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Internationally, there is a large body of scientific evidence concerning the benefits of integrating health and social care to ensure that frail older people living in the community receive the assistance they need to maintain independence. In the Brazilian city of Belo Horizonte, located in the state of Minas Gerais, an integrated care intervention has been developed: the Programa Maior Cuidado - Older Adult Care Programme (PMC). This programme represents a pioneering example in Brazil of the provision of carers for highly vulnerable older people, through integrated action between public health and social service agencies. This paper draws on the first phase of a mixed method evaluation of PMC, including data from documentary sources, focus groups, empirical observation and expert workshops, to examine the processes that led to the establishment of programme. The origins of the PMC are discussed and its operational processes, with a particular emphasis on integrated activities and the roles of different actors. The paper situates PMC within comparable international experiences of integrated provision for older people and considers how it has been affected by unique context and challenging of a middle-income country. [ABSTRACT FROM AUTHOR]

Continuity of care is concerned with quality of care over a period of time. It describes a process by which service users and their families are co-operatively involved with health and social care professionals in managing their care needs. Continuity of care can be divided into informational, managerial and relational and has been associated with improved user- and service-related outcomes. To date, there have been few studies which examine how continuity of care is developed and maintained in integrated primary care systems. This paper explores continuity of care in an integrated Over 75 Service for people living at home with complex health and social care needs. Using a case study approach, qualitative data was collected from multiple sources including interviews with managers and professionals, users and carers, care plans, steering group minutes and field notes. Data was analysed thematically. A number of factors are identified which characterise continuity of care, namely: information sharing through direct communication between providers and the development of trusted relationships within the team; identified care co-ordinators who acted as a conduit for information and communication; the development of ongoing relationships with users and carers requiring dedicated time and accessible and flexible services delivered in the users' own home. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project. Methods: SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans, evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap. Discussion: SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home. [ABSTRACT FROM AUTHOR]

Introduction: The cross-European research project SUSTAIN (2015-2019) was initiated to take a step forward in the development of integrated care for older people living at home. During the project, SUSTAIN research partners collaborated with local stakeholders from integrated care initiatives to design, implement and evaluate actions and activities to improve current practice, in terms of person-centredness, prevention-orientation, safety, efficiency and coordination. The comparison and integration of findings from these evaluations were expected to increase understanding of what works and with what outcomes when making improvements to integrated care. Methods: Thirteen established integrated care initiatives (sites) in seven European countries were studied, using a multiple embedded case study design. In all initiatives, qualitative and quantitative data were collected from multiple sources and analyzed using standardized procedures and tools to ensure uniformity of approach. After conducting site-specific analysis, an overarching analysis was performed, in which findings from the site-specific evaluations were compared and integrated to identify general lessons learned. Results: The objectives of the integrated care improvements of the different sites could be divided into two groups: (i) improving or expanding collaboration, communication and coordination between organizations and professionals (not yet) involved in the site; (ii) improving the actual care delivery process, for instance by making care delivery more person-centred. The extent to which integrated care improvements lead to a more person-centred, prevention-orientated, safe, efficient and coordinated way of working differed between sites and types of stakeholders. Professionals involved in implementing the improvements were often positive about outcomes of the improvements, while in some sites, a number of users and carers did not notice much of the changes that were implemented. Furthermore, similar facilitators for the implementation of improvements were identified across the sites, on different levels of the health and social care system, such as strong leadership, and shared and realistic goals. Also challenges towards implementation of improvements were identical among the sites, including factors such as lack of ownership, uncertainties about funding, high staff turnover and incompatible shared IT systems. Discussion, conclusions and lessons