Abstract
Background: Cardiovascular diseases (CVD) and diabetes (DM) are major burdens on European health systems, magnified by ageing populations and staff shortages. To face these challenges, partners from 21 countries joined forces to launch the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI), an EU-sponsored effort aiming to facilitate the strengthening of services in the context of these diseases. As part of this initiative, between 2023-2027, pilot projects targeting different points of the patient journey are prepared, implemented and assessed, considering also equity and diversity perspectives and sustainability.
Approach: In the framework of the Work Package on Integrated Care Pathways of JACARDI, 29 pilot projects from 11 EU member countries aim to foster integrated care for CVD and/or DM. To promote the use of already existing knowledge and experience, projects must build on practices from the EU Best Practice Portal or alternative practices that provide robust evidence. On this basis, project implementation takes place between November 2024 and November 2026.
A key challenge in implementing these pilot projects in such diverse contexts is holistic preparation. To ensure this, we put into practice a methodology in November 2023, providing the necessary tools. We have built on two pillars: [1]professional content, [2]implementation science. The first pillar was derived from the multimorbidity care model of CHRODIS+; the second from the Consolidated Framework for Implementation Research as well as the common methodological guidance of the Joint Action, covering the equity and diversity lens and the sustainability perspective. The resulting questionnaire tool was combined with optional individual consultations to help teams improve the explicit understanding of their contexts. Prompts to analyse stakeholders and involve end-users were pivotal segments of this questionnaire tool.
Results: 27 of the 29 pilot projects completed the situation analysis questionnaire. The established preparation process helped pilots crystallise their plans and delineate their project objectives and expected outcomes. We observed a significant diversity in the scale of projects, as well as their points of intervention, target groups and contexts. The most frequent focus areas for improvement ([1]Implementing guidelines and care standards, [2]Enhancing patient-centeredness, empowering patients and [3]Enhancing cooperation between healthcare professionals) provide a snapshot of major directions for the development of integrated care pathways across the EU. The tool helped to identify common patterns and barriers across projects and contributed to the definition of the assessment dimensions.
Implications: A methodologically sound preparation phase is a crucial component of successful integrated care pathway development. Building on this axiom, our initiative advanced a uniform project definition and situation analysis framework that paved the way to the establishment of the implementation and assessment plans. Executing these plans will require continuous reassessment of, and adaptation to the changing contextual and stakeholder-landscape. The provided tool, combined with rigorous and supportive monitoring, and the continuous diffusion of implementation science know-how aims to support this process, laying the groundwork for the EU-wide improvement in the care of CVD and diabetes. We expect that the results and lessons learnt along the way will constitute added value to all involved.