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Advancing in Integrated Care:Results of 4 years of evaluation

Authors:

Eva Lamiquiz Linares ,

Basque Government, Department of Health, ES
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Pepe Quintas Diez,

Basque Government, Department of Health, ES
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Iñaki De Pablos Vaca

Basque Government, Department of Health, ES
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Abstract

Objective: To show the progress in Integrated Care in the Basque Country through the evaluation of compliance of “Dimension 3: Integrated care” in Contract Program.

Methods: The Health Regulation Act of the Basque Country establishes the Contract Program (CP) as a regulation tool between the commissioner (Ministry of Health) and health providers (Osakidetza/Basque Health Service, etc.). The CP set financing and quality requirements. Therefore, in 2014 it was decided to use CP as an additional tool to drive real changes in health care organizations, in order to advance towards Integrated Care. To do this, a new orientation was necessary, both for the quality requirements and the way to evaluate their degree of compliance.

So, based on the Conceptual Framework developed by Kelley and Hurst with some modifications, we carry out an assessment model of the quality requirements in contracting. The model should meet the requirements of being: Integrated, based on international standards, that allow comparisons and, by means of weightings, give more importance to elements considered "critical” (for example: Integrated care); sensitive and viable by using the existing or easily constructible indicators. The result was a model with two axes of contracting and nine dimensions: The first axis (focused on the design and planning of services) contains 3 dimensions: D1: Resources; D2: Services and D3: Integrated care. The second one deals with the performance of the organizations and contains 6 dimensions: D4: clinical safety, D5: effectiveness, D6: Equity, D7: Centrality in the patients, D8: Accessibility to health services and D9: Efficiency.

D3 (Integrated Care) contains 4 indicators (5 indicators in 2017):

Ambulatory care sensitive conditions (ACSCs) admissions Rate:

Integration degree (Collaboration between clinicians from different care levels measured with the D'Amour Questionnaire)

Coordination degree for geriatric care in elderly homes

Coordination degree in polypathological patients management

Strengthening primary health care (included in 2017)

Results: Compliance of indicators and D3.

Ambulatory Care Sensitive Conditions (ACSCs)

2014    30,0

2015    30,6

2016    69,2

2017    87,4

Integration degree

2014   53,3

2015   65,4

2016   81,6

2017   93,6 *Only Long term care

Coordination degree for geriatric care in elderly homes

2014   27,9

2015   55,4

2016   59,2

2017   74,3

Coordination degree in polypathological patients management

2014   53,7

2015   53,1

2016   73,6

2017   82,2

Strengthening primary health care

2017    71,8

Overall compliance

2014   54,0

2015   63,8

2016   73,3

2017   83,3

Conclusions: The positive evolution reflects the effective implementation of actions aimed at real integrated care (functional integrated care), beyond structural integration. These actions include implementation of only one information system, Integrated care processes deployment, New professional roles, New alliances (Social care participation), Professional participation, Multidisciplinary Committees, etc.

How to Cite: Lamiquiz Linares E, Quintas Diez P, De Pablos Vaca I. Advancing in Integrated Care:Results of 4 years of evaluation. International Journal of Integrated Care. 2019;19(4):393. DOI: http://doi.org/10.5334/ijic.s3393
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Published on 08 Aug 2019.

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