learned: Across sites, several actions and activities had been implemented to improve person-centred, prevention-orientated, safe, efficient and coordinated care delivery. Many actions appeared to achieve some success, particularly according to professionals. Among users, however, there were mixed views on the improvements. While initiatives had been able to improve their current practices, they also encountered several challenges towards delivering and improving integrated care. A supportive context on different levels of the health and social care system is required for achieving sustainable integrated care improvements. Limitations: Where improving care is a challenge in itself, on top of that integrated care intiatives were required to implement improvements in a limited time span and often without additional resources, which may have influenced outcomes. A long-term approach and sufficient resources are recommended for achieving successful and sustainable integrated care improvements. Suggestions for further research: Sites participating in the SUSTAIN project experienced similar challenges in delivering and improving integrated care. Further research on how these barriers can be overcome is needed. [ABSTRACT FROM AUTHOR]

Introduction: ART is an integrated intermediate care service which provides clinical and personal care support for people who have health or social care needs, which previously would have been met by admission to hospital. The aims of the service are to provide time-specific care that is person-centred and co-ordinated, prevent hospital admissions or enable earlier, supported discharge. The team consists of general practitioners (GPs), senior nurses and therapists with integrated access to social care, and mental health. Ongoing support is provided by transitioning to mainstream services. Key drivers for the implementation of ART were fragmented services in primary and community care, social care, the ambulance service and secondary care; multiple transitions in care impacting on length of hospital stay and poor patient experiences; inconsistency of care; and poor communication at organisational level. Audit data demonstrated a positive impact on hospital admissions. The aims of this evaluation were to determine the extent to which ART delivered person-centred, co-ordinated care and to determine the experiences of professionals delivering the service and external stakeholders. Methods: Interviews were conducted with service users (n=16) and carers (n=13). The P3CEQ (Sugavanam et al, 2016)1, which measures the degree to which care is person-centred and coordinated was administered to users (n=21). Two focus group were conducted with the ART (n=10) and social care team (n=5). External stakeholders (n=5) were also interviewed. Descriptive statistics were used to analysis the survey data. Interviews and focus group data were analysed thematically. Results: The total score on the P3CEQ was 21.52/33 (SD±5.48) indicating a high degree of personcentred, co-ordinated care. Themes identified from user and carer interviews were experiences with receiving the service including timeliness; effects on health and wellbeing; support for selfmanagement; care transitions and consistency of care. Amongst professionals, leadership, engagement, information sharing and the importance of personal relationships were key themes. Discussion: The ART service supported the delivery of complex care in users' own homes and facilitated rapid access to different professionals and services. However, lack of capacity in mainstream services, particularly social care meant that discharging users from ART was difficult at times. Further work is needed in communicating information about the service in order to maximise uptake locally. Response Team (ART) in delivering person-centred, co-ordinated care Conclusions: A multiprofessional, integrated team can deliver person-centred care in an intermediate care setting. Having GPs with dedicated time to deliver the service was a key factor for success. Lessons learnt: Sustainability depends on adequate resources throughout the health and social care economy so that the team are able to stay focused on the main aims and objectives of the service. Limitations: The small sample size meant that further sub-group analysis of the P3CEQ was not possible. Suggestions for future research: The ART model of integrated intermediate care delivery could be compared to other rapid response services in terms of both process and patient-related outcomes. [ABSTRACT FROM AUTHOR]

Introduction: An increasing number of older people living at home with complex needs challenges health and social care systems. SUSTAIN or 'Sustainable Tailored Integrated Care for Older People in Europe' i s a 4 -year project which aims to support and monitor improvements to established integrated care initiatives for older people living at home with multiple health and social care needs. A primary care medical centre in the South East of England was selected as one of 14 case sites delivering integrated care for this population. The 'Over 75 Service' is led by senior practice nurses and delivered by a team of general practitioners, community nurses, social care workers, voluntary sector staff, health trainers and care navigators. This paper presents an evaluation of the implementation of this service and explores explanations for