, of multi-faceted interactions, a great variety of participating groups and individuals, with diverse and variable outcomes.
Project INTEGRATE will attempt to influence all of these different levels by promoting learning, developing guidance, and sharing ideas to support the adoption and successful application of integrated care“.
On behalf of the Project INTEGRATE Consortium
Project INTEGRATE aims to gain valuable insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term chronic conditions.
This project has already examined four case studies of best practices of integrated care in Europe, in the areas of COPD, Mental Health, Geriatric Conditions and Diabetes, that have had a proven impact in terms of improving patient experiences, generating better care outcomes and providing cost-effectiveness. The key aim of this part of the research was to define what constitutes good quality integrated care provision, and how integrated care systems can most effectively be built. In Phase 2 of the research, the project considered the cross-cutting themes process design, service delivery, skill mix, patient involvement, financial flows, regulatory conditions, and enabling information technologies in order to create connectivity, alignment and collaboration within and between the cure and care sectors.
In the final phase of work, Project INTEGRATE will provide managerial and policy recommendations, based on evidence from successful integrated care experiences examined in the early phases and evidence from international best practice. These recommendations will impact on the development of national and European policy development and practice.
Project INTEGRATE’s overall aim is achieved through 5 strategic objectives:
1. Gaining in-depth knowledge of how integrated care can be developed and delivered successfully through in-depth case studies and literature review analysis across four prevalent age-related conditions (diabetes, COPD, geriatric conditions and mental health). By investigating each case study from participating partners in different European countries, the purpose will be to examine how systems and organisations have implemented integrated care practices successfully in different national and local contexts.
2. Identifying success-promoting and hindering factors of integrated care. The case studies will seek to uncover information about the intrinsic characteristics of a successful integrated care strategy but they will also examine how strategies have varied according to the context in which they developed. Understanding these dependencies is vital to be able to transfer effective practice between care settings.
3. On the basis of the evidence obtained through the case studies, the project will generate specific knowledge on several key aspects important to the success of integrated care including: patient involvement, delivery models for care co-ordination, professional skills mix and HR management, information technology, financial flows, and regulatory issues. The findings will be contrasted with both European and international evidence.
4. The knowledge generated by will in particular seek to examine the management and leadership strategies that have been used to promote integrated care. The study will seek to produce practical recommendations, including a toolkit containing operational, managerial and leadership strategies.
5. The project will also formulate policy and managerial recommendations for fostering integrated care at regional, national and European levels.
The consortium activities are coordinated by IESE and guided by an Advisory Board. The Advisory Board (AB) assemble external experts from science, politics, international organisations, civil society representatives and other relevant stakeholders. It represents a bridge between different sectors, complement the collaboration in the context of other project activities and also guide the consortium activities by providing relevant thematic input and ideas, and sensitising the consortium members for cross-cutting issues.
The Advisory Board’s role includes:
- External monitoring and review of the project’s progress;
- Ensuring transparency and optimising the linkage between research and practice;
- Providing relevant thematic input and sensitising partners for cross-cutting issues;
- Giving advice with respect to strategic decisions;
- Facilitating contacts to academic, policy and civil society networks; where useful;
- Support the dissemination of results.
Members of the Advisory Board are:
- Richard Bohmer, Harvard Business School, USA
- Angela Coulter, University of Oxford, Foundation for Informed Medical Decision Making, The King’s Fund, UK
- Josep Maria Argimon, Director, Dept for Purchasing and Evaluation of Health Care, Catsalut, Spain
- Dennis L. Kodner, PhD, FGSA, International Visiting Fellow, USA
- Nick Fahy, Consulting – European Health Policy Expert, UK
- Tracey Cooper, Chief Executive, Health Information & Quality Authority, IE
- Hannele Hyppönen, Research Manager at National Institute for Health and Welfare, Finland
- Maria Iglesias Gomez, European Commission DG Sanco, EU
- Michael Rigby, Professor, Keele University, UK
- Stefan Gress, University Fulda, Germany
- Ed Wagner, Seattle University, USA
- Runo Axelsson, Professor, Sahlgrenska Academy, University of Gothenburg, Sweden
- Hernan Montenegro, Health Systems Adviser, WHO, Switzerland
Phase 1: The Case Studies: Integrated Care Experiences for Particular Conditions
The purpose of the four case studies is to provide an in-depth and analytical appraisal of the process of integration of care. Each written account asseses how and why the particular approaches to integrated care were established and seek to uncover the mechanisms triggered by certain interventions in certain contexts The chosen case studies provide a wealth of material and information on the current nature of integrated care across different conditions and different health systems.
