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Background: Relocations within and between nursing homes often induce stress, anxiety, and depression in residents and cause additional workload for and burnout in staff. To prevent this, many nursing homes deploy pre-transition initiatives, bridging initiatives, and post-transition initiatives to support residents and staff during the relocation process. As little is known about these initiatives, this study aims to explore the pre-relocation, bridging and post-relocation initiatives used for relocations within and between nursing homes. Methods: In seven Dutch nursing homes, eight focus groups were conducted with two to six participants (N = 37) who were actively involved in relocation processes in different roles (i.e., managers, healthcare professionals, support staff, client council members, residents and family). The focus groups were conducted based on a predefined topic list and lasted approximately 60 min. The transcripts were recorded, transcribed verbatim and analysed using thematic coding. Results: Nursing homes had to be inventive in developing relocation initiatives as neither shared guidelines nor knowledge exchange on this topic were available. A total of thirty-seven relocation initiatives were identified in these seven nursing homes. Nineteen pre-relocation initiatives were identified, of which eight emphasized information and engagement, three highlighted training and practice and eight stressed orientation and visualization. Seven bridging initiatives were identified, of which four emphasized coordination and continuity and three highlighted entertainment and celebration. Eleven post-relocation initiatives were identified, of which seven emphasized evaluation and troubleshooting and four highlighted change and adjustment. Conclusion: The identified relocation initiatives were developed unassisted by nursing homes, due to a lack of shared guidelines, knowledge exchange and mutual learning on this topic. Therefore, it may be expedient and more effective to develop general guidelines for relocations within and between nursing homes in collaboration with nursing homes. [ABSTRACT FROM AUTHOR]

Background and Objectives: COVID-19 disproportionally affects older adults living in nursing homes. The purpose of this review was to explore and map the scientific literature on the health impact of COVID-19 and related restrictive measures during the first and second wave among nursing home residents. A specific focus was placed on health data collected among nursing home residents themselves.Research Design and Methods: In this study, best practices for scoping reviews were followed. Five databases were systematically searched for peer-reviewed empirical studies published up until December 2020 in which data were collected among nursing home residents. Articles were categorized according to the type of health impact (physical, social and/or psychological) and study focus (impact of COVID-19 virus or related restrictive measures). Findings were presented using a narrative style.Results: Of 60 included studies, 57 examined the physical impact of COVID-19. All of these focused on the direct impact of the COVID-19 virus. These studies often used an observational design and quantitative data collection methods, such as swab testing or reviewing health records. Only three studies examined the psychological impact of COVID-19 of which one study focused on the impact of COVID-19-related restrictive measures. Findings were contradictory; both decreased and improved psychological wellbeing was found during the pandemic compared with before. No studies were found that examined the impact on social wellbeing and one study examined other health-related outcomes, including preference changes of nursing home residents in Advanced Care planning following the pandemic.Discussion and Implications: Studies into the impact of the first and second wave of the COVID-19 pandemic among nursing home residents predominantly focused on the physical impact. Future studies into the psychological and social impact that collect data among residents themselves will provide more insight into their perspectives, such as lived experiences, wishes, needs and possibilities during later phases of the pandemic. These insights can inform policy makers and healthcare professionals in providing person-centered care during the remaining COVID-19 pandemic and in future crisis periods. [ABSTRACT FROM AUTHOR]

Frail older people face a range of problems and risks that could undermine their ability to live safely at home. A comprehensive overview of these risks, from a multidimensional perspective, is currently lacking. This study aims to examine the prevalence of risks in multiple domains of life among frail older people living at home. We used cross‐sectional data from 824 people aged 65 years and older, who received a comprehensive geriatric assessment (the interRAI Home Care [interRAI‐HC]) between 2014 and 2018, as part of routine care from 25 general practices in the region of West‐Friesland, the Netherlands. The interRAI‐HC identifies amenable risks related to people's clinical conditions, functioning, lifestyle and behaviour, and social and physical environment. Descriptive statistics were used to examine population characteristics (age, gender, marital status, living arrangements and presence of chronic conditions) and prevalence of risks. Most common risks were related to people's clinical conditions (i.e cardio‐respiratory health, urinary incontinence, pain), functioning (i.e. limitations in instrumental activities of daily living and mood) and social environment (i.e. limitations in informal care and social functioning). More than 80% of frail older people faced multiple risks, and often on multiple domains of life simultaneously. People experiencing multiple risks per person, and on multiple domains simultaneously, were more often widowed and living alone. The multidimensional character of risks among frail older people living at home implies that an integrated approach to care, comprising both health and social care, is necessary. Insight in the prevalence of these risks can give direction to care allocation decisions. [ABSTRACT FROM AUTHOR]

