International Lessons


International Lessons

  • In the specialized literature, managers and policy-makers can find, on the one hand, several frameworks/models (Chronic Care Model, Rainbow Model, Bellagio Model, etc.) identifying the main critical factors of care integration and, on the other hand, several in depth case studies analyzing experiences of care integration. This is an important, valuable source of information for current and future experiences. However, several authors emphasize the context-dependent nature of integrated care initiatives and the lessons from experience highlight significant difficulties across Europe in moving from the pilot phases of integrated care projects that are often limited to specific geographical localities or which fail to progress effectively as the key components in building integrated care systems are overlooked.

    An important aspiration of the research consist of explaining the main causes of the observed variation in the international experiences. It is a complex task that requires building on existing knowledge and looking for pragmatic, evidence-based approaches. The work package on International Check builds on the results of the previous two phases of Project Integrate and the extant literature: (a) to develop and validate synthetic framework enabling standardized descriptions of care integration initiatives conducted in different contexts/settings; (b) to identify contextual variables, network/organizational level factors, and eventual complementarities/discrepancies between them that influence the progress of integrate care initiatives.

  • The study consist of four phases:
    1. Comprehensive literature review;
    2. Development and validation of a data collection tool;
    3. Data collection, based on the validated framework and a purposive sample of cases;
    4. Organizational raids on the case sites of Project Integrate’s first phase.

    First, the literature review aims to identify the main factors – at the macro, mess and micro level – influencing care integration development and success. This step is intended to capitalize on the current assets available in the extant literature.

    Second, the identified factors will be classified, selected and validated (with authoritative, external experts) in order to define a synthetic framework. This will take the form of a data collection tool enabling standardized, evidence-based, relevant descriptions of cases/initiatives, suitable for insightful comparisons.

    Third, based on the evidence from earlier phases in Project Integrate, 16 cases will be purposively sampled to allow controlled comparisons of experiences implemented in different contexts and settings across Europe. This will allow to test predefined hypotheses and refine/improve the data collection tool as a pragmatic, evidence-based diagnostic tool.

    Finally, the case sites involved in the first phase of the project will play a major role in “road-testing” the results based on the experience and in-depth knowledge of professionals involved in important, well-known care integration initiatives.

  • We expect to identify few, relevant aspects that might help policy-makers to either develop environments promoting/facilitating care integration or directly support care integration. In addition we hope to enable managers to identify and operationalize the aspects more relevant for conducting self-assessmen

  • The framework and the associated tool is expected to become a standard for international, cross-comparative analyses, thus fostering evidence-based accumulation of knowledge in this policy relevant field. Of key added value through our work will be the potential to determine the impact of key contextual differences (for example, related to the way care is financed or organized, or to the nature of the user-groups in receipt of integrated services). This is potentially important since we know that ‘no one size fits all’ in integrated care and that the characteristics of local contexts play a hugely significant part in its development. Any corroborated hypothesis might help decision-makers to focus on those aspects that require more emphasis rather than others. In addition, the tool itself might support, in a user-friendly way, managers tasked with leading and implementing change.

Contact Details

For more information on this work please contact:

Stefano Calciolari
Assistant Professor,
Healthcare Management,