Table 1
Characteristics of thirteen integrated care sites participating in the SUSTAIN project.
| Country | Region | Integrated care site | Type of care services |
|---|---|---|---|
| Austria | Vienna | Gerontopsychiatric Centre | Dementia care |
| Estonia | Ida-Viru | Alutaguse Care Centre | Home nursing and rehabilitative care |
| Tallinn | Medendi | Home nursing | |
| Germany | Uckermark | KV RegioMed Zentrum Templin | Rehabilitative care |
| Berlin Marzahn-Hellersdorf | Careworks Berlin | Home nursing and rehabilitative care | |
| Norway | Surnadal | Surnadal Holistic Patient Care at Home | Home nursing and rehabilitative care |
| Søndre Nordstrand in Oslo | Søndre Nordstrand Everyday Mastery Team | Rehabilitative care and mastery of activities of daily living | |
| Spain | Osona | Severe Chronic Patients/Advanced chronic disease/Geriatrics Osona | Proactive primary and intermediate care |
| Sabadell | Social and health care integration Sabadell | Proactive primary care | |
| The Netherlands | West-Friesland | Geriatric Care Model | Proactive primary care |
| Arnhem | Good in one Go | Transitional care | |
| United Kingdom | Kent | Over 75 Service | Proactive primary care |
| Kent | Swale Home First | Transitional care |
Table 2
Qualitative and quantitative measures to monitor and evaluate improvement progress and outcomes, adapted from de Bruin et al. [7].
| Data collection tool | Short description | Collection moment |
|---|---|---|
| SURVEYS | ||
| Socio-demographics of older people (users) | Survey developed by SUSTAIN researchers including information on age, gender, education, marital status, living situation and medical conditions | Recruitment and collection took place throughout implementation period |
| Socio-demographics of informal carers | Survey developed by SUSTAIN researchers including information on age, gender, education, marital status, relationship and distance to user, paid work and caregiving activities | Recruitment and collection took place throughout implementation period |
| Socio-demographics of professionals | Survey developed by SUSTAIN researchers including information on age, gender, nationality and occupation | Collection took place at the beginning and end of implementation period |
| Socio-demographics of managers | Survey developed by SUSTAIN researchers including information on age, gender, nationality and occupation | Collection took place at the beginning and end of implementation period |
| The Person Centred Coordinated Care Experience Questionnaire (P3CEQ) [40] | Survey measuring older people’s experience and understanding of the care and support they have received from health and social care services | Recruitment and collection took place throughout implementation period |
| Perceived Control in Health Care (PCHC) [41] | Survey addressing older people’s perceived own abilities to organise professional care and to take care of themselves in their own homes, and perceived support from the social network | Recruitment and collection took place throughout implementation period |
| Team Climate Inventory – short version (TCI-14) [42, 43] | Survey measuring vision, participative safety, task orientation and experienced support for innovation of the improvement team | Collection took place at the beginning and end of implementation period |
| INTERVIEWS | ||
| Semi-structured interviews with older people and/or their informal caregivers | Interview schedule developed by SUSTAIN researchers with items regarding users’ and carers’ perceptions of and experiences with the integrated care services and the extent to which they work in a person-centred, prevention-oriented, safe and efficient manner | Recruitment and collection took place throughout implementation period |
| Group interview with participating health and social care professionals | Interview schedule developed by SUSTAIN researchers with items regarding professionals’ perception of and experiences with the improvement process, its facilitating and impeding factors and the extent to which it impacted person-centeredness, prevention-orientation, safety and efficiency of their way of working | Collection took place at the end of implementation period |
| Semi-structured interviews with managers | Interview schedule developed by SUSTAIN researchers with items regarding managers’ perception of and experiences with the improvement process, its facilitating and impeding factors and the extent to which it impacted person-centeredness, prevention-orientation, safety and efficiency of their way of working | Collection took place at the end of implementation period |
| OTHER TOOLS | ||
| Analysis of older people’s care plans (when sites did not work with care plans, information was retrieved from clinical notes or other documentation) | Template developed by SUSTAIN researchers for predetermined content analysis of care plans, extracting information regarding needs assessments, goal-setting, medication reviews, falls, hospital and emergency admissions and advice on medication, safety and self-management | Recruitment and collection took place throughout implementation period |
| Sheet for efficiency indicators | Template developed by SUSTAIN researchers to collect information from staff regarding the number of hours dedicated to the improvement activities and costs of additional equipment and technology | Collection halfway through and at the end of implementation period |
| PROCESS INFORMATION | ||
| Steering group minutes | Minutes cover processes, discussions, decisions and contextual issues impacting on outcomes and implementation progress | Collection took place throughout development and implementation periods |
| Field notes | Field notes cover the researchers’ notes and reflections on implementation progress | Collection took place throughout development and implementation periods |
Table 3
Description of three-staged approach for data-analysis of the case studies.
