Towards integrated care for older people: experiences from two local initiatives in Catalonia (within the SUSTAIN project)

摘要

Background : Two local initiatives (North Sabadell and Osona) within the SUSTAIN European research project have developed improvement projects aiming to better implement person-centred integrated care for older people living at home. However, continuity, transferability and scalability of such projects to other contexts is still limited and uncertain. The evaluation of these two improvement projects, through a set of specific monitoring measures and tools, and the lessons learned from the professionals involved will shed light on successful and less successful implementation aspects, identifying barriers and facilitators. Recommendations based on these experiences can be relevant both for professionals (health and social), stakeholders (representatives of older people), service providers and policy makers (at a local, regional or national level). Aims and objectives : During this workshop, professionals from North Sabadell and Osona directly involved in the two local improvement projects for integrated care will share a first-hand account of their experience designing, implementing and obtaining an external evaluation of their projects. The aim of the workshop is to enable a dialogue between the implementers of the improvement projects, the research team in charge of the external evaluation, Catalan policy makers and the audience, by looking at successful outcomes, lessons learned and challenges, in terms of person-centredness and care integration, leading to recommendations for future integrated care developments. Particular attention will be paid to: 1. Professionals’ needs (e.g. training, change of work and organizational culture). 2. Continuity, transferability and scalability. Format : AQuAS will open the session with a short introduction about integrated care in Catalonia, and a brief overview of SUSTAIN’s research approach and evaluation methods (10’). Pilar Fernández Morral (North Sabadell) and Joan Espaulella (Osona) will jointly present the new work method (objectives, tools) for elaborating individualised integrated care plans for older persons living at home, highlighting particularities in each site (15’ + 5’ Q&A). Afterwards, they will share their experiences reflecting on main lessons learned, barriers and facilitators, professionals’ needs, and recommendations for scalability, in an interview-conversation format facilitated by AQuAS (20’). Professionals’ view will be contrasted with the user’s view collected by AQuAS using patient reported experience measures (5’), and then with the policy maker perspective, with Joan Carles Contel (PPAC-PIAISS) reflecting on the relevance of the two improvement projects for future Catalan integrated care (10’). Finally, presenters will engage with the audience to discuss lessons learned and recommendations for service providers and policy makers aiming at continuity, transferability and scalability across the territory (moderated by AQuAS, 25’). Target audience : Health and social professionals, stakeholders, decision-makers and researchers who want to hear and learn from first-hand experiences of professionals developing and implementing integrated care initiatives. Learnings : Participants will gain insight in: 1. Local experiences and outcomes related to improving integrated health and social care at different levels; 2.Workingand organizational culture: main lessons learned by health and social professionals working collaboratively towards integrated care; and 3. Recommendations for service providers and policy makers for escalating and implementing similar integrated initiatives.