We have purposefully chosen case studies from different countries and settings in order to draw meaningful insights and conclusions that can be transferable. To support this, two case studies are based on disease pathways (COPD and diabetes) and two case studies are based on more complex care coordination (geriatric care and mental health) were selected across four different countries with two different types of health systems: Spain/Sweden (Beveridge/national health system) and Germany/Netherlands (Bismarck/insurance mixed systems). The hypothesis in this selection of case studies is that each will have needed to develop a different approach to achieve success, but that common elements exist in their design and delivery that promote transferable lessons. This case study methodology will therefore allow the study to examine key success factors (KSF).View Case Studies
Phase 2: The Process of Integration: Examination of Key Influencing Factors
Building on the case studies, in Phase 2 the project will look into a set of ‘horizontal’ issues, as they emerge from the cases, check for transferability of best practice lessons and then formulate operational and policy recommendations.
1. Service design and delivery: The characteristics of the services to be provided are strongly dependent on the user health needs that are being supported. However, the process of diagnosis, treatment and follow-up can be resolved in many different formats that depend on other aspects (such as the settings where care is provided, the tools available, etc.). What is more, service can be understood in a wider sense to include aspects such as promotion of well-being, social care, rehabilitation, socialisation, etc; resulting in even further complexity.
2. Mix of professional skills: Integrated care typically relies on a number of different professionals working together with a variety of competencies and skills. One of the most significant aspects is the need to better understand what characterises effective coordination of work practices across such a variety of professionals and across different institutions.
3. Involvement of patients and carers: Patients (and their families) are becoming health consumers that want to be active participants in the management of their own health. This implies the right of choice and decision-making and this influences the characteristics of the services to be provided and must be properly understood. Continuity of care, and the relationship between patient and professional, is intrinsic to supporting patient-centred integrated care.
4. Funding mechanisms: The funding mechanisms that can best support integrated care services are poorly defined and we know from the literature that they are under-resourced. More often, financial flows and incentives tend to be fragmented which act as significant barriers to service integration. The research will look at the role that funding mechanisms play as limiting or promoting factors and how they should be set up and managed in order to act as incentives for the adoption of integrated care.
5. The role of IT in integrated care: The effective use of IT to support communication of patient data and connect professionals together is often seen as one of the cornerstones for making integrated care possible. However, many professionals fail to see the validity of such claims and argue that effective care co-ordination does not necessarily require sophisticated IT investment.View Cross Cutting Themes
Phase 3: International Check: Establishing Practical Lessons in Design, Delivery, Management and Policy-making
Results will be contrasted with international evidence and lead to the development of a set of managerial tools of integrated care, with a look at how these can be best deployed. At the macro level, the evidence generated will be translated into suggestions for improving regional, national and European policies in order to foster and facilitate integrated care. By looking at how integrated care was effectively built within each of the case studies, lessons will be drawn to support managers and leaders understand how best to facilitate and drive integrated care forward and the potentially different skill sets that may be required of managers when negotiating change across networks of professionals and providers. Such learning will be translated into much needed practical support and guidance to those who are tasked with making integrated care happen. A final element to the work will be to establish what policy makers in Europe can do to best support the successful implementation of integrated care that helps them meet the current and future demands being placed upon their care systems. Such recommendations will seek to understand what the key features of an enabling policy framework look like and how this can contribute to providing a more effective platform to support integrated care in practice.View Practical Lessons