Care integration in a vulnerable elderly population in Belgium : an evaluation of the third phase of Protocol 3

156 p.ill.,SCIENTIFIC REPORT 8 -- 1 INTRODUCTION TO THE PROTOCOL 3 PROJECTS 8 -- 1.1 BACKGROUND AND CONTEXT: AGEING IN PLACE AND INTEGRATION OF CARE 8 -- 1.2 TOWARDS ENHANCED INTEGRATED CARE FOR VULNERABLE ELDERLY PEOPLE: THE 3 PROTOCOL AGREEMENTS AND THE PROTOCOL 3 CONVENTION 9 -- 2 TOPIC OF STUDY IN THIS REPORT: EVALUATION OF THE THIRD PHASE OF THE PROTOCOL 3 CONVENTION 13 -- 2.1 THE BASE CONVENTION OF THE THIRD PHASE OF PROTOCOL 3 EXPLAINED 13 -- 2.1.1 Outline and aim of the convention 13 -- 2.1.2 Description of the reimbursed ‘base’ interventions 14 -- 2.1.3 Rules, period, units and amount of reimbursement 17 -- 2.1.4 General and specific terms and conditions for inclusion of a beneficiary in the protocol 3 project and ‘base’ interventions 19 -- 2.1.5 Registration process of the beneficiary 21 -- 2.2 THE ATTACHMENTS TO THE BASE CONVENTION OF THE THIRD PHASE OF PROTOCOL 3 EXPLAINED 22 -- 2.2.1 Description of the reimbursed ‘supplementary’ interventions 23 -- 2.2.2 Rules, period, units and amount of reimbursement 24 -- 2.3 CHARACTERISTICS OF THE PROJECTS WITHIN THE THIRD PHASE OF THE PROTOCOL 3 CONVENTION 26 -- 2.3.1 General characteristics of the 19 projects that signed the protocol 3 convention in 2019 26 -- 2.3.2 Amount of patients, expenditures and resources available 30 -- 3 RESEARCH QUESTIONS AND APPLIED STUDY METHODOLOGY 33 -- 3.1 RESEARCH AIMS AND QUESTIONS 33 -- 3.2 APPLIED STUDY METHODOLOGY 33 -- 3.3 ANALYSIS OF DATA AND REPORTING THE PERCEPTIONS OF THE DIFFERENT ACTORS 39 -- 4 FINDINGS FROM THE INTERVIEWS WITH MEMBERS OF THE STEERING COMMITTEE 41 -- 4.1 FULL CARE PACKAGE BASED ON NEEDS 42 -- 4.2 INTERPROFESSIONAL COLLABORATION AND INTEGRATED CARE 44 -- 4.3 BELRAI ASSESSMENT AND THE DRAWBACKS OF THE INCLUSION CRITERIA 46 -- 4.4 DRAWBACKS OF FEE-FOR-SERVICE FINANCING AND THE TERMS OF THE CONVENTION 46 -- 4.5 SHORTCOMINGS RELATED TO THE GOVERNANCE OF PROTOCOL 3 50 -- 5 FINDINGS FROM THE INTERVIEWS WITH COORDINATORS OF THE PROTOCOL 3 -- PROJECTS 53 -- 5.1 FULL CARE PACKAGE BASED ON NEEDS 54 -- 5.2 INTERPROFESSIONAL COLLABORATION AND INTEGRATED CARE 56 -- 5.3 ACCESSIBILITY 59 -- 5.4 BELRAI ASSESSMENT AND DRAWBACKS OF THE INCLUSION CRITERIA 60 -- 5.5 DRAWBACKS OF FEE-FOR-SERVICE FINANCING AND THE TERMS OF THE CONVENTION 62 -- 5.6 SHORTCOMINGS RELATED TO THE GOVERNANCE OF PROTOCOL 3 68 -- 6 PERCEPTIONS OF THE HEALTHCARE PROFESSIONALS WORKING WITHIN THE P3 -- INITIATIVES 71 -- 6.1 ACCESS 72 -- 6.2 FULL CARE PACKAGE BASED ON NEEDS 73 -- 6.3 INTERPROFESSIONAL COLLABORATION AND INTEGRATED CARE 79 -- 6.4 ACCESSIBILITY 82 -- 6.5 AWARENESS 83 -- 6.6 BELRAI ASSESSMENT AND DRAWBACKS OF THE INCLUSION CRITERIA 83 -- 6.7 DRAWBACKS OF FEE-FOR-SERVICE FINANCING AND THE TERMS OF THE CONVENTION 86 -- 6.8 SHORTCOMINGS RELATED TO THE GOVERNANCE OF PROTOCOL 3 90 -- 7 PERCEPTIONS OF THE PATIENTS AND INFORMAL CAREGIVERS 92 -- 7.1 ACCESS 93 -- 7.2 FULL CARE PACKAGE BASED ON NEEDS 93 -- 7.3 INTERPROFESSIONAL COLLABORATION AND INTEGRATED CARE 95 -- 7.4 ACCESSIBILITY 100 -- 7.5 AWARENESS 101 -- 7.6 SHORTCOMINGS RELATED TO COVID-19 REGULATIONS 102 -- 7.7 MESSAGE TO THE GOVERNANCE 103 -- 8 EVALUATION OF PROTOCOL 3 BY MEANS OF A META-EVALUATION INSTRUMENT 104 -- 8.1 THE STRATEGIC DIMENSION 109 -- 8.2 THE QUALITY DIMENSION 111 -- 8.3 THE PRACTICE DIMENSION 113 -- 8.4 THE FINANCIAL DIMENSION 118 -- 8.5 THE INNOVATION DIMENSION 119 -- 8.6 CONCLUSION 119 -- 9 INTEGRATION OF FINDINGS AND DISCUSSION 120 -- 9.1 POLICIES AND POLITICS ON INTEGRATION OF CARE AND PROTOCOL 3 121 -- 9.2 INTEGRATION OF THE RESULTS ON SYSTEM-, PROCESS-, AND PATIENT-LEVEL 124 -- 9.3 INDICATING FRAMEWORK CONDITIONS FROM A PRACTICE PERSPECTIVE 130 -- 9.4 THE QUINTUPLE AIM OF INTEGRATED CARE 134 -- 9.5 STUDY LIMITATIONS 135 -- 9.6 IN CONCLUSION 137 -- REFERENCES 140 -- APPENDICES 145 -- APPENDIX 1. INTERVIEW GUIDES 14