Introduction: Although person-centredness is a key principle of integrated care, successfully embedding and improving person-centred care for older people remains a challenge. In the context of a cross- European project on integrated care for older people living at home, the objective of this paper is to provide insight at an overarching level, into activities aimed at improving person-centredness within the participating integrated care sites. The paper describes experiences with these activities from the service providers' and service users' perspectives. Methods: A multiple embedded case study design was conducted that included thirteen integrated care sites for older people living at home. Results: Service providers were positive about the activities that aimed to promote person-centred care and thought that most activities (e.g. comprehensive needs assessment) positively influenced personcentredness. Experiences of service users were mixed. For some activities (e.g. enablement services), discrepancies were identified between the views of service providers and those of service users. Discussion and conclusion: Evaluating activities aimed at promoting person-centredness from both the service providers' and service users' perspectives showed that not all efforts were successful or had the intended consequences for older people. Involvement of older people in designing improvement activities could ensure that care and support reflect their needs and preferences, and build positive experiences of care and support. [ABSTRACT FROM AUTHOR]

In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person‐centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006–2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty‐seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty‐one different CGAs were identified, of which the EASYcare instrument, RAI‐HC/RAI‐CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person‐centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter‐)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel. [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]

Background and Objectives To protect residents with dementia from harm, nursing homes (NHs) often have closed-door policies. However, current research suggests a positive influence of freedom of movement, that is, the right to (decide to) independently move from one place to another, on the health of NH residents with dementia. This systematic review aims to collate, summarize, and synthesize the scientific evidence published to date on the influence of freedom of movement on health among NH residents with dementia. Research Design and Methods Multiple databases were searched up until March 2021. Peer-reviewed qualitative, quantitative, and mixed methods studies were included. Health was operationalized using the Positive Health framework, encompassing 6 dimensions: bodily functions, mental functions and perception, existential dimension, quality of life, social and societal participation, and daily functioning. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Results Sixteen studies were included of good to excellent quality. Compared to closed NHs, freedom of movement in semiopen and open NHs may have a positive influence on bodily functions, mental functions and perception, quality of life, and social and societal participation. The influence on daily functioning and on the existential dimension remains unclear. Discussion and Implications Freedom of movement of NH residents with dementia is often studied as part of a larger context in which other factors may contribute to health benefits. More research is therefore needed to unravel the underlying mechanisms of the positive influence of freedom of movement on health. [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: Older people living at home may experience problems in the physical, cognitive, psychological, social and/or environmental life domains, leading to complex care needs. Integration of health and social care is widely acknowledged as an adequate way to address these complex needs. An important component of integrated care programs is a comprehensive geriatric assessment CGA which helps to identify older people's care needs and preferences. A CGA provides the basis for a tailored care plan, consisting of specific actions to support older people in their homes. In the wide range of integrated care programs for frail older people, different CGA tools are being used. To the best of our knowledge, a comprehensive overview of the characteristics of the different CGA tools is currently lacking. The aim of our study was therefore to describe and compare different CGA tools and procedures for conducting them. Methods: A systematic literature search in the electronic databases Embase/Medline and Scopus was conducted to search for papers describing CGAs in integrated care programs for older people living at home. Our search yielded 814 potentially relevant publications. Two researchers independently assessed eligibility based on title and abstract and full text screening. In total, 26 integrated care programs were included in our review. The identified integrated care programs were reviewed as to their main characteristics: country, program objective, target group, setting and involved professionals. Data extraction for information about the CGAs included: CGA tool/instruments, comprehensiveness i.e. life domains being addressed, multidisciplinarity i.e. extent to which professionals from different disciplines are involved, person-centredness i.e. extent to which older people and informal carers are involved and procedures to conduct a CGA. Results: Included studies shows a great variety of CGAs used in integrated care programs. Most integrated care programs were implemented in the Netherlands and the United States. The majority of CGAs seemed to address comprehensiveness, multidisciplinarity and personcentredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. Furthermore, some identified instruments are broadly used in different countries e.g. RAI-CHA, whereas others e.g. [G]OLD instrument are developed and used exclusively in one specific program. Discussion/conclusion: This study shows that integrated care programs, in different settings and for different target groups, have different ways of conducting a CGA. Due to this heterogeneity, older people's needs and preferences are being assessed and addressed in different ways. It is still unclear what works best in conducting a CGA in the context of integrated care and whether the existing range of CGAs is adequate. Limitations/suggestions for future research: We did not include the entire range of existing CGAs in this review, as several papers did not adequately describe the CGA tool and procedures used. A more thorough description of CGAs as a component of an integrated care program is recommended to complement the current overview of CGAs. Further research is recommended to develop guidance on how older people's problems and care needs should best be assessed and to prevent researchers and professionals from reinventing the wheel. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As 'safety' prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important. Methods: We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design. Results: Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions. Discussion: Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives. [ABSTRACT FROM AUTHOR]

