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Introduction: Care integration in primary elderly care is suboptimal. Validated instruments are needed to enable the implementation of integrated primary care. We aimed to assess construct validity of the Rainbow Model of Integrated Care measurement tool (RMIC-MT) for healthcare professionals working in an integrated primary elderly care setting in the Netherlands. Methods: In a cross-sectional study, the RMIC-MT, a 36-item questionnaire covering all domains of the Rainbow Model of Integrated Care (RMIC), was sent out to local networks of primary elderly care professionals. Confirmatory factor analysis with maximum likelihood estimation was used for the validation of the factor structure the RMIC-MT. Model fit was assessed by the chi-square test and fit indices. Results: The RMIC-MT was completed by 323 professionals, primarily general practitioners, community nurses, practice nurses, and case managers. Confirmatory factor analysis and corresponding fit indices showed moderate to good fit, thereby confirming a nine factor model with a total of 36 items. Conclusions: The RMIC-MT is promising for the primary elderly care setting in the Netherlands. It can be used for evaluating integrated care initiatives in a primary care setting, thereby contributing to implementation of integrated primary elderly care. [ABSTRACT FROM AUTHOR]

Introduction: Rearrangements in primary care are needed to cope with aging populations, resulting in an increased prevalence of dementia and increasing health care costs. An essential strategy to establish a sustainable health care system for people with dementia is implementing integrated care in primary care settings. With DementiaNet, an integrated network-based approach, we facilitated collaboration between healthcare professionals from medical, care and social domains, and helped increasing their dementia expertise. Our aim is to evaluate the effects of the DementiaNet approach on quality of care, network collaboration and number of crisis admissions. Theory/Methods: In a longitudinal mixed methods multiple case study, 34 primary care networks participated; they adopted the DementiaNet approach in which a two-year tailor-made program was offered. Networks started between 2015 and 2020 and follow-up ended in 2021. Yearly, networks participated in data collection on their self-reported quality of care and crisis situations. Network collaboration was assessed yearly with scores on the eight integration domains of the Rainbow Model of Integrated Care based on semi-structured interviews with network leader(s). Descriptive statistics were used to identify changes in mean scores over time. Network characteristics and interview data was used to gain deeper understanding of the quantitative outcomes. Linear mixed models will be used to analyze the differences over time for quality of care and network collaboration. Results: Networks consisted on average of nine professionals (mainly a general practitioner, community nurse, practice nurse and case manager). Follow-up was 2-6 years. On average, quality of care of the networks increased for all measured indicators, of which the percentage of people discussed in a multidisciplinary meeting increased the most from 55% (range 0-100%) to 80% (range 48-100%). Advanced networks had less crisis situations compared to starting networks, 25% versus 30% (p=0.038) of their caseload of persons with dementia had a crisis situation. The quality of care was not associated with the number of crisis situations. Network collaboration increased as well over time and these results sustained or further improved after the two-year program ended. Conclusions: The DementiaNet approach improved quality of care and network collaboration and decreased the number of crisis situations of local primary dementia care networks. These effects sustained after the two-year program ended. Because of the improved collaboration, more advanced networks may be able to better communicate and act sooner in case of an oncoming crisis. Implications for applicability/transferability, sustainability, and limitations: Evaluation of a complex program such as DementiaNet requires an innovative design, flexibility and time. Previous studies did not find improvements after implementing integrated care, we showed that these improvements take at least two years to establish. Nevertheless, these effects were successfully sustained by the networks after the two years of support. Data is partly self-reported by network members. Despite the detailed data-collection protocols and definitions that were provided, the quality of the data may have suffered because of this strategy. Future research should focus on identifying if the DementiaNet approach is able to decrease healthcare costs. [ABSTRACT FROM AUTHOR]

Introduction Crisis admissions of persons with dementia are more prevalent due to the rising number of people with dementia living longer at home. Better collaboration between primary care professionals could prevent crisis situations. Therefore, the DementiaNet program focuses on a transition towards integrated care by supporting interdisciplinary networks of primary care professionals from the medical, care and social services to improve their collaboration. This study aims to determine the effect of the DementiaNet program on the number of crisis admissions. Theory/Methods DementiaNet networks started from 2015 onwards. This 2-year program is based on the Rainbow Model of Integrated Care and consists of coaching and support to help the networks go from ad hoc collaboration to a structured collaboration. Collaboration, network leadership, interdisciplinary education and quality improvement cycles are key elements to help networks improve their quality of care for the persons with dementia and their caregivers. Yearly, networks collect patient data on five quality of care indicators, and on admission to a hospital or nursing home due to a crisis. The data collection took place between 2015 and 2020. We compared the number of crisis admissions of advanced networks (>2 years active) with the number of crisis admissions of starting networks (<2 years active) by using an independent T-test. Logistic regression was used to determine the relation between quality of care and the number of crisis admissions. Result 34 networks with on average 9 professions (frequently: general practitioner, practice nurse, community nurse and case manager) were included. The networks collected data of 1689 patient years of which 479 patient years had a crisis. Preliminary results show that advanced networks had less crisis admissions than starting networks, 0.25 versus 0.30 respectively (p=0.038, CI=0.003 - 0.091). The quality of care was not associated with the number of crisis situations. Discussions In advanced networks, less crisis admissions took place; Surprisingly, this effect was not mediated by quality of care. A possible explanation is that better collaboration leads to less crisis admissions due to earlier intervention by professionals. Conclusions The Dementia program was able to facilitate a transition towards better interdisciplinary collaboration within networks of primary dementia care professionals. In advanced networks less crisis admissions occurred than in starting networks. The quality of care was not associated with the number of crisis admissions. Lessons learned A complex intervention, such as DementiaNet, is able to realize a transition towards network-based care and enhance interdisciplinary collaboration to reduce the number of crisis admissions. Limitations The dataset consists of patient years rather than patients, data was collected yearly and we were not able to adjust for the same persons present in the dataset several years in a row. Ideally, we would like to include patient trajectories in further research. Suggestions for future research Further research in a larger database could contribute to unravelling the complex relations between network maturity, quality of care and crisis admissions in primary dementia care. [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]