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Content archived on 2024-06-18

Benchmarking Integrated Care for better Management of Chronic and Age-related Conditions in Europe

Periodic Report Summary 3 - PROJECT INTEGRATE (Benchmarking Integrated Care for better Management of Chronic and Age-related Conditions in Europe)

Project Context and Objectives:
Project INTEGRATE produced valuable insights into the leadership, management and delivery of integrated care to support European care systems in their response to the challenges of ageing populations and the increasing of number of people living with long-term chronic conditions. For the benefits of integrated care to be realised, a set of policy lessons for policy-makers at EU and national level and managerial lessons for leaders in healthcare built on qualitative research and synthesis of evidence in the literature were established.
Project INTEGRATE looked into best practices of integrated care that had a proven impact in terms of positive patient care experiences, health outcomes and cost-effectiveness (each a dimension of the Triple Aim). The key aims were to define what constitutes good quality integrated care provision and to provide support for health providers and member states in better organising healthcare and systems. Project INTEGRATEs overall aims were achieved through 5 strategic objectives:
• Gaining in-depth knowledge of how integrated care can be successfully developed and delivered through in-depth case studies and literature review analysis across four prevalent age-related conditions (diabetes, COPD, geriatric conditions and mental health).
• Identifying facilitators and barriers for implementing and institutionalising integrated care. The case studies uncovered information about the intrinsic characteristics of a successful integrated care strategy, while also examining how strategies varied according to the context in which they were developed. Understanding these dependencies was vital to be able to transfer effective practice between care settings.
• On the basis of the evidence obtained through the case studies, the project generated the specific core horizontal themes mentioned above: process design, service delivery, skills mix, patients’ involvement, funding flows, regulatory conditions, and information technology for enabling connectivity, alignment and collaboration within and between the cure and care sectors.
• The knowledge generated by Project INTEGRATE highlighted the management and leadership strategies that have been used to promote integrated care. Practical recommendations, including a toolkit containing operational, managerial and leadership strategies were developed in the final phase of the project.
• Project INTEGRATE brought together a multi-disciplinary team with extensive knowledge of the challenges involved in promoting integrated care and built on the strong, existing network of IFIC (International Foundation of Integrated Care) to ensure scientific coherence in formulating policy and managerial recommendations for fostering integrated care at regional, national and European levels.

Project Results:
The phase 3 outcomes in Project INTEGRATE were built on the qualitative insights that emerged from the four European case sites. These findings were discussed with world-leaders in integrated care, an expert panel at the 2016 ICIC conference, Barcelona, and were revised with subsequent input.
• An Integrated Care Management Excellence Framework and tools were developed in Project INTEGRATE. Successful healthcare leaders have a clear vision, mission, and values that unites the workforce of an organisation in working together to meet goals so that excellence can be achieved. However, increasing expectations of populations and a lack of leadership training means that few have the skill-set to lead well. Having observed the qualities that make successful integrated care organisations, a framework, best strategies, and recommendations were developed to support healthcare leaders.
• A toolkit was also developed to support healthcare leaders. This lets leaders create a snapshot of the current status of their health organisation, and with insight from the Integrated Care Management Excellence Framework, develop plans and act upon them.
• Main recommendations to national and international policy makers were developed to provide recommendations and policy options to policy makers at EU and national level. Rich qualitative data from the Project INTEGRATE case sites and findings from a comprehensive literature review were used to identify major entry points that are essential for the development of integrative policies.
• Seven critical success factors facilitate the implementation of policy on integrated care. This report on lessons for policy-makers also identified the importance of reinforcing established integrated care frameworks.
• International comparison, and networking were elucidated with the development of a conceptual framework for healthcare professionals. This was also built on findings from the Project INTEGRATE case sties. A separate literature review was performed to identify the main elements necessary in the design and implementation of integrated care. Applied at the national and European levels, the framework was found to be effective in supporting the design and implementation of integrated care.
• The resulting framework was applied at the case sites of Project INTEGRATE. This highlighted the network of interactions between the macro, meso, and micro level. It also allows its users to better understand the core dimensions necessary in the implementation of integrated care.
These findings and the outcomes of the expert panel discussions from the ICIC conference in Barcelona were outlined in blogs that were posted to the Project INTEGRATE website.

Potential Impact:
Efficiency and quality of health services and systems are high on the EU agenda and, in light of an ageing population, increasing chronic conditions and continuous demand for better services, integrated care has been identified as a focus area in Europe 2020: Innovation Union. At the EU policy level, Project INTEGRATEs contribution is significant. Efficient and effective integrated care is a great opportunity for European health systems to strive for increased sustainability and quality and the research generated from these studies supports the importance of this. Project INTEGRATE brought together senior-level decision-makers from the European Commission and national governments to discuss, debate and promote its recommendations through international conferences and targeted round-table discussions.
Project INTEGRATE builds on the rich evidence of integrated care by involving partners working at the forefront of innovative care in their countries, supported by the guidance of experts from the IFIC network. To produce policy and managerial recommendations valuable to policy-makers and healthcare leaders, we built on the insight from the first two phases of Project INTEGRATE. Different innovations, together with lessons from operation and process management in other business areas were also used to generate creative ideas for stimulating new ways for care integration, while the holistic perspective contributes to the body of knowledge on social innovations.
For integrated care to be successful as a local strategy, it requires aligning goals, incentives and processes at system, organisational, functional, professional, and service delivery levels. Project INTEGRATE influences all of these by promoting learning, guidance, and ideas to leaders and policy-makers to support the adoption and successful application of integrated care - including benchmarking findings against international developments.
• Healthcare leaders are given the guidance for adopting and applying integrated care through valuable new insight into best practices (the IC managerial framework) in integrated care and recommendations for implementing these. The tools that were developed support healthcare leaders in their mission of meeting the demands of the population.
• Regional Funding and Organisational Bodies (e.g. health insurances/funds, municipalities commissioners) are supported through the policy recommendations developed and on-line resources with a range of practical evidence and advice available via project web-site to help them make effective strategic decisions. This may include how to develop the business case for investment in integrated care; options for funding and contracting for services.
• Policy-makers at the national and international levels are assisted with the development of integrated care building upon a mission, vision, and a strategy. Critical success factors for policy-making were elucidated to assist health ministries in different countries / regions implement integrated care. These learnings provide insight into recommendations for the integration of services – aligning with international trends of health system strengthening, universal health coverage, and the development of networks and frameworks. These guidelines act as an essential resource for the development of national and European policy development and practice.

List of Websites: