Intermediate care in the Netherlands: exploring good practices and the co-creation of a client-centered integrated care pathway

Background: Intermediate care offers temporary inpatient support for older adults living in the community in the Netherlands who have encountered an acute decline in health or functional abilities, the primary objective being to stabilize or enhance their condition, enabling them to return home. Currently there are no guidelines or pathways available on how to best organize intermediate care, and there is a large variety in patient characteristics and care provided between organizations and regions.

Approach: This study consists of two steps: 1) exploring good examples of care provision in intermediate care departments in the Netherlands, as well as opportunities to improve this care; and 2) the development of a new integrated care pathway in intermediate care.

Using a qualitative exploratory research design, good examples and opportunities to improve care were identified between September 2023 – July 2024 through literature research and semi-structured (group)interviews with stakeholders from participating care organizations, as well as with researchers and stakeholders from professional associations. The semi-structured group interviews were analyzed through deductive thematic analysis on predetermined topics. Themes evolving from these interviews formed the basis for online co-creation sessions with professionals actively engaged in intermediate care, with the goal of developing a new care pathway. Topics of discussion included referral processes, information dissemination, triage, care and treatment approaches, and discharge procedures.

Results: Seven group interviews with policymakers, managers, and healthcare professionals revealed challenges in current intermediate care; regarding a lack of up-to-date client information upon referral, insufficient capacity for observation and diagnosis, and lack of individual goals and attention to individual needs. These findings, supplemented by literature review and six co-creation sessions from January 2024 to September 2024 with nurses, physiotherapists, nurse practitioners, team leaders, and policymakers from nine participating healthcare organizations, resulted in a pathway focused on (a.o.) 1) optimizing information from referrals regarding cognitive status; 2) case discussions among professional regarding triage and admission criteria; 3) multidisciplinary intake and developing individual participation goals; 4) actively engaging informal caregivers during admission; 5)  and prepare clients for returning home by promoting independence and incorporating blended home visits.

Implications: A patient-centered integrated care pathway in intermediate care was developed in co-creation with professionals to better structure care and focus more on individual patient needs. Currently, a process and effect evaluation are taking place to assess whether or not the pathway leads to reduce length of stay, increase the rate of discharge to home, and improve achievement of recovery goals at home.