The ICARE4EU project wants to improve the care of people suffering from multiple chronic conditions. It will describe, analyze, and identify innovative integrated care programmes for people with multimorbidity in 31 European countries, and aims to contribute to more effective implementation of such programmes. During the project (from 2013 to mid 2016), members of the ICARE4EU consortium will keep readers of The BMJ informed about project developments.

Since our last blog in December, the ICARE4EU project has made much progress. I am a researcher at NIVEL and in March 2015 I joined the ICARE4EU project, which had just entered its third and final year. The turbulent phase of programme selection had recently been finalized: 101 innovative integrated care programmes in 26 EU member states for people with multimorbidity were identified and included in the ICARE4EU database. Some countries provided information about far more programmes than others: for instance 15 programmes from Spain were included but only one from Austria.

Of the 101 programmes that were included in the database, eight promising programmes were selected for a site visit by two of the project partners. These programmes were considered promising because they encompassed innovative ways of delivering integrated care for people with multimorbidity and could therefore serve as a source of inspiration for the (further) development of other integrated care programmes for multimorbid patients. Site visits were completed in Belgium, Germany, Denmark, Finland, Bulgaria, Cyprus, Spain, and the Netherlands. The results of these site visits have been described in eight case-reports, which will be published on the ICARE4EU website.

In the meantime I started drafting a report in which a reflection will be given on the 101 identified integrated care programmes as well as strategies and policies to foster such programmes in EU member states. It was remarkable to find only a few strategies and policies concerning the care for patients with multimorbidity in general, let alone strategies and policies that propose or stimulate integrated care for patients with multimorbidity. This may be due to the fact that integrated care remains very complex to organize, e.g. because it involves different social and healthcare providers and it needs to combine various structures of care delivery. Furthermore, when organizing integrated care, many different organizational and process-related aspects of care delivery need to be taken into account, in order for integrated care to be effective. This includes for instance performance management but also tools to warrant a patient-centered approach. These aspects are also included in the recently developed and validated Developing Model of Integrated Care (DMIC). This model of integrated care contains nine groups of in total 96 elements that should ideally be addressed when developing integrated care. It illustrates how extensive integrated care is and how complex it will be to shape it.

Besides the complexity of integrated care, characteristics of for instance the population and healthcare system of a country might determine the type of programmes that are developed to provide integrated care for multimorbid patients. For instance, in countries where older age is an important determinant of multimorbidity other programmes might be developed than in countries where the prevalence of cardiovascular disease is very high and the onset of multimorbidity. Furthermore, countries with a strong primary care system, may have more possibilities to explore ways of providing integrated care to people with multimorbidity than countries with a weak primary care system. These considerations will be included in the report.

Last week I joined an inspiring symposium on integrated care in the Netherlands. One of the speakers stated that integrated care can be held loosely in your hand, but when you strengthen your grip it slips through your fingers. It was also mentioned that in order to shape integrated care, there is a strong need for people who are eager and fearless enough to just try and make it work, regardless of the barriers they have to face. A general practitioner and a hospital director illustrated this by telling how they joined forces to organize integrated care in their region. Furthermore, there is a strong need for good examples of how intergrated care can be organized and what can be gained by it. The Gesundes Kinzigtal programme, which was one of the sites we visited and wrote a case study on, was mentioned as a good example of how integrated care can be established. It was also mentioned that this programme may be one of the few programmes that shows how integrated care can save costs.

Regardless of its complexity, there is increasing awareness that integrated care is the way forward. With the ICARE4EU project we were able to identify promising integrated care programmes for people with multimorbidity. These programmes can inspire others who aim to provide integrated care for multimorbid patients. Our next step in the ICARE4EU project will be to write policy summaries in which each of the central themes of the project i.e. patient centeredness, management and professional integration, financing systems, and use of e-health technology, will be described in depth. In October 2015 we will present some of our first results during a workshop at the EUPHA conference.

Furthermore, the Berlin team members are working hard to organize the final ICARE4EU conference, which will take place in March 2016 in Brussels.

Acknowledgements:
This blog arises from the project Innovating care for people with multiple chronic conditions in Europe (ICARE4EU), which has received funding from the European Union, in the framework of the Health Programme.

Involved partners

• NIVEL (Netherlands institute for health services research), project coordinator
• TUB (Technische Universität Berlin)
• UEF (University of Eastern Finland)
• INRCA (Italian National Institute of Health and Science on Aging)
• University of Warwick
• AGE Platform Europe
• Eurocarers, European association working for carers

Thanks to the European Observatory on Health Systems and Policies for their support.

Competing interests: I declare that I have read and understood the BMJ policy on declaration interests and I have no relevant interests to declare.

Iris van der Heide is a researcher in the department of care needs of the chronically ill and disabled at The Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.