Background: Narratives have the potential to promote person-centred practice, yet few studies have been undertaken on the impact of a narrative approach on learning for care professionals or students. With this in mind, we co-designed an educational programme on the use of older persons' narratives for professionals in research, education and nursing. Aims: To investigate the impact of attending a narrative educational programme on the learning of nursing and healthcare assistant students, and on their person-centred practice. We also examined what factors characterised and influenced this learning. Methods: This was a mixed-methods evaluation study. We evaluated the impact of a narrative educational programme on third-year healthcare assistant students and second-year nursing students. Students were invited to complete a survey before and after the educational programme. After the programme, we performed interviews with all the educators and some of the students. Results: Students' learning from the narratives was varied, and there were differences in the extent to which the programme raised awareness. Some students demonstrated new understandings, actions and behaviours. Students self-reported that they had experienced learning related to 12 learning outcomes and to their person-centred practice. According to educators and students, this learning was experiential and reflective, and was influenced by the students' level of participation, personal characteristics and openness to other perspectives, as well as the educators' guidance and the workplace conditions. Conclusion: This study shows that the educational programme 'Tell Me! Learning From Narratives' can contribute to the learning of healthcare assistant and nursing students in terms of their understanding of the field of narrative inquiry as well as the development of their person-centred practice. Providing support for educators is a prerequisite for the programme to work. Implications for practice: * The programme has the potential to contribute to a person-centred care curriculum * Self-evaluation, for example via the self-scan person-centred care survey in this study, prompts awareness in students * Educators should be supported in their use of a narrative approach, person-centred care values and didactic skills * Educators should reflect the values of person-centred care in their practice and in their relationships with students as role models [ABSTRACT FROM AUTHOR]

