Understanding first to improve later: integrated care initiatives for older people living at home in Europe (SUSTAIN Project) – Baseline assessments of two experiences from Catalonia

摘要

Introduction : Nowadays European health systems are facing the challenge of offering long-term care and support services to an increasing number of older people with a high prevalence of frailty, (multi) morbidity and disability. More and more integrated care initiatives are being implemented in healthcare systems to address the health and social demands of chronic patients. Sustainable tailored integrated care for older people in Europe (SUSTAIN) project is an European project that seeks to improve integrated care for older people living at home with multiple health and social care needs. The project will work with fourteen integrated care initiatives in seven countries with the aim of enhancing their integrated care models and ensuring that improvement work is transferable to other health systems in Europe. In Catalonia, two established integrated care initiatives for older people living at home with multiple health and social care needs were selected for participation. One from Osona’s region: “Chronic complex patients/Advanced chronic patients/Geriatrics” which is a hospital-based integrated care public program running since 2012 and covering an area of 150,000 inhabitants. The target population are chronic complex patients suffering from multimorbidity, advanced chronic patients and frailty patients older than 85. Different care levels are coordinated (primary care, acute care, intermediate and long-term care) and social care is being provided from each of these levels. The other integrated care initiative is “Social and health care integration in Sabadell”, which is a city-level and public initiative running since 1984 which covers the northern area of Sabadell with 50,000 inhabitants. The target population are people with multiple social (e.g., lack of or unskilled caregivers) and health care needs (e.g., chronic disease, complex pharmacological treatment). It is a primary care-based initiative involving GPs, clinicians’ specialists, social workers, nurses, social educators, managers and home-care teams. The aim of the current study is to present progress results of the baseline assessments of these two integrated care initiatives in Catalonia. Methods : The SUSTAIN project is divided into three interrelated phases: a)Preparation phase: baseline assessments in each of the 14 integrated care initiatives identified in 7 European countries will take place in order to understand experiences, and to identify strengths and weaknesses; b)Implementation of tailored sets of improvement to existing integrated care initiatives: based on the outcomes of the baseline assessments, sets of improvement will be designed and implemented together with local stakeholders Overarching analyses will be undertaken to compare and integrate data from the different initiatives; c) translation to products and impacts for different user groups. SUSTAIN is now in the preparation phase. By means of qualitative methods, baseline assessments of each integrated care initiative will consist of interviews and workshops with the aim of knowing the degree at which the initiatives are providing patient-centred, prevention-oriented, efficient, and safe care services. Semi-structured interviews with four key informants of each initiative (organization manager, health professional, patient and carer) will explore different characteristics and contextual factors (e.g., policies, leadership, innovation, sustainability, resilience, among others) to have a first snapshot of strengths and weaknesses as well as potential areas of improvement of each one. The information collect through these exploratory interviews will be recorded and anonymized and a common methodology for the analysis will be applied. A qualitative approach to data analysis framework using grids which allows the combination of themes and case-based approach will be used to analyze the verbatin transcription of the interviews. Emerging themes will be used as prompts for discussion in workshops with local stakeholders. A set of tailored improvements along with specific qualitative and quantitative set of indicators to monitor implementation and evaluation will be consensuated during these workshops. Local Ethical Committees from each site approved the protocol. Informed consent were signed by the participants prior to interview. Progress report : So far, the analyses of all eight exploratory interviews for the baseline assessment were completed. Strengths and weaknesses and areas of improvement for each integrated care initiative have been identified and they will be discussed in the upcoming workshops with local stakeholders next March, 2016. Discussion/Conclusion : These baseline assessments will be a first step towards a better understanding of the needs and challenges that both initiatives are facing. The results from all participating sites will be translated into local improvement projects to be implemented in the sites to achieve more comprehensive, patient-centered, preve