Figure 1
Development Model for Integrated Care.
Table 1
Development Model for Integrated Care – Description of development phases.
| PHASE 1 Initiative and design phase: The collaboration between health care providers has been intensified or started up. The starting point is a common problem or chance occurrence, or builds on current cooperation among care professionals. There is a sense of urgency and there are possibilities for working on these challenges in collaboration. The targeted patient group, the care chain and care process have been defined, as also the needs of patients and stakeholders. The level of ambitions, motivation and leadership determine the progress achieved. A multidisciplinary team designs an experiment or project to execute the current ideas. The collaboration can be signed up to in an agreement among care partners. Keywords: Exploring possibilities/impossibilities, ambitions and chances, (project) design and collaboration agreements. |
| PHASE 2 Experimental and execution phase: New initiatives or projects are being executed in the care chain. The aims, content, roles, and tasks in the care chain have been clarified and written down in care pathways and protocols. There is coordination at the level of the care chain by for instance installing coordinators or setting up meetings. Information about patient groups, working procedures or professional knowledge is exchanged. There are experiments within the collaboration, results are evaluated to learn from and reflect on. Preconditions for projects have been considered and boundary conditions have been solved by collaborative means or agreements among care providers. Key words: Writing down aims and content of the collaboration, coordination at care chain level, experimenting and reflecting. |
| PHASE 3 Expansion and monitoring phase: Projects have been expanded or integrated in integrated care programs. Agreements on the content, tasks and roles within the care chain are clear and signed up. Collaboration is no longer on an informal basis. Results are systematically monitored and improvement areas identified. The targeted population has been surveyed. More collaborative initiatives emerge such as mutual education programs. There is a continuous commitment to the ambition of the integrated care program. Interorganisational barriers and fragmented financial structures are on the agenda of the care partners. Keywords: Further development and maturity, monitoring and improving results, new questions and innovation. |
| PHASE 4 Consolidation and transformation phase: The integrated care program is the regular way of working and providing care. Coordination at care chain level is operational; information is shared, transferred and fed back. A monitoring system periodically shows if results are being sustained, what specific improvement possibilities have been identified and to what extent patient needs have been met. The program builds further on successful results. Organisational structures transform or are newly designed around the integrated care program. Financial agreements are arranged with financers by means of integral contracts covering the care chain as a whole. Partners in the care chain explore new options for collaboration in the external environment with other partners. Keywords: Continuous improvement, new ambitions, structures fitting the integrated care program (organisational structures, integral financing). |
Table 2
Characteristics of stroke services (2012, 2015).
| Characteristics stroke services | 2012 (n = 53, 100%) | 2015 (n = 53, 100%) |
|---|---|---|
| Age | Average 9 years (range 0 – 17) | Average 12 years (range 3 – 20) |
| Total care provider organisations | Average 7 (range 2 – 19) | Average 7 (range 2 – 19) |
| Number of stroke patients last year | Average 345 (range 120 – 983) | Average 492 (range 79 – 1650) |
| Background of members in workgroups | Only managers: 4% Only professionals: 13% Both: 70% No workgroups: 13% | Only managers: 0% Only professionals: 17% Both: 78% No workgroups: 5% |
| Coordinator | Yes: 92% Average 7,5 hours per week (range: 0 – 24) | Yes: 100% Average 9 hours per week (range: 0 – 24) |
| Signed agreement of collaboration between providers of the stroke services | Yes: 81% | Yes: 81% |
| Regular meetings with partners of the stroke network | Yes: 77% | Yes: 91% |
| Data collection on indicators | Yes: 87% | Yes: 99% |
| Agreement with healthcare insurance company | Yes: 55% | Yes: 51% |
Figure 2
Average percentages of implemented integrated care elements per cluster 2012 (blue line) and 2015 (red dotted line).
Figure 3
Stroke services per phase of development based on the Development Model for Integrated Care in 2012 (black line) and 2015 (grey line).
Table 3
Top-10 of most implemented elements in 2012 and 2015.
| Top-10 | Elements most implemented in 2012 | N (100% = 53) | Elements most implemented in 2015 | N (100% = 53) |
|---|---|---|---|---|
| 1. | Being a member of the Stroke Knowledge Network Netherlands | 53 | Being a member of the Stroke Knowledge Network Netherlands | 53 |
| 2. | Organising a 24-hour availability for thrombolysis in the care chain (7 days a week) | 50 | Working in multidisciplinary teams | 53 |
| 3. | Defining the targeted patient group | 49 | Directing the care chain by appointing a limited number of people with coordinating tasks | 53 |
| 4. | Working in multidisciplinary teams | 49 | Organising a 24-hour availability for thrombolysis in the care chain (7 days a week) | 52 |
| 5. | Installing a coordinator working at the chain-care level | 46 | Defining the targeted patient group | 52 |
| 6. | Achieving adjustments among care partners by means of direct contact | 46 | Installing a coordinator working at the chain-care level | 52 |
| 7. | Reaching agreements on referrals and the transfer of patients through the care chain | 46 | Involving leaders in improvement efforts in the care chain | 52 |
| 8. | Delivery of indicator data of the chain to the benchmark of the Stroke Knowledge Network Netherlands | 46 | Delivery of indicator data of the chain to the benchmark of the Stroke Knowledge Network Netherlands | 51 |
| 9. | Using evidence-based guidelines and standards | 45 | Assuring the leadership commitment of the partners involved in the care chain | 51 |
| 10. | Reaching agreements on chain logistics (e.g. waiting periods and throughput times) | 45 | Striving toward an open culture for discussing possible improvements for care partners | 51 |
Table 4
Most prioritized elements of 2012.
| Top-5 | Most prioritized in 2012 | Difference in implementation (n = n2015 – n2012) |
|---|---|---|
| 1. | Monitoring patient judgements and satisfaction for the whole care chain | 4 |
| 2. | Developing connections with the databases of partners in the care chain | 7 |
| 3. | Developing a multidisciplinary care pathway | 13 |
| 4. | Using a single patient-monitoring record accessible to all care partners | –3 |
| 5. | Collecting patient feedback and patient experiences for improving the care chain | 7 |
Table 5
Elements with highest implementation rate between 2012 and 2015.
| Top-5 | Highest implementation rate 2015 | Difference in implementation (n = n2015 – n2012) |
|---|---|---|
| 1. | Using uniform patient-identification numbers within the care chain | 20 |
| 2. | Reaching consensus about partner domains | 19 |
| 3. | Gathering patient-related performance data (health status, quality of life) | 19 |
| 4. | Describing the tasks and authorities of leaders, coordinators and advisory boards in the care chain | 18 |
| 5. | Attention to connect the care chain to house-, welfare- and work domains | 18 |