Background: Countries are adapting their health and social care systems to better meet the needs of growing populations with (multiple) chronic conditions. To guide this process, assessment of the 'patient experience' is becoming increasingly important. For this purpose, the Person‐Centred Coordinated Care Experience Questionnaire (P3CEQ) was developed in the United Kingdom, and translated into several languages. Aim: This study aimed to assess the internal and construct validity of the Dutch P3CEQ to capture the experience of person‐centred coordinated care of people with chronic conditions in the Netherlands. Participants and Methods: Adults with chronic conditions (N = 1098) completed the Dutch P3CEQ, measures of health literacy and patient activation, and reported the use and perceived quality of care services. Data analysis included Principal Component and reliability analysis (internal validity), analysis of variance and Student's T‐tests (construct validity). Results: The two‐component structure found was pretty much the same as in the UK validation study. Sociodemographic correlates also resembled those found in the United Kingdom. Women, persons who were less educated, less health‐literate or less activated experienced less person‐centred coordinated care. P3CEQ scores correlated positively with general practitioner performance scores and quality ratings of the total care received. Conclusion: The Dutch P3CEQ is a valid instrument to assess the experience of person‐centred coordinated care among people with chronic conditions in the Netherlands. Awareness of inequity and more attention to communication skills in professional training are needed to ensure that care professionals better recognize the needs of women, lower educated or less health‐literate persons, and improve their experiences of care. Patient Contribution: The P3CEQ has been developed in collaboration with a range of stakeholders. Eighteen persons with (multiple) chronic conditions participated as patient representatives and codesign experts in (four) codesign workshops. Other patient representatives participated in cognitive testing of the English‐language instrument. The usability of the P3CEQ to capture the experience of person‐centred coordinated care of older persons has been examined by interviewing 228 older European service users, including 13 living in the Netherlands, as part of the SUSTAIN project. More than a thousand persons with chronic conditions participated in the validation study of the Dutch P3CEQ. [ABSTRACT FROM AUTHOR]

Introduction: In the northwest of the Netherlands, health and social care professionals have sought to structure and coordinate care and support for older people living at home with multiple health and social care needs. The region was selected as one of the case sites of a European project called SUSTAIN, which aimed to facilitate and evaluate improvements to established integrated care initiatives for older people living at home. By participating in the SUSTAIN project, local stakeholders collaborated with researchers to further improve their way of working. This case study describes the process and outcomes of the development and implementation of improvements, as well as the factors that influenced this improvement process. Insight into this process may provide valuable lessons that could be transferable to other integrated care initiatives Methods: Using a participatory approach, guided by the Evidence Integration Triangle (Glasgow, 2012), local stakeholders defined and implemented a tailored intervention aimed at improving collaboration and communication between health and social care professionals. Researchers monitored and evaluated this improvement process. Multiple data sources were used, including the Team Climate Inventory (n=11), interviews with managers and professionals delivering health and social care (n=8), meeting minutes (n=10) and field notes. Results and Discussion: The tailored intervention consisted of regular intervision meetings (i.e. meetings consisting of peer supervision and methodical discussion to reflect on professional development) as well as workplace visits. According to professionals, the intervention resulted in improved communication and collaboration. Facilitating factors included the safe and informal setting in which the meetings took place and the personal relationships that developed during the project. Managers also valued the intervention, although they voiced concerns about the scale and sustainability of the implementation. Issues such as staff shortages, time constraints and privacy regulations made it difficult to implement the intervention on a larger scale. In addition, lack of ownership and accountability among managers and different organizational cultures and interests hindered the improvement process. Still, this bottom-up participatory approach encouraged the development of trust, shared goals and a shared sense of urgency on the level of both managers and professionals. Conclusions: A shared sense of urgency, personal relationships and trust on different organisational levels were important factors facilitating the improvement of an established integrated care initiative in the Netherlands. Lessons Learned: This case study highlights that participatory approaches, in which interventions are co-created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with competing interests. Limitations: Our study sample is relatively smalldue to the limited number of participating stakeholders. Still, similar patterns were found in the different data sources. In addition, given the relatively short implementation period, we were not able to assess whether the improvement impacted older people's experiences with care and support. Suggestions for further research: Further research may focus on the sustainability of improvements to established integrated care initiatives, and look into possibilities to scale up these improvement activities. [ABSTRACT FROM AUTHOR]

