How measurements on the Rainbow model of integrated care support us with implementing integrated care in the Netherlands! Lessons for care networks and Health Research and Development programs.

Introduction

Developing a care network in practice to design integrated care, involves many challenges. As part of the ‘local networks of cohesive elderly care’ program of The Netherlands Organisation for Health Research and Development , we supported 10 care networks in their quest to build a sustainable patient centered care network for fragile elderly living at home.

Description of practice change implemented

Goal of the program is to support professionals from different organisations to collaborate  within a solid care network. The professionals have to put their organisational interest aside, develop a joint vision and goals, make analysis of their stakeholders, their weaknesses and strengths and their position in de region and select projects to strengthen their collaboration.

Based on the Rainbow model of Integrated Care we used a validated questionnaire to provide insight into the starting position of the network and to measure their transition.

Aim

The aim was to support the networks in becoming more sustainable. Through an extra funding of ZonMw networks received resources to set up a more professional infrastructure.

Population and stakeholders

Target population are elderly (fragile) living at home. Key professionals in the network are het GP, district nurse and social workers.

Timeline

2019 – present.

Highlights

In the past two years we supported 10 networks and applied the questionnaire in local networks at multiple points in time. The measurements indicates to what extent integration has taken place on a clinical, professional, organizational and systemic, normative and functional level.

Sustainability

All networks managed to strengthen their care network throughout the course of program by working on the predesigned milestones. The measured increase of integration over time however is low. (In)Formal leaders like the GP tend to give higher scores on the degree of integrations, whereas professionals that are new to the network give the lowest scores. This indicates that building networks is time-consuming and requires continuous effort, especially to reach the professionals.

Transfer-ability

Discussing the measurements within networks gives direction to the development opportunities and interventions. A learning network was helpful.

Conclusions

•           Measurements give insight in the level of integration within a network and progress in development over time.

•           Starting networks show the same form of network development and in all networks the normative component is the most developed.

•           When efforts are made to strengthen cooperation, this shows on all elements of the model.

Discussions

What do the results say about the  effectiveness of the program? Which milestones contribute most to building networks? How can we translate the insights gained from the rainbow model into effective interventions?

Lessons learned

•           Measurements gives practical support to networks who wish to strengthen their care network.

•           Networks benefit from the dialog on the results to aim their direction of development.