success. A Patient Participation Group (PPG) gave feedback on the service and the evaluation. Methods: SUSTAIN uses a multiple embedded case study design (Yin, 2013) and an implementation science approach. Data was collected from multiple sources including interviews and focus groups with Over 75 Service managers and professionals (n=7), steering group minutes (n=9) and field notes, staff hours date. Data was analysed thematically. Results and Discussion: A key decision, made early on in the design of the service, was to use the Dalhousie frailty screening tool which enabled a shared vision and understanding of frailty. Collaboration and multidisciplinary teamworking was facilitated by effective multidisciplinary team meetings, which provided a vehicle for establishing personal contacts, sharing information, promoting understanding of individual roles and responsibilities and increasing knowledge of available services. There was a culture of inclusiveness with all agencies valued equally for their contribution. Positive interpersonal relationships were key to the success of the service and direct, personal contact was highly valued. Organisational structures supported the development of close working relationships and collaboration as one individual from each organisation was assigned to the Over 75 Service. The practice matrons were a single point of contact for service users and staff and were able to share information and provide advice and support to the team. Specific challenges were short-term funding contracts, increasing demand and a lack of capacity to deliver some services. There were also challenges around data protection, access to data and unwieldy IT systems hindering information sharing. Conclusions: A highly localised organisational structure, positive interprofessional personal relationships and a shared vision were important ingredients facilitating successful implementation of the Over 75 Service. Lessons Learnt: Relational continuity is an important enabler of integrated care initiatives for older people with complex needs in a primary care setting. However, delivery is dependent on the availability of adequate resources. Limitations: Although results are context-specific, lessons can be learnt about what works in terms of delivering integrated care for frail, older people in this setting. Suggestions for further research: Further research is needed on the scale and spread of integrated care initiatives in primary care. [ABSTRACT FROM AUTHOR]

Background: Numerous integrated care initiatives for people with complex needs have been rolled out, in different settings and contexts. There is a widely held belief that integrated care will improve quality of care and health outcomes. Despite many studies evaluating the effectiveness of integrated care programs, evidence remains inconsistent. A potential explanation could be that studies did not use appropriate outcome measures for people with complex needs, such as frail older people and people with multimorbidity. Studies often cover general health outcomes (e.g. health status, physical functioning, quality of life), whereas outcomes such as wellbeing, social functioning, social participation and goal attainment might be more appropriate for vulnerable target groups. Additionally, evaluations in integrated care often merely focus on quantitative outcomes, whereas mixed methods approaches, taking into account the contexts in which these programs are implemented, might be more appropriate in evaluating complex interventions such as integrated care. Currently, different EU-funded research initiatives are taking place that take innovative approaches to measure the outcomes of integrated care practices for vulnerable populations with complex needs. In all projects, (improvements to) existing integrated care initiatives are being evaluated, but they do so in different ways, using different instruments and indicators. These projects include: 1. Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN, www.sustaineu. org); 2. Sustainable Integrated Care Models for Multi-Morbidity: Delivery, Financing and Performance (SELFIE, http://www.selfie2020.eu/) and 3. Advancing Care Coordination and Telehealth deployment at Scale (ACT@Scale, https://www.act-at-scale.eu). Aims & objectives: During this session, we will first present the innovative approaches to measuring outcomes that we take in the different projects and how we aim to tackle some of the common challenges in outcome measurement. We will further discuss the importance and value of regular exchange between the three EU projects in order to harmonise outcome m easurement and as such facilitate cross-country comparisons. Finally, we will address common lessons learned: what does and does not work in evaluating integrated care? Format: In this interactive session, representatives of each project will explain their approaches to outcome measurement, the instruments and indicators they use, and lessons learned. After that, discussion with the audience will focus on the following topics: 1. Which outcome measures are most relevant to evaluate health and wellbeing, patient experiences and costs?; 2. Do we use appropriate indicators and instruments to measure outcomes in people with complex needs?; 3. Which practical issues should be taken into account when collecting data in vulnerable populations?; 4. What challenges are to be expected when harmonising outcome measurement across and within countries?; 5. How can lessons learned from these projects collectively bring evaluation of integrated care practices forward? Target audience: This workshop is targeted at researchers and decision-makers who want to know more about evaluating integrated care initiatives. Learnings: After this session, participants will have: 1. insight in innovative approaches of outcome measurement in different EU-funded projects, 2. learned about successes and challenges experienced in these projects, and 3. insight in how combining experiences from different projects can bring research further. [ABSTRACT FROM AUTHOR]