Introduction: While several evaluation studies on (cost-)effectiveness of integrated care have been conducted in recent years, more insight is deemed necessary into integrated care from the perspective of service users. In the context of a European project on integrated care for older people living at home (SUSTAIN), this paper shares the experience and methodological reflections from applying a Patient Reported Experience Measure (PREM) on person-centred coordinated care -the P3CEQ- among this population. Methods: A combination of quantitative and qualitative data and analysis methods was used to assess the usability and the quality of applying a PREM among older people presenting complex care needs, using the P3CEQ delivery in SUSTAIN as a case study. 228 service users completed the P3CEQ and nine SUSTAIN researchers participated in a consultation about their experience administering the questionnaire. P3CEQ scores were analysed quantitatively using principal component analysis and multilevel linear regression. P3CEQ open responses and researcher notes collected when administering the questionnaire were thematically analysed. Results: Service user inclusion was high and most P3CEQ items had low non-response rates. Quantitative analysis and researcher experience indicate the relevance of faceto- face administration for obtaining such an amount of data in this population group. The presence of a carer increased inclusion of more vulnerable respondents, such as the cognitively impaired, but posed a challenge in data interpretation. Although several P3CEQ items were generally understood as intended by questionnaire developers, the analysis of open responses highlights how questions can lead to diverging and sometimes narrow interpretations by respondents. Cognitive impairment and a higher educational attainment were associated with lower levels of perceived person-centredness of care. Conclusion: This study shows essential preconditions to meaningfully collect and analyse PREM data on older peoples' experiences with integrated care: face-to-face administration away from care providers, collection of reasons for non-response and open comments providing nuances to answers, and multilevel modelling taking into account diversity in the target population. Several areas of improvement for future PREM use in this population have been identified: use of administration and coding guides, inclusion of clear and easy to understand definitions and examples illustrating what questions do and do not mean, measures of the expectations of personcentred coordinated care, and procedures ensuring sound ethical research. These methodological learnings can enhance future evaluation of integrated care from a service user perspective. [ABSTRACT FROM AUTHOR]

Background: Numerous integrated care initiatives have been rolled out in a wide range of settings and contexts, in order to improve care and support for frail older people living at home. Despite this rich and varied field of practical examples, evidence on the effectiveness of integrated care remains inconsistent and knowledge on successful implementation and transferability of experiences to other contexts is still limited. To take a step forward in the development of integrated care, the cross-European research project called SUSTAIN was initiated in 2015, with a two-fold objective: 1. to support and monitor improvements to established integrated care initiatives for older people living at home, and 2. to identify improvements that could be applicable and adaptable to other health and social care systems and regions in Europe. Over the past two years, local stakeholders from thirteen existing integrated care initiatives in seven European countries have worked together with SUSTAIN project partners to improve their current way of working. Supported by SUSTAIN project partners, stakeholders from the different initiatives (i.e. managers, health and social care professionals, representatives of older people and informal carers, local policy officers) designed and implemented improvement plans tailored to local priorities. Using a multiple case study design, SUSTAIN project partners monitored and evaluated experiences and outcomes related to the design and implementation of these improvements in each initiative (or 'case'). Comparing and integrating data from these different cases provides insight into what works for whom and in which context. Aims and objectives: During this workshop, we will share lessons learned so far from the implementation and evaluation of the improvement projects in the SUSTAIN project. The aim of the workshop is threefold: 1. inform the audience about the objectives and design of the SUSTAIN project, 2. illustrate outcomes and experiences related to designing and implementing improvements in three of the participating integrated care initiatives, and 3. present preliminary findings from the integration of outcomes and experiences of all participating initiatives. Format: During the first presentation, we will briefly show SUSTAIN's overall structure, approach and activities to generate evidence on improving integrated care. During the second, third and fourth presentation we will share experiences from participating integrated care initiatives located in West-Friesland (the Netherlands), the Arnhem region (the Netherlands) and Sabadell (Spain). The fifth presentation will focus on preliminary findings based on overarching analyses of experiences from all initiatives. After the presentations, we will discuss with the audience how lessons learned during the SUSTAIN project can bring the development of integrated care further. Target audience: This workshop is targeted at researchers and decision-makers who want to know more about improving established integrated care initiatives. Learnings: After this session, participants will have insight in: 1. the objectives and design of the SUSTAIN project, 2. case-specific experiences and outcomes related to improving integrated care, and 3. preliminary outcomes of the overarching analyses which supports the understanding of what works for whom, in which context and with what outcomes. [ABSTRACT FROM AUTHOR]

Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co‐created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors. [ABSTRACT FROM AUTHOR]