Evaluating Integrated Care in the Basque Country: Using IEMAC-ARCHO and D’Amour Questionnaire

Background : The Basque Country has been implementing integrating care policies since 2010 [1]. One of the cornerstones of this strategy has been the launch of 13 Integrated Health Care Organisations (IHOs) to integrate under the same structure Primary and Secondary Care Services [2]. However one of the challenges that arise from this process comes from the difficulty of evaluating its progression. In order to overcome this problem the Basque Country designed a conceptual framework and co-developed two tools for evaluating integrating care initiatives. In 2014 the Ministry of Health decided to include these tools (IEMAC-ARCHO [3] and D’Amour Questionnaire [4] ) within the Commissioner-Provider Contract. This contract regulates the relationship between the Ministry of Health (Commissioner) and each of the IHOs (Health Providers). The inclusion of IEMAC and D’Amour in this Contract provides both the Government and IHOs with a powerful tool to measure how structural integration is working but also to identify areas of improvement. In this sense it serves three different purposes at once: (i) at a meso and micro level it allows health managers and professionals to have a diagnosis of the situation at their own setting and agree on a set of improvement actions, (ii) at a macro level it allows the Ministry to have an annual report on the progression of its policies and last but not least (iii) it gives health professionals the opportunity to take ownership of the process by engaging them in the assessment. Objective : To provide both the Ministry, health managers and health professionals with a systematic analysis on Integrated Care Policies using IEMAC-ARCHO at an organisational level and D’Amour Questionnaire at a health professional level. Methods : A total of 20 evaluations using IEMAC sessions were conducted with 18 Health Organisations. Each session was run by health professionals and managers from both levels of care (Primary and Hospital Care) but actors from other areas such as mental health and social care were also represented. The methodology consists of a self-assessment of 75 evidence based interventions that help them measure their degree of implementation of chronic care management models. It should be highlighted that the added value comes from the discussion that is generated between both levels of care and its different perception of the score of each intervention, allowing them to identify, share and then agree the areas of improvement they want to work on. Regarding D’Amour, the questionnaire was developed in 2012 to assess Interprofessional collaboration between two different levels of care based on 10 items. This questionnaire had been previously used by some IHOs but never in a systematic way in all the Organisations within the Basque Health Service. In order to fulfil this task, a working group was created to include the questionnaire in the Intranet and allow its escalation to all the system. For the dissemination strategy, each health professional (19.000 plus) was sent an email explaining the purpose of the questionnaire and a link to a banner in the main page of the website. A reminder was also send during the response period. Results : As for IEMAC each of the 18 Health Organisations that form the Basque Health Service (3 Mental Health Networks, 3 Long term care Hospitals and 12 Integrated Healthcare Organisations) have systematically used IEMAC as a self assessment tool. An analysis is currently being undertaken to evaluate the results and they will be presented in the Conference. Regarding D’Amour, the response rate was 1078/19000 and the analysis of the data is currently being done be done. Results will also be presented in the Conference. Reference: 1. Departamento de Sanidad y Consumo del Gobierno Vasco. A Strategy to Tackle the Challenge of Chronicity in the Basque Country. 2010. [cited 2015 24 Oct] Available from: http://www.osakidetza.euskadi.net/r85-cknoti03/es/contenidos/informacion/documentos_cronicos/es_cronic/adjuntos/ChronicityBasqueCountry.pdf 2. Osakidetza/Basque Health Service. Lineas estrategicas y planes de accion 2013-2016 [Strategic Lines and Action Plans 2013-2016]. 2013. [In Spanish] [cited 2015 24 Oct] Available from: http://www.osakidetza.euskadi.net/r85-ckserv01/es/contenidos/informacion/osk_publicaciones/es_publi/adjuntos/estrategia/lineasEstrategicasOsakidetza.pdf 3. Nuno-Solinis R, Fernandez-Cano P, Mira-Solves JJ, Toro-Polanco N, Contel J, Guilabert Mora M, et al. Desarrollo de IEMAC, un Instrumento para la Evaluacion de Modelos de Atencion ante la Cronicidad [Development of an instrument for the assessment of chronic care models]. Gac Sanit 2013;27(2):128–34. [In Spanish] 4. Nuno-Solinis R, Berraondo Zabalegui I, Sauto Arce R, San Martin Rodriguez L, Toro Polanco N. Development of a questionnaire to assess interprofessional collaboration between two different care levels. International Journal of Integrated Care. 2013 Apr 12; 13:e015. Print 2013 Apr