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Introduction: The rising incidence and policies to keep dementia patients in their own homes are increasingly putting pressure on primary care systems and budgets. The DementiaNet program stimulates development of primary care networks of medical, nursing and welfare professionals for community-dwelling dementia patients through practice facilitation. This study aimed to provide insight into the merits and drawbacks of this program, mechanisms and which contextual factors influenced them. Methods: In this longitudinal mixed methods multiple case study, primary care professionals with shared caseloads of dementia patients, were enrolled to form networks in the DementiaNet program. Data collection consisted of continuously kept logs, yearly structured interviews to rate the network maturity score (range 0-24), yearly quality of care assessment through a sum score of quality indicators (range 0-100), and in-depth interviews regarding experiences and perceived effects. Quantitative data were analyzed through mixed models; qualitative data with thematic analysis. Results were integrated by combined interpretation. Results: Thirteen networks were successfully initiated in the program, consisting of a median of 9 professionals. Overall, the networks showed an average yearly increase of 2.03 (95% CI 1.20-2.96) on network maturity and 8.45 (95% CI 2.80-14.69) on quality indicator sum scores. Mixed methods interpretation revealed patterns regarding network and contextual factors enabling the transition towards more mature networks and better quality of care. Discussion: Time trends in network maturity and quality of care indicators showed overall improvements. Several enabling factors for the transition to network-based care were identified including strong and adequate leadership (preferably with leaders from primary care practice), high involvement of motivated primary care physicians, high acquaintanceship with other network members, and network seize with a compact network that operates in a relatively small geographical area. Conclusions: Participation in the DementiaNet program was associated with increased network maturity and subsequent beneficial effects on quality of care. Adaptation towards a more mature network seemed to favour quality of care improvements. Lesson learned: The multiple case study design demonstrated its value in the evaluation of DementiaNet as example of a complex health care innovation by incorporating interactions and contextual dependency. Limitations: The main limitation of the study was the limited follow-up. The DementiaNet approach demands considerable changes in behaviour and practice from large numbers of actors; such adaptations require time and will be different per network. Indeed, networks work different in speed of change and improvement goals. Nonetheless, these initial results show improvements even over one and two year timeframes. Suggestions for future research: A succeeding study will be initiated to ensure longer followup of existing networks, while simultaneously expanding the number of networks. [ABSTRACT FROM AUTHOR]

Introduction: Rearrangements are needed in primary care because of aging populations, the increased prevalence of dementia and increasing costs of health care. With DementiaNet, we aim to enhance primary care via integrated network-based care. We focus on structural collaboration from healthcare professionals from medical, care and social domains, and increased dementia expertise. Here, we describe our evaluation study on the DementiaNet innovation to provide insight in the merits and drawbacks of the DementiaNet innovation. Methods: The evaluation study is a longitudinal, mixed methods, multiple case study. The study population consists of two levels: (i) local DementiaNet networks of primary care professionals, and (ii) dyads of dementia patients and their informal caregivers who receive care from DementiaNet networks. At the start of participation and after 12 and 24 months, quantitative data is collected in each network on the maturity of the network, quality of care indicators, and outcomes reported by informal caregivers. Additionally, qualitative data is collected via in-depth interviews with professionals in the networks and dyads of patients and informal caregivers which provide insight in experiences and opinions regarding effects of the DementiaNet approach and the mechanism through which changes in quantitative outcomes are effectuated. Results: This study is currently ongoing with 17 networks included. Preliminary results of the first five networks show stable or improved quality of care and mostly positive experience with the DementiaNet approach. Analysis of quantitative data at 12 months (n=12) and at 24 months (n=5) will show time trends of these networks regarding their quality of care scores and association with informal caregiver-reported outcomes. Additionally, qualitative results from the interviews will be available. Discussion: This study will show whether the DementiaNet innovation leads to improved quality of dementia care and if this is associated with informal caregiver-reported outcomes, through an innovative study design that is designed to capture the complexity. Furthermore, it will provide insight in how this approach is perceived by primary care professionals. This evaluation study adds to the evidence-base of integrated health care, taken from a complex systems perspective. Conclusion: To conclude, this evaluation study will provide insight in the merits and drawbacks, facilitators and barriers, and improvement opportunities of the DementiaNet approach for integrated dementia care. [ABSTRACT FROM AUTHOR]

Introduction: Collaborative primary care is needed to meet the complex needs of individuals with dementia and their informal caregivers. In the Netherlands, shortcomings of current dementia care still exists, including ad hoc based collaboration, lack of feedback on quality to professionals involved, and incomplete implementation of established multidisciplinary guidelines. We developed and implemented DementiaNet, an integrated care approach in primary care that aims to reduce the burden of the disease on individuals, health care services, and society. DementiaNet is network-based care which stimulates collaboration, enhances knowledge and skills and encourages quality improvement cycles. We applied a bottom up and tailor made approach and supported local primary care networks in the Netherlands to implement 5 core processes: network based care, clinical leadership, quality improvement cycles, inter professional practice based training, and communication support tools. A two year leadership support program for network leaders was an important part of the intervention and our study included a one group pre-test-posttest design using Leadership Practice Inventory (LPI-self and LPI-observer; score 30 to 300) to investigate the network leaders performance. Results: Currently, 17 local networks are formed and 22 clinical leaders developed leadership collaborative competencies (2 General Practitioners (GPs), 11 Community Nurses (CNs), 3 Practice Nurses, 4 Dementia care case managers and 2 Occupational Therapists). The networks vary on membership, quality of care and strength of collaboration due to local circumstances. Activities and goals of each networks vary as well, ranging from getting to know each other in person, improving on dementia care knowledge to introducing shared care plans. Poor communication between GPs and CNs, hindered implementation, as well as lacking management's support and poor financial arrangements. The leadership program helped clinical leaders to facilitate network collaboration and stimulate improvement of dementia care as a joint effort. Discussion: Networked care is difficult to accomplish because many complex factors have to be taken into account. Although leadership is often expressed as an important prerequisite for implementing collaborative care models, clinical leaders are not often explicitly supported in executing their leadership role. Conclusion: Results show that clinical practice varies and the DementiaNet approach can lead to quality improvement and stronger collaboration with medical and nursing professionals in leadership roles. Collaborative leadership has to be actively supported and empowered, as professionals are not automatically qualified to execute this leading role in an collaborative network. [ABSTRACT FROM AUTHOR]