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A survey study to validate a four phases development model for integrated care in the Netherlands.

Minkman MM, Vermeulen RP, Ahaus KT, Huijsman R - BMC Health Serv Res (2013)

Bottom Line: The percentage of implemented elements increased for every further development phase; the percentage of planned elements decreased for every further development phase.Integrated care development is characterised by a changing focus over time, often starting with a large amount of plans which decrease over time when progress on implementation has been made.The four phases model has the potential to serve as a generic quality management tool for multiple integrated care practices.

View Article: PubMed Central - HTML - PubMed

Affiliation: Vilans, National Center of Excellence for Long-term care, PO Box 8228, 3503, RE Utrecht, The Netherlands. m.minkman@vilans.nl

ABSTRACT

Background: The development of integrated care is a complex and long term process. Previous research shows that this development process can be characterised by four phases: the initiative and design phase; the experimental and execution phase; the expansion and monitoring phase and the consolidation and transformation phase. In this article these four phases of the Development Model for Integrated Care (DMIC) are validated in practice for stroke services, acute myocardial infarct (AMI) services and dementia services in the Netherlands.

Methods: Based on the pre-study about the DMIC, a survey was developed for integrated care coordinators. In total 32 stroke, 9 AMI and 43 dementia services in the Netherlands participated (response 83%). Data were collected on integrated care characteristics, planned and implemented integrated care elements, recognition of the DMIC phases and factors that influence development. Data analysis was done by descriptive statistics, Kappa tests and Pearson's correlation tests.

Results: All services positioned their practice in one of the four phases and confirmed the phase descriptions. Of them 93% confirmed to have completed the previous phase. The percentage of implemented elements increased for every further development phase; the percentage of planned elements decreased for every further development phase. Pearson's correlation was .394 between implemented relevant elements and self-assessed phase, and up to .923 with the calculated phases (p < .001). Elements corresponding to the earlier phases of the model were on average older. Although the integrated care services differed on multiple characteristics, the DMIC phases were confirmed.

Conclusions: Integrated care development is characterised by a changing focus over time, often starting with a large amount of plans which decrease over time when progress on implementation has been made. More awareness of this phase-wise development of integrated care, could facilitate integrated care coordinators and others to evaluate their integrated care practices and guide further development. The four phases model has the potential to serve as a generic quality management tool for multiple integrated care practices.

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Self-assessed phase for three types of services.
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Figure 1: Self-assessed phase for three types of services.

Mentions: All integrated care services self-assessed their development phase (Figure 1). Overall, the respondents felt able to position their practice in one of the four described phases. Some respondents commented that elements from later phases were also recognised in the current phase or remarked that their integrated care was about to enter the next phase. For stroke, one integrated care service self-scored their practice in phase one; the most self-scored phases were in phase three (n = 17) and two (n = 9). The AMI services most self-assessed phase one (n = 4) and four (n = 3). The dementia services covered all phases, with the most self-assessment scores in phase two (n = 22) and three (n = 15). The service coordinators who self-assessed a phase two to four were asked if they had been through the previous phase as presented in the description. Of the respondents 92% (n = 75 with assessed phase 2 to 4, 4 missing) confirmed that they recognised and had completed the previous phase.


A survey study to validate a four phases development model for integrated care in the Netherlands.

Minkman MM, Vermeulen RP, Ahaus KT, Huijsman R - BMC Health Serv Res (2013)

Self-assessed phase for three types of services.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3733829&req=5

Figure 1: Self-assessed phase for three types of services.
Mentions: All integrated care services self-assessed their development phase (Figure 1). Overall, the respondents felt able to position their practice in one of the four described phases. Some respondents commented that elements from later phases were also recognised in the current phase or remarked that their integrated care was about to enter the next phase. For stroke, one integrated care service self-scored their practice in phase one; the most self-scored phases were in phase three (n = 17) and two (n = 9). The AMI services most self-assessed phase one (n = 4) and four (n = 3). The dementia services covered all phases, with the most self-assessment scores in phase two (n = 22) and three (n = 15). The service coordinators who self-assessed a phase two to four were asked if they had been through the previous phase as presented in the description. Of the respondents 92% (n = 75 with assessed phase 2 to 4, 4 missing) confirmed that they recognised and had completed the previous phase.

Bottom Line: The percentage of implemented elements increased for every further development phase; the percentage of planned elements decreased for every further development phase.Integrated care development is characterised by a changing focus over time, often starting with a large amount of plans which decrease over time when progress on implementation has been made.The four phases model has the potential to serve as a generic quality management tool for multiple integrated care practices.

View Article: PubMed Central - HTML - PubMed

Affiliation: Vilans, National Center of Excellence for Long-term care, PO Box 8228, 3503, RE Utrecht, The Netherlands. m.minkman@vilans.nl

ABSTRACT

Background: The development of integrated care is a complex and long term process. Previous research shows that this development process can be characterised by four phases: the initiative and design phase; the experimental and execution phase; the expansion and monitoring phase and the consolidation and transformation phase. In this article these four phases of the Development Model for Integrated Care (DMIC) are validated in practice for stroke services, acute myocardial infarct (AMI) services and dementia services in the Netherlands.

Methods: Based on the pre-study about the DMIC, a survey was developed for integrated care coordinators. In total 32 stroke, 9 AMI and 43 dementia services in the Netherlands participated (response 83%). Data were collected on integrated care characteristics, planned and implemented integrated care elements, recognition of the DMIC phases and factors that influence development. Data analysis was done by descriptive statistics, Kappa tests and Pearson's correlation tests.

Results: All services positioned their practice in one of the four phases and confirmed the phase descriptions. Of them 93% confirmed to have completed the previous phase. The percentage of implemented elements increased for every further development phase; the percentage of planned elements decreased for every further development phase. Pearson's correlation was .394 between implemented relevant elements and self-assessed phase, and up to .923 with the calculated phases (p < .001). Elements corresponding to the earlier phases of the model were on average older. Although the integrated care services differed on multiple characteristics, the DMIC phases were confirmed.

Conclusions: Integrated care development is characterised by a changing focus over time, often starting with a large amount of plans which decrease over time when progress on implementation has been made. More awareness of this phase-wise development of integrated care, could facilitate integrated care coordinators and others to evaluate their integrated care practices and guide further development. The four phases model has the potential to serve as a generic quality management tool for multiple integrated care practices.

Show MeSH
Related in: MedlinePlus