Consensus on Integrated Care for Older People Among Dutch Experts: A Delphi Study

Area of Science:

• Gerontology
• Healthcare Management
• Public Health Policy

Background:

• An initial programme theory (PT) guided integrated care programmes (ICPs) for community-dwelling frail older people.
• ICPs require local tailoring, necessitating context-specific validation of programme elements.
• Previous rapid realist review (RRR) identified key interrelated factors influencing ICPs.

Purpose of the Study:

• To assess expert consensus on the relevance of RRR-identified items for ICPs in the Dutch setting.
• To refine the programme theory (PT) for integrated care programmes (ICPs) based on Dutch expert consensus.
• To ensure ICPs are contextually appropriate for frail older adults in the Netherlands.

Main Methods:

• A two-round e-Delphi study was conducted with Dutch experts.
• Seventy-one items identified in a prior RRR were evaluated for relevance.
• Expert consensus was determined through a structured Delphi process.

Main Results:

• Consensus on relevance was achieved for 57 out of 71 items (80%).
• Refined programme theory included factors like an increasing older population, hospital bed access, implementation processes, case management, patient portfolios, government roles, system alignment, care management, HCP-patient relationships, and feedback mechanisms.
• Key areas for refinement focused on system-level factors and provider-patient interactions.

Conclusions:

• The programme theory for integrated care programmes (ICPs) was successfully refined for the Dutch context.
• Items lacking consensus require further investigation to understand underlying reasons.
• The refined PT provides a more contextually relevant framework for implementing ICPs for frail older adults in the Netherlands.