Background: Innovative process improvements in integrated care programs are increasingly implemented in daily practice by improving certain service elements e.g. safety, personcenteredness, or patient selection to achieve program sustainability and/or program upscaling. Because of the often complex nature of these initiatives, it is challenging to prove effectiveness. We use evidence-based methods from implementation research to monitor and to evaluate integrated care programs during process improvement actions, and to understand if and how implemented actions affect the program in an operational setting. In implementation research, it is important to consider all aspects of the implementation of the program, including the context in which it is being implemented, perspectives of all relevant stakeholders in particular the end users, as well as the organizational processes around the programs. Implementation research also promotes the systematic application of research findings in practice Peters et al 2013. The projects Advancing Care Coordination and Telehealth deployment at Scale ACT@Scale1, Sustainable Tailored Integrated Care for Older People in Europe SUSTAIN2, and DementiaNet3 all apply participatory approaches where local stakeholders design and implement local improvements. The projects all use cyclic improvement processes with the ambition to achieve rapid flow of evidence to practice and to disseminate knowledge and good practices at national and European level. The projects cover a wide variety of integrated care programs running in different settings, having different target populations e.g., chronically ill, multi-morbid, frail elderly, and mental health, and implement different improvement actions. Despite these differences, many common denominators exist, which will be elaborated in this session. Aims and objectives: The overall aim of this session is to provide an overview of implementation research methodologies and to provide examples how to implement and evaluate quality improvement actions in integrated care. Each project will present their experiences with and preliminary results of applying participatory approaches in clinical daily practice, covering different contexts and populations. Common denominators and differences will be discussed. In the discussion part, generalisability of these experiences for other European projects on integrated care will be highlighted. Format timing, speakers, discussion, group work, etc: During the session, the different participatory approaches applied in ACT@Scale, SUSTAIN and DementiaNet will be presented. The authors will further share their experiences applying the participatory approach, using concrete examples and results from actual program improvement actions. After the presentations, common lessons learned in the projects will be identified and discussed with the audience. Target Audience: This workshop targets all stakeholders from clinical management and researcher background who are involved or interested in integrated care improvement methods. Sharing of your own experiences in the open discussion is an integral part of this session. Learnings / Take away: After this session, participants will: 1. have insight in different implementation research approaches for improvement processes in integrated care; 2. will be informed about how to apply these methods and what the pros, cons, barriers and enablers are; and 3. Gain ideas on how to translate and apply lessons learned to their own practice. [ABSTRACT FROM AUTHOR]

Introduction: In an increasing number of EU countries, integrated care initiatives are being put in place as new models to support older people with complex problems living in the community. Evidence of the effectiveness of integrated care is, however, inconclusive. Also there is little knowledge of what is the best way to practice integrated care, how to successfully implement it and how to transfer successful initiatives to other regions and health systems. Aim: SUSTAIN is a European-wide project in which thirteen organizations from nine European countries collaborate to work towards the following aims: 1. improve established integrated care initiatives for older people living at home with multiple health and social care needs and 2. ensure that improvements to the integrated care initiatives are applicable and adaptable to other health systems and regions in Europe. Targeted population and stakeholders: The SUSTAIN project is currently 18 months underway. We have established working relationships with thirteen integrated care initiatives spread across seven European countries. These initiatives vary in terms of e.g. type of care services being offered, involved stakeholders