International Journal of Integrated Care, 1 September 2001 - ISSN 1568-4156
Book review
The birth of integration: explorative studies on the development and implementation of transmural care in the Netherlands, 1994–2000
Edited by Barbara van der Linden
Thesis, Utrecht University, 2001, pp 155,
ISBN 90 393 2722 X
Junko Yamada

The importance of integration in health care has been emphasised and discussed not only in most western countries but also in Japan. Renkei (which means cooperation and integration in Japanese) between different health care sectors has been one of the major concerns in Japanese health care. Renkei also aims to remove the traditional professional boundaries for integration on the same level. A variety of measures such as the improvement of referral systems and the introduction of clinical pathways have been taken to improve efficiency and quality in health care. Renkei, however, has still been one of the most challenging themes. The Birth of Integration: Explorative Studies on the Development and Implementation of Transmural Care in the Netherlands 1994–2000 offers us the Dutch experience as a practical and valuable reference for the future health care.

The Birth of Integration, which is originally the author's dissertation, provides us with a comprehensive and lucid picture of what has been attained and what has not been attained in the field of transmural care in the Netherlands from 1994 to 2000. In addition, this book aims to provide recommendations for further research and proposes strategy measures that can promote integration of health care in the years after 2000.

Transmural care was introduced in the beginning of the 1990s in the Netherlands. It is defined as ‘care, geared to the needs of the patient, provided on the basis of cooperation and coordination between general and specialised caregivers, with shared responsibilities and specification of delegated responsibilities’. The goal of transmural care is to overcome the wall that exists between general primary care and specialised hospital care. It should be noted that transmural care, according to the author, has been developed by bottom-up approach by local caregivers and managers without top-down enforcement from the government.

This book is based on five explorative studies (two surveys, two case studies and a literature study) and contains eight chapters and a summary. Chapter 1 offers a general introduction of transmural care in the Netherlands, and provides the background and aims of the book for the more detailed chapters that follow. It includes a figure which provides an overview of the topics studied in the book and those that are being covered elsewhere by other research groups. This figure is of great help with mapping and understanding the Dutch situation concerning studies on the development and implementation of transmural care.

Transmural care projects are grouped into seven categories. They are: specialised transmural nurse, home care technology, discharge planning, consultation by medical specialists, guideline development, rehabilitation wards and pharmacological transmural care. Chapter 2 is based on a nation-wide survey of 271 transmural care facilities. The survey was conducted in order to determine the extent of the development of transmural care.

The following chapter, Chapter 3, provides a closer and deeper insight into three of the most common types of transmural care (specialised transmural nurse, home care technology and discharge planning). Those three care types were chosen and explored by national survey data analysis and literature study. Subsequently, in Chapter 4 one other type of transmural care, consultation by medical and nursing specialists to primary caregivers, was focused and explored by a quantitative analysis of patient data. To determine the results of the regional implementation of a home care infusion project, comparative analysis was conducted in Chapter 5.

Chapter 6 makes a valuable contribution to the ongoing debate in the field of integrated care on the importance of patient perspectives. This chapter is based on a patient survey that was conducted for the first time in the Netherlands and which focused especially on intersectoral continuity.

In the final chapter, Chapter 8, the author addresses implications and recommendations for health care professionals, managers and policy makers based on the results of a literature study on innovation and implementation in the previous chapter. Lastly, the author's conclusion in the summary that “with transmural care, the notion of integrated care has been born in the Netherlands but that this development must be nurtured with care in the coming years in order to ultimately result in an accessible and patient oriented health care system of optimal quality and efficiency” (p. 142) is especially impressive. In order to facilitate the integration further, appropriate top-down measures such as financial incentives are necessary.

The Birth of Integration is definitely worth reading if you are seriously interested in the area of integrated care. Health care professionals, administrators, policy makers, researchers, students and those involved in the development, the implementation and the study of integrated care will find this book especially suggestive.