Community Research and Development Information Service - CORDIS

H2020

SUSTAIN Report Summary

Project ID: 634144
Funded under: H2020-EU.3.1.

Periodic Reporting for period 1 - SUSTAIN (Sustainable tailored integrated care for older people in Europe)

Reporting period: 2015-04-01 to 2016-09-30

Summary of the context and overall objectives of the project

The problem being addressed:
Population ageing and the economic crisis have put pressure on European health systems. Presently, it is not known what the best way is to respond to these challenges. In an increasing number of EU Member States, a diverse range of integrated care initiatives are being put in place as new models for safe and efficient, prevention-oriented care to an increasing number of older people.

Evidence of the effectiveness of integrated care is, however, inconclusive. Also there is little knowledge of how to successfully implement integrated care and of how to transfer successful initiatives to other regions and health systems. While integrated care is being rolled out and infrastructures are in place, improvements to existing initiatives are necessary to make them more patient-centred, prevention-oriented, efficient, and safe. Moreover, approaches are needed that actively and meaningfully engage all stakeholders and that optimally facilitate the transfer and uptake of best practice across contexts and countries. The overall aims of SUSTAIN are therefore twofold: 1. to improve established integrated care initiatives for older people living at home with multiple health and social care needs, ensuring they are patient-centred, prevention-oriented, efficient, and safe; 2. to ensure that improvements to the integrated care initiatives are applicable and adaptable to other health systems and regions in Europe. In seven countries, established integrated care initiatives will therefore be improved in close collaboration with local care providers and the target group of elderly people and the informal caregivers. The implementation processes and overall evaluation will be guided by our theoretical based multi-methodological approach, the Evidence Integration Triangle. Overarching analyses will be undertaken to compare and integrate data from the different sites to robustly identify what works for whom, in what context and with what outcome. As such, we will obtain EU evidence on the applicability and adaptability of integrated care initiatives for older people living at home with multiple health and social care needs in relation to different European health systems and regions. Equally importantly, we will identify the steps that are necessary to realise improvement of existing initiatives. Project results will be translated to a roadmap targeted at policy-makers and decision-makers in care systems tasked with designing, establishing and maintaining systems of integrated care that focus on older people with complex needs.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

