Using the Project Integrate Framework for assessing progress towards care integration: results from a formative evaluation of a complex intervention in Central Coast Local Health District, NSW Australia

Background : The Central Coast Integrated Care Program CCICP is one of three integrated care demonstrator projects within NSW Australia funded for three years to challenge existing service fragmentation within and between health and social care sectors. The district-wide complex intervention focused on vulnerable youth, vulnerable older persons and people with chronic and complex conditions. As part of the formative evaluation of the CCICP, the Project Integrate Framework was used to map integrated care progress. This Framework provides an evidence-based understanding of the key dimensions and items of integrated care associated with successful implementation. Methods : Based upon the Project Integrate dimensions, an online survey of key stakeholders was undertaken. The survey results underpinned a workshop to assist CCICP team reflection and assessment of progress. This exercise enabled future program priorities and strategies to be set. Key stakeholder interviews were mapped to the Project Integrate dimensions for additional perspective. Results : The research results indicated where progress had been achieved, where learnings had been embedded in service delivery and aided the determination of priorities for action. Learnings about the suitability of Project Integrate dimensions and their use in online, interview and workshop formats will enable its use in other Australian and international settings. Discussion : The Project Integrate Framework aims to provide a conceptual basis for reflecting on the design and implementation of integrated care programs/projects. Our research found the survey tool alone was inadequate to assess integrated care progress, with many answers reflecting uncertainty Neither Disagree nor Agree. The data was reviewed in a workshop with the CCICP team to contextualise the uncertainty, particularly given the formative assessment stage. This greatly enhanced the understanding of progress in care integration on the Central Coast. This finding is congruent with the recommendation for the use of the Framework outlined in the original research. The Project Integrate Framework was identified by the CCICP team as a key communication tool, enabling a consistent terminology for integrated care. However, certain terminologies were not always understandable or meaningful to everyone. Group discussions were important to generate collective understanding of the meaning and importance of the dimensions. As with international case examples, progress towards system integration was regarded as poor, with substantial structural barriers beyond the control of the CCICP team. The intervention appears to be tracking more favourably in the dimensions of person-centred care, clinical and professional integration which was linked to sustained efforts to build relationships and enable a shared understanding of what the CCICP was seeking to achieve normative integration. Conclusion : Use of the Project Integrate framework supported by appreciative dialogue has enabled the CCICP team to reflect on progress and spread of integrated care within the Central Coast Local Health District and on what should be their next steps for spreading and building sustainability.  The research findings are being used to refine the Project Integrate Framework as a means to support on-line assessments of integrated care to enable programs to have meaningful group discussions on design and implementation, and as a means to facilitate comparative research.