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Background: To address issues related to suboptimal insight in outcomes, fragmentation, and increasing costs, stakeholders are experimenting with value-based payment (VBP) models, aiming to facilitate high-value integrated care. However, insight in how, why and under what circumstances such models can be successful is limited. Drawing upon realist evaluation principles, this study identifies context factors and associated mechanisms influencing the introduction of VBP in stroke care. Methods: Existing knowledge on context-mechanism relations impacting the introduction of VBP programs (in real-world settings) was summarized from literature. These relations were then tested, refined, and expanded based on a case study comprising interviews with representatives from organizations involved in the introduction of a VBP model for integrated stroke care in Rotterdam, the Netherlands. Results: Facilitating factors were pre-existing trust-based relations, shared dissatisfaction with the status quo, regulatory compatibility and simplicity of the payment contract, gradual introduction of down-side risk for providers, and involvement of a trusted third party for data management. Yet to be addressed barriers included friction between short- and long-term goals within and among organizations, unwillingness to forgo professional and organizational autonomy, discontinuity in resources, and limited access to real-time data for improving care delivery processes. Conclusions: Successful payment and delivery system reform require long-term commitment from all stakeholders stretching beyond the mere introduction of new models. Careful consideration of creating the 'right' contextual circumstances remains crucially important, which includes willingness among all involved providers to bear shared financial and clinical responsibility for the entire care chain, regardless of where care is provided. [ABSTRACT FROM AUTHOR]

Introduction: Integrated stroke care in the Netherlands is constantly changing to strive to better care for stroke patients. The aim of this study was to explore if and on what topics integrated stroke care has been improved in the past three years and if stroke services were further developed. Methods: A web based self-assessment instrument, based on the validated Development Model for Integrated Care, was used to collect data. In total 53 coordinators of stroke services completed the questionnaire with 98 elements and four phases of development concerning the organisation of the stroke service. Data were collected in 2012 and 2015. Descriptive-comparative statistics were used to analyse the data. Results: In 2012, stroke services on average had implemented 56 of the 89 elements of integrated care (range 15-88). In 2015 this was increased up to 70 elements on average (range 37-89). In total, stroke services showed development on all clusters of integrated care. In 2015, more stroke services were in further phases of development like in the consolidation and transformation phase and less were in the initiative and design phase. The results show large differences between individual stroke services. Priorities to further develop stroke services changed over the three years of data collection. Conclusions: Based on the assessment instrument, it was shown that stroke services in the Netherlands were further developed in terms of implemented elements of integrated care and their phase of development. This three year comparison showed unique first analyses over time of integrated stroke care in the Netherlands on a large scale. Interesting further questions are to research the outcomes of stroke care in relation to this development, and if benefits on patient level can be assessed. [ABSTRACT FROM AUTHOR]

Introduction: The Rotterdam Stroke Service (RSS) in the Netherlands, is a stroke service network of hospitals, nursing homes, rehabilitation centers and community care organizations, collaborating to provide an optimal quality of care after stroke for patients in the acute, rehabilitation and chronic phase. The aim of the RSS is to realize an optimal treatment and outcomes for every stroke patient, according to the most recent (scientific) standards. Policy Context and objective: Audits should make it possible to check on quality of care, although it is a challenge to judge if the care process and quality of collaboration in an integrated care network is sufficient. Therefore a unique instrument for auditing the quality of collaboration was developed. Targeted population: The Stroke Knowledge Network Netherlands (SKNN) developed a unique audit instrument derived from the Development Model for Integrated Care (DMIC) (1). The DMIC consists of nine clusters in which is described what is necessary to realize good quality of care. Also, the indicators from the Dutch Institute for clinical auditing and care standard CVA/TIA were integrated in the audit instrument. The instrument exists of 2 main parts: self-evaluation and care standard (38 norms) and benchmark (4 norms). The actual working methods are compared with regulations, evidence based guidelines, norms/indicators and regional agreement/commitment. The audit focusses particularly on collaboration with integrated care partners and that is what makes the audit instrument unique. In 2017, an audit team from SKNN visited the RSS and used the new audit instrument. The audit team studied documentation and information beforehand: i.e. (transfer of) medical files, documentation about (the education of) the personnel/workforce, agreements and guidelines. During the audit they made a tour in the organizations and interviewed numerus health care workers. After the audit, they reported on their findings. High lights (innovation, impact and outcomes): Seven stroke services received a report on their best practices and points of improvement. The audit team complimented the RSS for their clear information and the comprehensive commitment of all the integrated care partners. The organization and quality of education and research were rated very positive. There was also much appreciation for the "stroke after-care" method that was developed in the RSS. Points of improvement were the interdisciplinary collaboration, exchange of patient information via ICT and involvement of informal caregivers. Furthermore, results of new projects were not always sufficiently disseminated between the organizations and the collaboration between the integrated care partners and general practitioners was not always satisfactory. Comments on transferability: To be able to work on the points of improvement, the RSS organized a meeting with the organizations. Input of all the representatives have been translated in an improvement plan for 2018 and 2019. Innovative cure and care in the RSS creates a better treatment and rehabilitation environment, resulting in an increasing area of support among professionals in the stroke service. This seems to manifest itself in better communication, better data collection and a better quality of delivered stroke care. [ABSTRACT FROM AUTHOR]