Guiding Principles for Transformation Towards Integrated Acute Care for Older Adults Close to Home: Lessons from Nine Dutch Regional Partnerships. A Realist Evaluation.

Background: Integrated Acute Care for Older People (IACOP) close to home is a promising approach to overcome care fragmentation, but little is know about effective meso- and macro-strategies to foster integration. This Realist Evaluation (RE) explores which strategies were employed and recommended in nine Dutch regional partnerships.

Methods: The Rainbow Model, RE-theory, Coleman's boat and ripple effects functioned as theoretical basis. We conducted a document analysis (n = 19), semi-structured interviews (n = 11) and two focus groups (n = 8). Participants were (project) managers, directors and experts. The qualitative data were clustered into guiding principles, underpinned with strategy-context-mechanism-outcome configurations.

Results: Six guiding principles for transformation towards IACOP close to home emerged. Meso-level principles included: 1) committing to a shared regional IACOP vision and goals; 2) fostering a culture of collaborative and coordinated action; 3) prioritising, implementing and developing micro-level interventions systematically. Macro-level principles were: 4) ensuring congruent policy; 5) stimulating functional integration and 6) stimulating normative integration.

Conclusions: Transforming towards IACOP close to home is complex and requires continuous action across integration levels, health practices and sectors. The meso-level principles guide regional partnerships in applying context-specific strategies; activating the underlying mechanisms for transformation like 'enjoying the process'. Yet, successful transformation also hinges on actions by system stakeholders.