Abstract
Background: Initiated in 2017, the Caring Leuven project addresses the challenge of creating sustainable, integrated care by uniting diverse stakeholders around a shared vision to improve health outcomes and contribute to the Sustainable Development Goals (SDGs).
Approach: In 2025, Caring Leuven will transition into a living lab co-designed with academic partners, patients, caregivers, and community representatives. Key stakeholders include KU Leuven's Population Health Management (PHM) Unit, local general practitioners (GPs), pharmacists, other primary care representatives, regional hospitals, and a local medical center. Citizen involvement is central, ensuring alignment with community needs and values.
The living lab involves multidisciplinary teams, including integrated neighborhood teams, specialist teams focused on specific conditions, and a dedicated integrator team to align efforts. Vertical disease-specific care pathways are integrated with horizontal preventive and lifestyle actions, supported by population health management techniques.
Digital tools are a cornerstone of this initiative, enabling real-time data collection and analysis to support care coordination and generate real-world evidence. These tools are developed and tested in collaboration with KU Leuven’s PHM Unit. Additionally, the living lab seeks to uncover the microprocesses and systemic changes that contribute to successful integrated care.
Results: Caring Leuven has built a robust stakeholder consortium comprising over 73 partners, including healthcare organizations, social services, academic institutions, and community representatives. A total of 410 primary caregivers - representing approximately 60% of GPs, pharmacists, nurses, and other primary care professionals in the region - are actively engaged in eight integrated neighborhood teams.
Furthermore, 8723 patients have participated in at least one innovative action through Caring Leuven. These efforts have significantly enhanced interdisciplinary collaboration and enabled the effective implementation of integrated care pathways. Visionary and managerial leadership at both micro and meso levels has been instrumental in harmonizing leadership across medical and social care sectors and fostering coordination through a central Integrator team.
Implications: Caring Leuven demonstrates a scalable and replicable model for collaborative, community-driven healthcare innovation. Lessons include the importance of co-design, distributed leadership, and transparent locoregional planning in fostering multidisciplinary teamwork and advancing integrated care. Chronic care program coaching and strong liaison roles have been key facilitators in achieving these outcomes.
The living lab’s success highlights its potential for broader application across regions and sectors. By leveraging sustainable, partnership-driven models, Caring Leuven showcases how health systems can deliver value to diverse stakeholders while driving system-wide transformation in alignment with the SDGs.