A self-evaluation tool for integrated care: the

Development Model for Integrated Care

applied in practice

Dr. Mirella Minkman & Msc. Lidewij Vat

INIC Conference

San Marino, March 30, 2012

What do we see in the Netherlands?

• Agenda: a need for integrated care

• Development: grow of initiatives across sectors

• Implementation: lots of projects and activities

• But: unclear what essential activities are, where to

start? How to improve?

• What can guide development?

• Needs: tools, knowledge of development of integrated

care, framework or model to guide

(Research) questions

Where to start and how to proceed? Practical models/ frameworks?

Which interventions are essential? Related to each other?

How can integrated care development be characterized?

Phd Research

Practice: case studies

• 23 case studies stroke care (improvement program)

• 8 dementia networks (case management)

Literature

• Literature review quality management models CCM and EFQM/MBQA

• A generic model for integrated care is missing

Model development and validation

• Delphi study, Concept Mapping, questionnaires

• Validation study in 84 integrated care services

Cluster

Result management (16)

• making results

transparent

• indicators

• aims and targets

• successes, (almost)

failures

• improvement

Diabetes network…

Multidisciplinary expert team…

Auditing team….

Indicators

Cluster

Integrated care

commitment (11)

• mutual commitment

• ambitions

• dependencies

• contract

• engaged leaders

• domains and trust

Diabetes network…

Signed contract…

Commitment with aims and ambition Synchroon..

4 Phases of development

1. Initiative and design phase

Exploring possibilities and chances, project design, agreements

2. Experimental and execution phase

Defining aims and content, coordination care chain, experiments

3. Expansion and monitoring phase

Further development and maturity, monitoring, new questions

4. Consolidation and transformation phase

Continues improvement, new ambitions, integrated structures

Use of the DMIC model

• Self-evaluation, guiding and steering, indicators

on process- and organisation level, monitoring

development over years, framework for further

research on integrated care, purchasing ic

• Integrated care services that have used the

model:

– Stroke, Acute Myocardial Infarction, Dementia

– Autism, youth care, palliative care, diabetes

DMIC as a self-evaluation tool

Insight in improvement opportunities

and more focused development

Insight in experiences and ideas of

integrated care partners

Comparing with others (benchmarking)

or over years

Web-based self-evaluation tool (one, or multiple

persons)

Self-evaluation traject

Preparation and personal accounts

Example diabetes: general practitioner, nurse,

specialist, dietist, manager, client federation

Use of the online self-evaluation tool

Results: diabetes network

Results (diabetes)

• Phase by respondents

• Phase by DMIC

Lessons learned

• DMIC helped services with a more objective focus on

their integrated care activities.

• They used the results for their annual (improvement)

plan, quality management, as input for conversations

with partners about the development of their service…

• DMIC is generic: can be used for multiple types of

integrated care services.

• Next steps: more integrated care services,

international validation, research between the

organisation of integrated care and its results.

• Interesting for an international audience?

Literature

• Minkman, M (2011). Developing integrated care. Towards a development model for integrated

care. Thesis. Kluwer, Deventer. ISBN 978-90-13-10026-6.

• Minkman, M.M.N., Ahaus, K.T.B. & Huijsman, R. (2007). Performance improvement based on

integrated quality management models: what evidence do we have? A systematic literature

review. International Journal for Quality in Health Care, 19(2), 90-104.

• Minkman, M.M.N., Ahaus, K.T.B., Fabbricotti, I.N., Nabitz, U.W. & Huijsman, R. (2007). A

quality management model for integrated care: results from a Delphi and concept mapping

study. International Journal for Quality in Health Care 21 (2009a), nr.1, 66-75.

• Minkman, M.M.N., Ahaus, K.T.B. & Huijsman, R. (2009b). A four phase development model for

integrated care services in the Netherlands. BMC Health Services Research 9(42).

• Minkman M, Ahaus K, Huijsman R (2009). Modellen voor Ketenkwaliteit. In: Ketenzorg, Praktijk

in perspektief, H26, p277-291.

• Minkman, M.M.N., Ahaus, K.T.B. & Huijsman, R. (2011). The empirical validation of the

Development Model for Integrated Care. BMC Health Services Research.

• Minkman M, Ahaus K, Huijsman R (2010). Het Ontwikkelingsmodel voor Ketenzorg. In: M&O, nr5

sept, p26-43.

• De Eerstelijns (2011/2012): Diabetes pilot Synchroon en interview met Lidewij Vat en Mirella

Minkman.

• New 2012 (in Dutch): Essay in TSG, publication in Zorgmarkt, Kwaliteit in Zorg

Contact

Vilans, National Center of Expertise in long term

care. Utrecht, the Netherlands

• Lidewij Vat, Msc

l.vat@vilans.nl / Mob. +31-6-22810670

• Mirella Minkman, dr

m.minkman@vilans.nl / Mob. +31-6-12285416