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SCALING INTEGRATED CARE IN CONTEXT [SCIROCCO] [710033] - Project
Project abstract

Grounded in the extensive experience of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), SCIROCCO aims to provide a validated and tested tool that facilitates the successful scaling-up and transfer of good practices in integrated care across European regions. SCIROCCO will specifically focus on successful local interventions (good practices) that have demonstrated significant benefits to citizens, communities and service providers and that feature moving towards community-based, integrated health and social care service models.SCIROCCO will deliver an assessment of the contextual requirements necessary for the scale-up of these interventions and the capacity of regions to adopt them. SCIROCCO will also compare the readiness of five European regions to adopt good practices in the provision of integrated care, to demonstrate the effectiveness of the tool in practice.SCIROCCO explores how matching regions that have complementary strengths and weaknesses can deliver two major benefits: a strong basis for successful twinning and coaching that facilitates shared learning and effective knowledge transfer; and practical support for the scaling-up of good practices that promote active and healthy ageing and participation in the community.Finally, SCIROCCO captures the lessons learned from twinning, coaching and knowledge transfer activities as a significant contribution to supporting the broader implementation and scaling-up of local integrated care interventions in Europe, in line with the European Commission's 'European Scaling-up Strategy in Active & Healthy Ageing'.

Summary of context, overal objectives, strategic, relevance and contribution of the action

Overall Objectives of SCIROCCO
Grounded in the experience of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), SCIROCCO aims to provide a refined and tested tool to facilitate scaling-up and transfer of good practices in integrated care across the regions of Europe. SCIROCCO will specifically consider local interventions showing the benefits of moving towards community-based health and social care.

Strategic Relevance and Contribution of the Action to the Health Programme
This proposal addresses 2.1.3 Actions under Thematic Objective 3 – Contributing to innovative, efficient and sustainable health systems, and specifically, 2.1.3.1 Support for the implementation and scaling up of good practices in the areas of integrated care, frailty prevention, adherence to medical plans and age-friendly communities (Thematic Priority 3.5 of Annex to the Programme Regulation).

SCIROCCO will contribute to the annual Work Programme in four ways, through:
1. Specific contributions to the EIP on AHA.
2. Specific contributions to the European Scaling Up Strategy in Active and Healthy Ageing and its 5 steps model of scaling-up.
3. Compatibility with a three (or more) complementary activities and existing actions, namely: Joint Actions addressing chronic diseases and promoting healthy ageing across the life cycle (CHRODIS-JA) and EIP on AHA.SCIROCCO will also seek synergies with projects under Horizon 2020 and INTERREG Europe funding programmes.
4. Liaison with six (or more) existing European networks involved in scaling-up, namely: Community of Regions for Assisted Living (CORAL); The International Foundation for Integrated Care (IFIC); The Assembly of European Regions (AER); European Regional and Local Health Authorities (EUREGHA); European Connected Health Alliance (ECHA); European Regions for Research and Network Innovation (ERRIN).

Methods and means

SCIROCCO uses a step-based approach, with each of the steps reflecting SCIROCCO’s specific objectives. The process is described in detail below:

Step 1: Validity assessment of the B3-MM
Step 2: Maturity assessment of good practices
Step 3: Refinement of the B3-MM
Step 4: Self-assessment of European regions
Step 5: Further refinement of the B3-MM

Work performed during the reporting period

The following work was performed during this reporting period:
a) Establishment of a functioning Consortium, planning and organisation of the tasks and responsibilities of the partners.
b) Establishment of communication channels to facilitate effective communication with the partners.
c) Three project assembly meetings were organised during this reporting period; Project Kick-off Meeting, Luxembourg, 11-12 April 2016; First Project Assembly Meeting, Bilbao, 18-19 October 2016; Second Project Assembly Meeting, Puglia, 27-28 June 2017.
d) Active liaison with other EU funding projects and European and international networks.
e) Project website and branding.
f) Project leaflet introducing the project, its objectives, expected outcomes and partners was designed and delivered on 1 August 2016.
g) Dissemination Strategy and Action Plan has been developed and is updated regularly on quarterly basis.
h) Validation of the B3-MM through the Delphi study.
i) Collection of 30 good practices in integrated care in 5 SCIROCCO regions.
j) Assessment of maturity requirements of 15 good practices with potential for scaling-up in 5 European regions.
k) Two refinements of the B3-MM in terms of the changes to the descriptions of the domains and improvements in the definitions of the assessment scales.
l) First prototype of an online self-assessment tool.
m) Methodology / Guide on how to use SCIROCCO online self-assessment tool.
n) Development of training materials on how to use SCIROCCO tool.
o) Self-assessment process in five SCIROCCO regions.
p) Testing of SCIROCCO tool in 30 European regions and organisations in Europe.
q) Organisation of the focus group meetings to capture the experience of local stakeholders with SCIROCCO tool.