and organizations, and targeted populations of older people (e.g. older people discharged from hospital, older people with cognitive impairment, frail older people in primary care). Practice change implemented: Despite their differences, these sites encounter quite similar bottlenecks to coordination and integration of care, and as such aim to improve in similar areas. Areas of improvement include clearer agreements on tasks and responsibilities of stakeholders involved, better collaboration between professionals from health and social care, better information exchange and more intense engagement of older people and their informal carers. Theory of change: SUSTAIN research partners are collaborating with local stakeholders (e.g. health and social care professionals, managers, older people, policy-makers) attached to the different sites to change the current way of working; all intended to move towards more person-centred, prevention-oriented, safe, and efficient care. Time line and highlights: Improvement projects will be rolled-out and outcome and progress will be monitored during an 18 month period (approx. October 2016-April 2018). This process is underpinned by the Evidence Integration Triangle, an approach targeted at effective implementation of scientific evidence in daily practice. Sustainability and transferability: Overarching analyses will be undertaken to compare and integrate data from the different integrated care initiatives to robustly identify what works for whom, in what context and with what outcome. As such, we will obtain EU evidence on the applicability and adaptability of integrated care initiatives for older people living at home with multiple health and social care needs in relation to different European health systems and regions. Equally importantly, we will identify the steps that are necessary to realise improvement of existing initiatives. Project results will be translated to a roadmap targeted at policy-makers and decision-makers in care systems tasked with designing, establishing and maintaining systems of integrated care that focus on older people with complex needs. Conclusion, discussion and lessons learned: During this workshop, we will share the lessons that we have learned so far during the SUSTAIN project. During the first presentation, we will provide a general overview of the project. The second presentation focusses on our overall methodological approach and the methodological challenges that we have encountered. During the third and fourth presentation, we will provide insights in the participating integrated care sites from the Netherlands and Catalonia respectively and their experiences with the roll-out of their improvement projects so far. The fifth presentation is dedicated to the development process of the roadmap. We will discuss with the audience what will be important elements of the roadmap and inform them how we aim to move forward. [ABSTRACT FROM AUTHOR]

Background: Sustainable tailored integrated care for older people in Europe (SUSTAIN) is a Horizon 2020 nine country collaborative project that aims to improve existing integrated care initiatives for older people living at home with multiple health and social care needs, ensuring they are patient-centred, prevention-oriented, efficient, and safe. This paper to be presented will describe our approach to evaluation and present some early findings of its application in practice. In the world of integrated care, health and social care solutions involve complex problems in complex community and healthcare environments, faced by complex patients, settings, and cultures. These challenges demand evaluation approaches that can accommodate this complexity but ensure robust and timely outcomes, creating evidence that is based on the experience of those who know, live, and work with the problem that the evidence needs to solve (Green 2001). The Evidence Integration Triangle model: With its origins in implementation science, the Evidence Integration Triangle (EIT) (Glasgow 2013) moves away from often unreliable and slow efficacy approaches towards creating a dynamic and transferable flow of high quality evidence to practice, ensuring a rapid and informed response to change and improvement. The EIT is a participative approach, including practitioners, policymakers, and citizens, and fosters robust and high-impact knowledge implementation by practitioners and community partnerships. Such knowledge is created through 'rapid learning cycles' and can support sustainability of initiatives. The EIT depicts in a simple framework the complex multilevel factors affecting the integration of scientifıc knowledge into practical applications. There are three main components to the model, namely the evidence-based intervention; participatory implementation processes; and practical measures of progress and outcome. Bringing evidence and relevant stakeholders together is central. These three components enable stakeholders to use scientific evidence to maximise positive health impact and encourage development and sharing of new knowledge to inform future interactions. The high participation and user involvement levels within this evaluation model enable the research to be relevant and applicable from the onset, and ensure that indicators and measures generated to gather evidence remain sensitive and applicable to the research and practice