| Step 1 | Data were analysed seperately for each individual data source (for each individual case study). For each data source, uniform templates for analysis have been generated, as appropriate for that specific data source. Qualitative data have been analysed thematically, quantitative data have been analysed using statistical methods. Appendix 1 provides the templates that have developed to analyse each data source. |
| Step 2 | After analysing each individual data source, results for that source were reduced to a series of thematic statements (in case of qualitative data) and summaries (in case of quantitative data). These summaries and thematic statements were provided in English. |
| Step 3 | For each case study, English thematic statements and summaries were amalgamated and underwent a process of pattern-matching across the data to gain insight into the experiences with the improvement process of the integrated care site. In order to guide this process, an analysis framework was developed (Appendix 2). Research partners analysed data against two propositions and five analytical questions:
|
Table 4
Analysis framework used for overarching content analysis of country-specific reports.
| Codes | Sub-codes |
|---|---|
| Design of health and social care delivery process | Activities |
| Experiences from older people and their informal caregivers | |
| Experiences from health and social care professionals and managers | |
| Staff training | Activities |
| Experiences from older people and their informal caregivers | |
| Experiences from health and social care professionals and managers | |
| Communication and information exchange between professionals, older people and informal carers | Activities |
| Experiences from older people and their informal caregivers | |
| Experiences from health and social care professionals and managers | |
| Facilitating the involvement of older people and informal carers in care and support | Activities |
| Experiences from older people and their informal caregivers | |
| Experiences from health and social care professionals and managers |
Table 5
Number of participants involved in each case study.
| Integrated care site | Number of participating older people | Number of participating informal carers | Number of participating managers | Number of participating professionals |
|---|---|---|---|---|
| Total | 244 | 80 | 35 | 205 |
| Gerontopsychiatric Centre | 7 | 3 | 2 | 6 |
| Alutaguse Care Centre | 28 | 6 | 1 | 10 |
| Medendi | 24 | 8 | 1 | 13 |
| KV RegioMed Zentrum Templin | 31 | 6 | 1 | 7 |
| Careworks Berlin | 30 | 7 | 1 | 14 |
| Surnadal Holistic Patient Care at Home | 29 | 6 | 2 | 18 |
| Søndre Nordstrand Everyday Mastery Team | 11 | 2 | 2 | 12 |
| Severe Chronic Patients/Advanced chronic disease/Geriatrics Osona | 19 | 12 | 3 | 59 |
| Social and health care integration Sabadell | 22 | 7 | 2 | 11 |
| Geriatric Care Model | 13 | 7 | 4 | 8 |
| Good in one Go | 5 | 6 | 2 | 8 |
| Over 75 Service | 15 | 5 | 8 | 31 |
| Swale Home First | 10 | 5 | 6 | 8 |
Table 6
Activities that aimed to promote person-centredness as part of integrated care sites within SUSTAIN.
| Clusters of activities | ||||
|---|---|---|---|---|
| Design of health and social care delivery process | Working in multidisciplinary care teams | Implementing electronic care plans | Conducting comprehensive assessment of care needs | Changing the location of health and social care delivery from institutions and doctors’ offices to people’s homes |
| Staff training | Providing training on shared decision-making and person-centredness of care | Providing training on health conditions and diseases (i.e. early detection of dementia) of older people | Providing training on inter-professional communication and collaboration | |
| Communication and information exchange between professionals, older people and informal carers | Providing various options for older people and informal carers to communicate with professionals | Sharing information about available community services | Providing older people with a single point of contact as pertains to their health and social care needs | Giving older people and informal carers access to care plans |
| Facilitating the involvement of older people and informal carers in care and support | Discussing older people’s needs, preferences, goals and priorities | Involving informal carers in the care process | Empowering older people (i.e. providing them with training on shared decision-making and self-management of health) | Stimulating enablement and self-care |