The main output achieved so far and their potential impact and use by target group (including benefits)

The development of an online self-assessment tool for integrated care at the early stage of the project (December 2016) is the major result of SCIROCCO project at this interim reporting period. The tool was designed on the basis of validated B3 Maturity Model (B3-MM) for Integrated Care. The user-centred design is the core principle in the designing of the tool. This earlier introduction of the tool allows for its continuous refinement and improvement reflecting regularly the feedback of the users of the tool. The tool was also translated in three additional languages (Czech, Italian and Spanish) to facilitate the access of stakeholders to the tool. A number of illustrative videos, educational and training documents were developed to support the use of the tool.

The tool has been tested so far in the assessment of maturity requirements of good practices and maturity of health and social care systems. More than 30 European regions are currently involved in the testing of the SCIROCCO tool that illustrates its good uptake and use throughout Europe. The experience of stakeholders with the SCIROCCO tool is systematically captured and analysed to inform its future potential use.

Achieved outcomes compared to the expected outcomes

The following expected outcomes were envisaged for SCIROCCO in this reporting period:

1. Improved access to learning embedded in good practices
SCIROCCO validated the B3-MM as the tool for the maturity assessment of good practices. The intention was to contribute to an improved understanding of the contextual requirements of good practices as preconditions for their successful scaling-up and replication in Europe. However, further work is needed to explore how to improve SCIROCCO adopted methodology to make embedded learning more readily accessible to potential adopters to stimulate and accelerate the implementation process of good practices in the provision of integrated care in Europe.

2. Improved capacity of regions for adoption of good practices
SCIROCCO has initiated the assessment of the maturity of the context of the health and care system to understand its readiness and capacity for the adoption of a particular good practice. The experience of the regions is systematically captured to inform about the outcomes of this activity.

3. Increased use of the B3-MM in the process of scaling-up
SCIROCCO provided a refined and tested B3-MM to assist regions with scaling-up and adoption of good practices. SCIROCCO tool and methodologies on how to improve the process of knowledge trasnfer learning were developed and are currently testing to help to maximise the scaling-up of integrated care solutions. Currently, more than 30 European regions are involved in the testing of the SCIROCCO tool for this purpose.

Dissemination and evaluation activities carried out so far and their major results

SCIROCCO Dissemination activities

The main objective of SCIROCCO dissemination activities is to raise awareness about the project activities and engage with its targeted audience in order to test the SCIROCCO tool and exploit its future refinement and improvement. SCIROCCO has contributed to over 30 dissemination events so far. SCIROCCO actively engages with various European, national and regional networks and EU funded projects to disseminate the project findings and increase the impact of project's activities. In addition, collaboration with other EU funded projects has been established in order to align activities of SCIROCCO projects and maximise the impact of these projects.

These engagement activities led to the following results:
a) Members of the B3 Action Group on Integrated Care of the EIP on AHA: contributed to the Delphi study with the objective to validate the B3-MM; submitted 5 good practices for SCIROCCO project to test the B3-MM as a tool to assess the maturity requirements of the good practices;contributed to the refinement and further improvement of the B3-MM; participated and contributed to SCIROCCO dissemination events; were invited to collaborate with the EU Expert Group on Health Systems Performance Assessment (HSPA) on a new report related to the assessment of integrated care "Tools and Methodologies to Assess Integrated Care in Europe".
b) The European Social Network actively tested the B3-MM as a tool to assess the maturity requirements of good practices in the real life setting of the Mararo City in Catalonia.
c) Three regional and healthcare authorities of EUREGHA, Flanders region in Belgium, Catalonia and Skane in Sweden, tested the B3-MM as a tool to assess the maturity of healthcare systems. All three regions will also be involved in the upcoming twinning and coaching activities for SCIROCCO project.
d) A joint dissemination workshop with EUPHA (Section on Chronic Diseases) at European Public Health Conference in Vienna on 10-12 November 2016.
e) Reference to the B3-MM and the submission of SCIROCCO good practices for the "European Blueprint - Digital Innovation for the Ageing Society" as part of EHTEL's involvement as a Blueprint Champion.

SCIROCCO Evaluation activities
The following evaluation activities have been carried out so far in the SCIROCCO project:
a) Testing of validity and reliability of the B3 Maturity Model for Integrated Care (B3-MM)
First, a review literature was undertaken to compare B3-MM with other instruments developed to measure the level of maturity of integrated care. Following on, an international Delphi Study was performed. Full agreement among the experts on the relevance of the 12 B3-MM dimensions, their indicators, and assessment scale was reached after the third Delphi round. The outcomes of the study were presented in the form of a paper and submitted to a peer-reviewed scientific journal.
b) Measuring of knowledge transfer
The DMIC Quick Scan based on the validated Development Model of Integrated Care (Minkman et al.) is being used to test the construct validity of SCIROCCO tool. The survey was translated in three languages (Czech, Italian and Spanish) to increase the response rate from the local sites. All stakeholders who participated in the local self-assessment processes in 5 SCIROCCO regions have be invited to fill out the DMIC survey at baseline and one follow-up measurement.