environment. Qualitative and quantitative evidence is accumulated and used throughout so that the change process remains responsive to improvement. Context is pivotal to the EIT. The conditions surrounding health problems and intervention opportunities in a particular place with a particular population, is a key starting point. Context also changes over time, and continually informs the other key components. The EIT model promotes a reorientation of the current clinical effectiveness research paradigm toward greater recognition of innovation and practice-based approaches to evidence (Green 2008). Within this model, a multi-method evaluation encompasses both an outcomes-based and a process evaluation in order to comprehensively identify whether and how improvements in integrated care initiatives came about. Translating the model to SUSTAIN: • the intervention will focus on existing integrated care sites and the over 65s living at home, and consist of a tailored set of improvements constructed with stakeholders, aimed at the micro, meso, and macro levels within the health and social care system; • the practical measures will consist of 1) a core set of qualitative and quantitative indicators measured at intervals; 2) multi-method process evaluation focusing on implementation processes and perceptual outcomes; • the participatory implementation process will consist of key stakeholders attached to the existing integrated care initiatives (e.g. decision-makers, policy makers, senior citizens, health insurers, health and social care providers, commissioners and representatives from the technology industry). They will use the on-going data collection and analysis and their own experiences to give regular feedback informing on progress, identifying problems and creating solutions and modifications to further the intervention improvements to service delivery. Conclusions: This approach is highly suited to SUSTAIN. Given the integrated care complexities and associated difficulties identifying meaningful outcomes, this methodology will help us to find out what works for whom, how, in what context and with what outcomes. In terms of the wider research agenda, the EIT model can also identify and guide strategic decision-making about research areas to pursue as initiatives are rolled out, so that evidence can inform health promotion and healthcare-quality research. [ABSTRACT FROM AUTHOR]

Background: In the climate of service reorganisation and sensitivity surrounding cost, health and social care systems are confronting many pressures. In England for example, most of the funding is tied up in acute and long term social care, current NHS contracts are widely regarded as insufficient for the transformation agenda and stifle innovation, and Payment by Results does not incentivise the reduction in admissions or social care changes but in fact acts as a perverse incentive (Curry et al 2011). As a consequence, commissioners of health and social care must rapidly consider contracting arrangements to drive forward service integration that is person-centred, innovative, sustainable and transferable. The aim of this project was to develop and externally validate a contracting model blueprint for long-term conditions that was integrated care focused, evidence-based, collaborative and based on achievable joint outcomes. The intention of the model was to ensure high quality integrated care for people with long-term conditions to support self-management and end of life care. Literature review, method and outcome: There were three phases to this project: 1. A critical international literature review of contracting models from within health and social care and industry was undertaken, in order to underpin the model with theory and evidence of effectiveness. This identified eight key contracting models (Alliance, Lead Provider, Partnering model, Outcomes-base commissioning, Accountable Care Organisations, value-based healthcare, incomplete contracts and the Alzira model). Overall there is little evidence of effectiveness, but much on values and principles underpinning the models and an equal amount of qualitative and anecdotal data theorising success and failure (Billings & de Weger 2015). 2. A design group of stakeholders from Clinical Commissioning Groups, acute and community health and social care, contracting and legal services, and technologists from industry was convened to develop the model. It met at monthly intervals over a six month period. A set of underlying principles were initially determined upon which a model should be developed that were person-centred (eg promoting self-management and high quality integrated care) and organisational (eg motivate the workforce, be flexible and innovative). These were isolated from best practice aspirations within professional and integrated care literature (eg Goodwin et al 2014). Secondly, relevant aspects identified in the literature review were extracted for inclusion. This included aspirational leadership and incentivisation from Accountable Care Organisation principles, trust and relational embeddedness between organisations from Alliance models, and person-centred values from outcomes-based commissioning approaches. Following the six months of design, the model consisted of two levels of detail with four overarching core elements - a) (joint) outcomes; b) partnership: collaboration and leadership; c) financial: incentives and risk; and d) legal. Each core element then had a series of more detailed contracting criteria, followed by further detailed specifications to guide the contract development. 