出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : 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, structural integration does not deliver better care by its own. Each of the IHOs has had its own experience in integration/”IHOrmation” (ranging from 2010 to 2016) and best practices have not been systematically shared among them. In fact, merging structures could have the opposite desired effect if not followed by a cultural change among health professionals from both levels of care. IntegraSarea (Network for Integration in Basque) was launched in June 2015 with the aim to facilitate cultural change and uses a collaborative methodology to do so. It should be highlighted that professionals, managers and patients from all Integrated Care Organisations are invited to agree on a set of actions that at the end of the project will be incorporated in the integration narrative of the Basque Country. The objective is to combine a traditional top-down approach (the creation of the network is a priority set by the Governing Body of the Health System) together with a bottom-up approach (the actions to be implemented will be agreed by the people who work at the IHO´s) so that all actors at macro, meso and micro level take ownership of the project. Aims : The aim of IntegraSarea is that IHOs share and agree on their best practices and create a common narrative of integration that is shared by everyone. The idea behind this goal is: (i) to foster integration instead of competition between IHOs, (ii) homogenize best practices and certain key aspects of integration so that everyone can benefit, (iii) engage with health professionals and allow them to take ownership of integration policies in the Basque Country and (iv) incorporate the discourse for People and Person Centred Care to the core of the health care system as suggested by WHO [3]. Methodology : Firstly, a literature review to select the most relevant areas of work for integration was conducted and contrasted with relevant actors both internally (Managers of IHOs) and internationally (IFIC and AQuA). The areas that came after this review are: People Centred Care, Social and Care Coordination, Community Health, Model of care for Chronicity and Management. Secondly, one working group per area of work and formed by health professionals from all IHOs has been created and given the task of: (i) co-create a status report of their area of work in the Basque Country, (ii) review the best practices that exist at a local level (iii) agree on a series of actions/practices to scale them up. It should be stated that participants, mostly clinicians and intermediate cadres will play a vital role as agents of change back in their own IHO. Thirdly, in order to overcome the challenge of dissemination among all 35.000 professionals a newsletter is being sent monthly and an online repository in the intranet has been created to allow interaction of professionals from different IHOs. And last but not least, a panel of experts from both inside and outside the Basque Country has been given the mission to guide each workforce throughout the project in order to give technical support when needed. Results : This stage of the project will be completed in June 2016 and preliminary results will be presented in the Conference. In addition to the fulfilment of the deliverables described above a series of evaluation tools linked with integrated care will be used: IEMAC-ARCHO [4], D’Amour Questionnaire [5]. References: 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. Líneas estratégicas y planes de acción 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. WHO. WHO global strategy on people-centred and integrated health services. 2015. [cited 2015 24 Oct] Available from: http://apps.who.int/iris/bitstream/10665/180984/1/WHO_HIS_SDS_2015.20_eng.pdf?ua=1&ua=1 4. Nuño-Solinís R, Fernández-Cano P, Mira-Solves JJ, Toro-Polanco N, Contel J, Guilabert Mora M, et al. Desarrollo de IEMAC, un Instrumento para la Evaluación de Modelos de Atención ante la Cronicidad [Development of an instrument for the assessment of chronic care models]. Gac Sanit 2013;27(2):128–34. [In Spanish] 5. Nuño-Solinís R, Berraondo Zabalegui I, Sauto Arce R, San Martín Rodríguez 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
关键词：integrated health care organisation ; networks ; cultural change ; basque country ; collaborative methodology