The SUSTAIN project will last 48 months and is divided into three interrelated phases covering eight interrelated work packages. In the first phase of the project (i.e. preparation phase), which has just ended, we established working relationships with two integrated care initiatives in seven countries (Austria, Estonia, Germany, Norway, Spain, the Netherlands, United Kingdom), where improvements will be implemented. To understand where improvements are necessary, baseline assessments have taken place in each of the countries to understand characteristics of the different integrated care initiatives, the services’ care settings, key objectives, care pathways, contextual issues, funding and governance structures. We also asked the sites how they gave shape to SUSTAIN’s core domains, (i.e. patient-centredness, safety, efficiency, and prevention-orientation) and what they thought what would be potential improvement areas. In the second phase (i.e. implementation research to improve existing integrated care initiatives), which has just started, based on the outcomes of the baseline assessments, tailored sets of improvements are being designed and implemented by the sites together with stakeholders (i.e. policymakers, commissioners, health insurers, health and social care professionals, older people, informal carers). In the following sections we will outline in more detail which activities have taken place in each of the WPs.
Objective 1. Conduct baseline assessments in established integrated care initiatives for older people with multiple health and social care needs in participating countries to examine their patient-centredness, prevention orientation, efficiency, and safety, alongside a comprehensive assessment of contextual issues.
Status: In all 14 sites, baseline assessments have taken place in each of the countries to understand characteristics of the different integrated care initiatives, the services’ care settings, key objectives, care pathways, contextual issues, funding and governance structures. We also asked the sites how they gave shape to SUSTAIN’s core domains, (i.e. patient-centredness, safety, efficiency, and prevention-orientation) and what they thought what would be potential improvement areas. The baseline assessment was conducted over two stages. During the first stage of the assessment, interviews were carried out with one user, one carer, one manager and one professional at each site. The professionals and managers were recruited by the research partners, while the users and carers were recruited by those professionals and managers. The results of the first stage of the assessment were the basis of discussions with key stakeholders during workshops organised by the research partners. The aim of the workshops was to discuss the initiatives’ strengths, weaknesses, and areas for improvements in order to develop an improvement plan.
Objective 2. Improve established integrated care initiatives through an implementation plan developed in close collaboration with local key stakeholders based on the outcomes of the baseline assessments and implement these improvements in different European countries.
Status: We have just started the second phase of the SUSTAIN project, where research partners are developing improvement and implementation plans. These plans are developed in collaboration with local stakeholders (e.g. representatives of older people and their carers, health and social care professionals, representatives from municipalities etc.), assembled in so-called Steering Groups. Each of the 14 sites has their own Steering Group, and composition of Steering Groups varies across sites. SUSTAIN partners are working on opportunities to facilitate exchange between sites.
The development of the improvement and implementation plans differs a bit between sites; some sites already have clear plans for improvement, whereas others still need to decide on which issues they want to work and how to implement changes. Partners are generally in close contact with their sites. Partners use a template for describing their improvement projects and their implementation to facilitate comparison across sites. The templates will be regularly updated to monitor progress, any changes etc. Data collection partners are the ones that will complete these templates, with input from a key person from their site. As such, the template can be used as input for the steering group meetings.
Objective 3. Evaluate the implementation process and identify how the established integrated care initiatives have improved.
Pending; we are now in the first stage the second phase of the project. Once improvement and implementation plans have been developed; the implementation process will be monitored. We will use different methods for data collection.
Objective 4. Assess the applicability and adaptability of improved integrated care initiatives to other health systems and regions in Europe.
Pending; this will be part of the evaluation of the implementation process.
Objective 5. Design and implement dissemination strategies, including a roadmap for policy-makers and decision-makers, to maximise impact of project findings.
Status: From the start of the project, we have been working on dissemination strategies. A dissemination plan has been developed, outlining the different options for dissemination and our target audiences in the different countries. Strategies used so far, have been: SUSTAIN website (http://www.sustain-eu.org/), presenting content in different languages (i.e. Dutch, Catalan, Spanish, Estonian, English, Norwegian). Content in German/Austrian will be added soon. We have further developed leaflets for professionals and older people, again in the languages of the different SUSTAIN partners (http://www.sustain-eu.org/products/). Further presentations at different workshops have been given or will be given in the near future (e.g. ICIC conference in Barcelona, meeting at UCSF Centre for Excellence in Primary Care, annual conference of Geriatric Society of America). In June and September 2016, newsletters of the SUSTAIN project have been circulated; with currently over 250 subscriptions (http://www.sustain-eu.org/products/newsletter-no-1-june-2016/).

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The SUSTAIN project has been initiated from the noted shortcomings of the current approach to integrated care. In order to take integrated care to the next level, a novel approach is needed that draws on the strengths of Europe’s diversity but transcends the current limitations. The sample of fourteen integrated care initiatives in seven European countries offers a rich and varied view on diverse methods applied in a variety of specific contexts, that also diverge in their means of evaluating progress and generating evidence and useable knowledge. The Evidence Integration Triangle (EIT), developed as an arm of implementation science, provides a mechanism through which we can realise our research ambitions. The first step, which we have already taken, is the design of a tailored set of improvements in each of the selected programmes, which will be followed by a process of implementation with active participation from care providers and elderly people, who have already been engaged in the design phase. The progress and outcomes of the implemented improvements will be monitored, and how they have affected the central criteria of patient-centredness, prevention orientation, efficiency and safety will be evaluated. The monitoring will allow the identification of facilitators and barriers, and the evaluation of what works and what does not, against what costs and time investments. The largest stride will then be to bridge the gap from the particular experiences to know-how in which the collective experiences are crystalised, aided by the toolbox. Furthermore, the result should be such that is transferable and can be adapted to other contexts. This will then provide a roadmap for integrated care improvement and innovation in Europe, providing a structured and practice-oriented manual to move towards more patient-centred, prevention-oriented, efficient and safe integrated care for people aged 65 years and their carers. First steps in the development of the roadmap and toolbox have already been taken. With such a roadmap in hand, the involvement of policy-makers and other forces shaping society will be greatly facilitated, as will input from ‘market forces’, ultimately benefitting clients.

Related information

Record Number: 195193 / Last updated on: 2017-02-22