3. This model was subsequently validated with a wide range of national and international experts to ascertain relevance and applicability across diverse contexts. The model has been assessed through consultation with five national and four international contracting, legal and long term care experts, and with organisations such as Monitor, the European Centre for Social Welfare Policy and Research, and NHS England. In addition it has been presented at webinars, conferences and discussed with professionals. Overall, those experts and bodies consulted expressed favourable opinions and were in agreement that the contracting model had face validity and potential in the field of integrated care. Discussion and Conclusion: This contracting blueprint signals a significant departure from how current contracts are developed, agreed and operationalised in England, tuned as it is towards integrated care and joint outcomes, and potentially can provide a 'backbone' for the achievement of the transformation agenda. However, despite the extensive validation and perceived relevance of such a model, it must remain aspirational until tested in the field. This is even more so, in that the strive for evidence to strengthen the conceptual development of the model was largely faulty, weak or absent; hence the literature underlining its development was equally aspirational. However, new agendas require new thinking. Work is underway to explore technological solutions to its application, developing software that will simulate bespoke contracts for localities using the model as a framework for developing joint outcomes. [ABSTRACT FROM AUTHOR]

This workshop will serve to launch the publication ?Long-term care in Europe ? Improving policy and practice?, edited by Kai Leichsenring, Jenny Billings and Henk Nies [1] and present selected issues and findings from a transversal analysis of themes and key-issues in constructing integrated long-term care, carried out on the basis of the FP7 Project INTERLINKS (http://interlinks.euro.centre.org). The presentation will use numerous practice examples to illustrate innovative processes and potential ways ahead in integrating long-term care for older people in Europe. The main focus of the workshop will be to discuss latest trends in integrated long-term care beyond managed care and standards on disease management. The workshop will focus in particular on the following topics (see separate abstracts attached): * Identity-building as a precondition for integrated long-term care [2] * Prevention and rehabilitation and integrated long-term care [3] * Quality development across organisations and settings [4] * The role of information technology in integrating long-term care [5] It is also planned to invite policy-makers from the Netherlands, Germany and Austria to this workshop to comment on opportunities to learn from European knowledge exchange. [ABSTRACT FROM AUTHOR]

a) Introduction. One characteristic of emerging practice in long-term care (LTC) for older people is the lack of evidence concerning specific interventions that have been applied. While evidence-based medicine has started to become a mainstream issue, practitioners and policymakers in the realm of LTC seem to lack guidance for this kind of working. This is in part due to the still emerging nature of LTC as a discreet system, but also due to the tensions that exist in how evidence is understood and used for both health and social care practice and policy. An aspect of the EU 7th Framework INTERLINKS project was to investigate how accumulated practice examples had evaluated their interventions. b) Methods. A methodological and transversal analysis of 59 practice examples that described implemented projects was conducted using the following broad dimensions: Category 1 - robust pluralist evaluation; Category 2 - robust single evaluation approaches; Category 4 - developing and employing evaluation tools; Category 4 - limited evaluation. c) Results. Eight examples demonstrated robust pluralist evaluation (Category 1), 17 demonstrated strong elements of evaluation using predominantly single methods, either quantitative or qualitative (Category 2); four examples demonstrated ways in which instruments had been developed and tested that sought to assist practitioners in measuring levels of care (Category 3); and in 30 examples, evaluations were incomplete or on-going, or included limited amounts of data drawn from small scale investigations, informal feedback, screening tools, audits, or a range of different un-co-ordinated sources (Category 4). d) Discussion and Conclusion. Given the small amount of fully evaluated projects, what seems to be evident in INTERLINKS, is that evidence still struggles to move away from the 'informal'. It was of interest that in Category 4, despite small scale or absent evaluation, projects were being rolled out or parts of them were being replicated elsewhere, as they were seen as innovative, significant and relevant, and there was an urgency to address perceived need. This would signify a movement away from seeking outcomes and effects towards 'precautionary' implementation due to service and political imperatives. [ABSTRACT FROM AUTHOR]