International Check Conceptual framework and Comparative assessment exercise S. Calciolari, L. González, N. Goodwin, V. Stein Work Package: 11 This project has received funding from the European Union’s Seventh www.projectintegrate.eu Framework Programme for research, technological development and Promoting learning | Developing guidance | Sharing ideas demonstration under grant agreement no. 305821
Agenda Introduction to WP11: research objectives and approach Conceptual framework: dimensions and elements Reflection of the validity and usefulness of the framework: – Standardizing descriptions for comparative purposes – Support implementation Using frameworks to measure and promote integrated care Panel discussion: 3 expert panellists Promoting learning | Developing guidance | Sharing ideas
Introduction: PI “International Check” What are the relevant Necessity to compare similarities/differences between initiatives integrated care initiatives? Necessity to identify a – Can the identified similarities standard set of relevant be reasonably generalized? aspects describing any – Can variability between initiative of care integration initiatives be reasonably explained in terms of specific Necessity to select criteria aspects? (e.g., contextual for a purposive sampling factors). Promoting learning | Developing guidance | Sharing ideas
Methodological steps (1/2) • More than 700 abstracts analyzed Comprehensive, literature review focused on conceptual frameworks or relevant aspects explaining integrated care • 175 aspects codified from 18 1 selected articles/documents § Five structured iterations to agree on a synthetic list of 40 items/elements Development & validation of a new conceptual framework • grouping (dimensions) to generate standardized descriptions of initiatives • merging (elements) 2 • wording (elements) § Expert survey to validate the list • clarity (elements) • wording (elements) • relevance (elements) • missing aspects Promoting learning | Developing guidance | Sharing ideas
Key Dimensions and Elements of Integrated Care Initiatives (framework) Person-centered care – engaging and empowering people in their health and wellbeing (7 elements) Clinical integration – care and services that are organized and coordinated around people’s needs (7) Professional integration –partnerships that enable professionals to work together – e.g. in teams and networks (5) Organizational integration – joint working between organizations that supports professional/clinical integration (5) Systemic integration - care systems provide an enabling platform for integrated care at an organizational, professional and clinical level (e.g. alignment of governance and financing) (6) Functional integration – the capacity to communicate data and information across partners of an integrateddelivery system (4) Normativeintegration – shared vision, norms and values (6) Promoting learning | Developing guidance | Sharing ideas
Example Dimension 1: Person-Centered Care Code Element Elements 1.1 Health literacy: Service users and care professionals work together to obtain and understand basic health information needed to make appropriate health decisions 1.2 Supported self-care: Service users are empowered to self-manage the symptoms, treatments, physical, social, emotional, and behavioural consequences of living with long- term conditions 1.3 Carer support: Caregivers are supported in a way that builds their capacity of caring and managing the burden of their care relationship 1.4 Shared decision-making: Service users are actively involved in decisions about their care and treatment options 1.5 Shared care planning: Service users are actively involved in establishing a holistic care plan 1.6 Feedback: Service users are supported to give regular feedback on quality and continuity of care received 1.7 Health data access: Service users have access to their own health care records Promoting learning | Developing guidance | Sharing ideas
Reflection on the validity and usefulness of the framework Promoting learning | Developing guidance | Sharing ideas
Methodological steps (2/2) New conceptual framework Selection of a purposive sample of integrated care initiatives (« case sites ») Three « organizational raids » conducted in Berlin, Barcelona and Stockholm in Jan-Mar • 16 case-site types defined: 2016 § Tax-/Insurance- based § Primary care/Hospital-led § Disease/Condition (4) • 25 contacts invited to join a survey Use of the framework to describe Use of the framework to analyze the and compare the « case sites » case studies of PI phase one 4 3 Promoting learning | Developing guidance | Sharing ideas
Standardizing descriptions to govern heterogeneity (comparative perspective) Target Organizational Most similar (1) Partly different (2) Partly different (3) Most different (4) Care integration population raid (0) (same two features) (vary funding) (vary care setting) (vary both features) Geriatric Hospital Charité D conditions - Insurance-based - Insurance-based - Tax-based - Insurance-based - Tax-based - Hospital-led - Hospital-led - Hospital-led - Primary care led - Primary care led i (G) m COPD Hospital Clinic Barcelona e - Tax-based - Tax-based - Insurance-based - Tax-based - Insurance-based (C) - Hospital-led - Hospital-led - Hospital-led - Primary care led - Primary care led n 7 s Diabetes Dutch Care Groups - Insurance-based - Insurance-based - Tax-based - Insurance-based - Tax-based i (D) - Primary care led - Primary care led - Primary care led - Hospital-led - Hospital-led o n Mental TioHundra AB s health - Tax-based - Tax-based - Insurance-based - Tax-based - Insurance-based - Primary care led - Primary care led - Primary care led - Hospital-led - Hospital-led (M) Promoting learning | Developing guidance | Sharing ideas
Analysis of context-dependence Similarity/Difference features (Xs): financing, leading care setting, disease/condition Outcome measure (Ys): frameworkdimensions (not “system”) Most differentcase sites – With similar outcomemeasures=> context-independent aspects Most similarcase sites, except for one feature – with different outcomemeasures=> context-dependentaspects Promoting learning | Developing guidance | Sharing ideas
Analysis of interdependence between dimensions Influential factors (Xs): framework dimensions 2-6 Influenced factors (Ys): selected framework dimensions (person-centered care and normative integration) Clinical Person-centered Professional Organizational Normative Systemic Functional Person-centered Relationship analysis of: Clinical Professional (1) Xs <=> Ys and (2) Xs, Ys: Organizational Functional Normative Systemic Promoting learning | Developing guidance | Sharing ideas
Supporting self-assessment and quality improvement to support implementation The framework is intended to be a means both to support the design and implementation of integrated care programmes and to compareor benchmarkinitiatives We undertook 3 ‘organisational raids’ with case sites in Barcelona, Berlin & Norrtalje to test out the framework with multi- disciplinaryteams of managersand professionals Further feedback from those with experience of deploying integratedcare initiatives is being sought Promoting learning | Developing guidance | Sharing ideas
Supporting self-assessment and quality improvement to support implementation Key observations on the validity of the framework included: – There was agreement that the framework elements had relevance, BUT some elements were seen as more important across the different case contexts and at the different developmentalstage of initiatives. – Further explanation of both the meaning and justification of dimensionsand elements was often needed. – There was greater agreement and engagement with dimensions at the micro- and meso-level – less with factors related to organisationand system dimensions. Promoting learning | Developing guidance | Sharing ideas
Supporting self-assessment and quality improvement to support implementation Key feedback on the usefulness of the framework included: – Managers and professionals wanted to understand the ‘how’ of deployments of different framework elements rather than just the ‘what’, indicating the need for implementationguidance. – The framework was, however, considered as a useful tool for self- reflection amongst groups of professionals and decision-makers, a process requiring facilitation rather than being a paper-based exercise. – The framework should not be considered as a ‘tick-box’ exercise, but as a tool for engaging partners in care to have discussions on the progress,priorities and future actions of their joint initiatives. Promoting learning | Developing guidance | Sharing ideas
Guest Intervention Using frameworks to measure and promote integrated care: key learning from innovation in the USA Dr Richard Antonelli Medical Director of Integrated Care Boston Children’s Hospital / Harvard Medical School Boston, USA Promoting learning | Developing guidance | Sharing ideas
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