Abstract
Identifying and evaluating best practices in the social and health care systems of Catalonia have been a challenge in the last years. It implies defining what integrated care models are, what these models look like, understand their dynamics, needs, commonalities and contexts. Different strategic initiatives have coexisted in the Catalan policy agenda. More recently, integrated care referent professionals have been promoted to further understand what happens at local and regional level.
In this context, a commissioned research project was launched in 2022 with the goal of mapping and assessing integrated social and health care models in three key areas: home care, mental health and residential care; information technology as a forth cross-sectional area. A two-step approach was applied to identify, map and assess these models of care in Catalonia.
First, an open call through integrated care referent professionals and a review of published initiatives aided in the mapping. For an experience to be included, the following criteria where applied: a) model with at least one of the priority care areas, b) different deployment levels, c) shared care model, d) two or more services or settings working together in a formal manner, e) coordinated work among professionals in the same model of care. A semistructured form allowed collecting a minimum set of information of each experience. In a second phase, a semi-structured questionnaire aided in assessing in more depth each experience. A checklist was also collected to assess the degree of their maturity. A face-to-face interview with coleaders in each experience was carried out from May to October 2023. A qualitative content analysis was carried out by the research team.
A total of 135 integrated care experiences were identified and described according to their goals, type of providers, professionals involved, target populations, programs, regions, priority areas, degree of implementation status. The constant changes in the management of organizations, priority settings and the need of enough time of evolvement was a constant challenge to update best practices and their assessment. During a short period, 47 integrated care experiences were further analysed showing heterogeneity in their implementation flow. Few have evaluated their benefits and impacts. Even if heterogeneity was present, common needs were detected to evolve as best practice models.
To our knowledge, this is the widest mapping and assessment exercice of integrated social and health care in the Catalan context. One of the most important learnings has been the need to reach agreements and common understandings among professionals in the experiences, territorial management level, more macro policy-making perspective and research/ evaluation point of view. These perspectives are required, even if challenging, and necessary to push forward a real and sustained integrated perspective of care.