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Reading: Contextualised implementation and scale-up of Integrated Care in Europe


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Contextualised implementation and scale-up of Integrated Care in Europe


Lutz Kubitschke

Empirica Gesellschaft Für Kommunikations- Und Technologieforschung Mbh, DE
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Care authorities across Europe often experience the need for capacity building and technical support for the successful implementation of integrated care programmes, and for ultimately achieving the “quadruple aim” of integrated care system performance. A number of challenges are however impeding the implementation of better joined-up care delivery practices in concrete care settings, including:

•           Coping with complexity – the challenge of contextualising generic models for implementation purposes,

•           Focussing the stakeholders’ joint efforts – the challenge to arrive at a “common narrative”,

•           Exploiting digital solutions for supporting integrated care delivery - the challenge of pursuing a multi-pronged innovation approach,

•           Capitalising on existing knowledge and tools – the challenge of exploiting available evidence for practical implementation purposes.

The European project VIGOUR (“Evidence-based Guidance to Scale-up Integrated Care in Europe”), co-funded by the European Union’s Health Programme, is designed to guide and support 16 care authorities across seven European countries in progressing the implementation of sustainable models for care integration.

A contextualised and targeted approach to scale

In view of diverse framework conditions within which integrated care service delivery will be implemented, the service integration strategy pursued needs to be flexible in terms of service process and technology deployment. Thus, regions will be supported through a staged process of analysis, advice and capacity building, comprising three distinct methodological steps.

Ambition Focusing: Regions start with a conceptual focussing of their initial scaling-up ambition. A number of service integration aspects are addressed:

•           What is the point of departure?

•           Where does each region want to get to?

•           What are the expected impacts?

Self-Assessment: Following the ambition focusing, each region works on examining strengths and weaknesses of the envisaged care integration approach by means of a SWOT analysis. Depending on the given framework conditions, a range of different factors potentially impede the successful implementation of the ambition by means of a fully up-and running pilot scheme. Equally, diverse supportive capacities are potentially available for putting the currently envisaged care integration approach into practice, albeit these may not yet have been considered in a systematic way. As a tangible output, the analysis will help to identify:

•           Potentials for further optimizing the envisaged approach,

•           Local circumstances that may make it difficult to practically implement the initially stated ambition,

•           Options available for addressing any identified “road blockers” for the implementation,

•           Definition of meaningful assessment criteria.

Operational Planning: A planning framework will be developed and applied, resulting in a structured initial implementation plan for each region. It will include a revised set of priority integration targets (ambitions, activities, interventions) together with a map of the interests of all stakeholders in respect of each priority activity.

Conclusions and next steps

Regions will be guided by targeted support measures relying on a contextualised consolidation of the evidence base currently available. This comprises different steps, including matching the available evidence against the initial scaling-up plans, and targeted support mechanisms such as twinning.

How to Cite: Kubitschke L. Contextualised implementation and scale-up of Integrated Care in Europe. International Journal of Integrated Care. 2021;21(S1):139. DOI:
Published on 01 Sep 2021.


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