Introduction. Globalization, innovation, urbanization, climate change and ageing have consequences for public health and for health care systems. It has led to new health problems, to more diversity among the population, to a different societal context, and to new possibilities and threats in the health care system. Answers to these global and local challenges include intersectoral collaboration and integration. Belgium is undertaking steps to move to more integrated care, with initiatives like first line zones and decentralization of health care towards primary care level. Few initiatives are evaluated, which leaves a knowledge gap on implementation, effectiveness and cost. This proposal aims to contribute to implementation and evidence of high quality integrated care, in Belgium and in other contexts
Research objectives. The objectives of the research plan are to increase quality of integrated care, by 1) respond better to diversity and new health needs in the changing society; 2) adaptation, implementation and evaluation of health and care models that strengthen links between public health and primary care and between patient, health providers and community; and 3) to contribute to sustainable change by improving institutional and health system context for integrated care, through linkage between health policy and implementation.
Approach and methods. The plan builds upon the transversal themes of 1) diversity and vulnerable groups and changing health needs, in particular multi-morbidity; 2) new forms of organization and collaboration and; 3) role of data and information systems. The underlying conceptual approach takes into account health systems dynamics, meaning the study of the relations between different elements in the system and with the context. It is structured in three work packages. WP1 examines the variation and cost of multi-morbidity; implementation and effectiveness of interventions to address diversity and multi-morbidity; and the monitoring of multi-morbidity in health systems. WP2 studies network dynamics and outcomes of provider collaboration and patient health care utilization in different care models; task-shifting and intersectoral collaboration. WP3 examines digital tools support vulnerable groups; strengthening of data management systems to support collaboration and integrated care and evaluates the impact of increased sharing of health information data on patients and society. The methods will include epidemiological surveys, secondary data analyses of quantitative datasets, health expenditure and costing analyses, and stakeholder analyses using qualitative methods.
The identified priority areas in this proposal provide opportunities to link existing research work of the four spearhead research groups, and collaboration with operational partners and policy makers in the local and regional context of Antwerp.
Impact. After 5 years, this research strategy has led to the following results. 1) new knowledge on multi-morbidity among different population groups; 2) evidence on effects and cost of new care models in the Belgium context,; and 3) utilization of digital tools and health data for research and practice; and 4) recognition of the spearhead research of the UA on quality of integrated care.