An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study

Level	Dimension	Description dimension	Determinant MCN-IQ	Determinant DBC-IQ	Description determinant
Micro	Clinical integration	The coordination of person-focused care in a single process across time, place and discipline.	Case management	Case management	Coordination of care for clients’ with a high-risk profile (e.g. identifying risks, developing policies and guidance).
Micro	Clinical integration		Continuity	Continuity	The organization of care is aimed to provide fluid care delivery for an individual client.
Individual multidisciplinary care plan	Individual multidisciplinary care plan	Implementation of a multidisciplinary care plan at the individual client level.
Client participation	Client participation	Clients are (pro) actively involved in the design, organization and provision of care at the operational level.
Meso	Professional integration	Inter-professional partnerships based on shared competences, roles, responsibilities and accountability to deliver a comprehensive continuum of care to a defined population.	Inter-professional education	Inter-professional education	Inter-professional education for professionals focused on interdisciplinary collaboration.
Meso	Professional integration		Shared vision between professionals	Shared vision between professionals	A shared vision between professionals focused on the content of care.
Multidisciplinary guidelines and protocols	Multidisciplinary guidelines and protocols	Multidisciplinary guidelines and protocols are implemented coherently at the operational level.
Inter-professional governance	Inter-professional governance	Inter-professional governance focused on openness, integrity and accountability between professionals at the operational level (e.g. joint accountability, appeal on pursued policies and responsibilities).
Meso	Organizational integration	Inter-organizational relationships (e.g. contracting, strategic alliances, knowledge networks, mergers), including common governance mechanisms, to deliver comprehensive services to a defined population.	Performance management	Performance management	Collective elaborated performance management between organizations within the collaboration.
Meso	Organizational integration		Learning organisations	Learning organisations	Collective learning power between the organizations within the collaboration (e.g. joint research and development programs).
Complaints procedure	Complaints procedure	Existing complaints procedure for the partnership.
	Interest management	A climate that attempts to bridge the various interests (e.g. social, organizational and personal interests) at the operational, tactical and strategic level.
Macro	System integration	A horizontal and vertical integrated system, based on a coherent set of (informal and formal) rules and policies between care providers and external stakeholders for the benefit of people and populations.	Stakeholder management	Stakeholder management	Engagement of various stakeholders (e.g. municipality, patient organizations and health insurance company).
Macro	System integration		Environmental climate	Environmental climate	Political, economic and social climate in the environment of the collaboration (e.g. market characteristics, regulatory framework, competition).
	Available resources	Available resources in the environment of the collaboration (e.g. usable buildings, (over) capacity, professionals and funding streams).
	Good governance	Creating trust towards external stakeholders (e.g. municipality and health insurance company) due to working method, reputation, management, control and/or supervision.
Micro, meso, macro	Functional integration	Key support functions and activities (i.e. financial, management and information systems) structured around the primary process of service delivery, to coordinate and support accountability and decision making between organizations and professionals to add overall value to the system.	Information management	Information management	Aligned information management systems accessible at operational, tactical and strategic levels (e.g. monitoring and benchmarking systems).
Micro, meso, macro	Functional integration		Service management	Service management	Aligned service management for the client (e.g. collective telephone number, counter assistance and 24-hour access).
Regular feedback of performance indicators	Regular feedback of performance indicators	Regular feedback of performance indicators for professionals at the operational level to enable them to improve their performance.
	Resource management	Coherent use of resources (e.g. collective real estate and funding).
Micro, meso, macro	Normative integration	The development and maintenance of a common frame of reference (i.e. shared mission, vision, values and culture) between organizations, professional groups and individuals.	Experienced trust		The extent to which those involved in the collaboration at operational, tactical and strategic levels experience trust from their partners.
			Visionary leadership	Visionary leadership	Leadership based on a personal vision that inspires and mobilizes people.
			Quality features of the informal collaboration	Quality features of the informal collaboration	Effectiveness and efficiency of the informal collaboration at the operational, tactical and strategic levels (e.g. group dynamics and attention to the undercurrent).
Trust	Trust	The extent to which those involved in the collaboration at operational, tactical and strategic levels trust each other.
	Reliable behaviour	The extent to which the agreements and promises within the collaboration are fulfilled at operational, tactical and strategic levels.

[i] Adapted with permission from: “Towards a taxonomy for integrated care; a mixed-methods study” [28].

* Both questionnaires are available in English and Dutch (see attached files). Researchers are allowed to use the questionnaires for research purposes after permission of the author.

Table 2

Missing item values and the maximum percentage missing per item for each dimension of integration for MCN-IQ and DBC-IQ.

Dimension	MCN-IQ (n = 707)				DBC-IQ (n = 58)
Dimension	Total items	Missing items (n)	Missing per domain (%)	Missing per item; maximum (%)	Total items	Missing items (n)	Missing per domain (%)	Missing per item; maximum (%)
Clinical integration	2532	296	12	11.1	222	10	5	6.9
Professional integration	2659	169	6	8.8	223	9	4	6.9
Organizational integration	1943	178	9	10.9	223	9	4	6.9
Functional integration	1923	198	10	11.6	220	12	5	13.8
System integration	1317	97	7	10.9	214	18	8	12.1
Normative integration	2586	242	9	9.3	224	8	4	5.2
Total	12960	1180	9	10.4	1326	66	5	8.6

Table 3

Integration characteristics of Maternity Care Networks.

			CI		PI		OI		FI		SI		NI		TI
VSV	N	Range	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD
1	32	1–4	2.05	0.46	2.35	0.67	2.14	0.55	1.43	0.37	1.75	0.71	2.80	0.51	2.09	0.38
2	30	1–4	1.98	0.53	2.29	0.59	1.97	0.39	1.63	0.52	2.13	0.56	2.79	0.45	2.13	0.33
3	13	1–4	1.73	0.31	2.53	0.60	2.12	0.43	1.21	0.29	1.69	0.60	2.85	0.55	2.02	0.33
4	27	1–4	2.27	0.53	2.37	0.59	1.94	0.37	1.43	0.45	2.33	0.65	2.88	0.48	2.20	0.30
5	23	1–4	1.80	0.31	2.41	0.58	2.02	0.25	1.46	0.44	1.98	0.80	2.55	0.61	2.04	0.36
6	18	1–4	1.95	0.47	2.81	0.59	2.30	0.27	1.78	0.44	2.61	0.37	3.06	0.36	2.42	0.21
7	24	1–4	2.18	0.47	3.02	0.77	2.61	0.46	2.17	0.48	2.56	0.66	3.16	0.56	2.62	0.40
8	13	1–4	1.92	0.48	1.58	0.44	1.67	0.70	1.26	0.31	1.65	0.66	2.47	0.46	1.76	0.33
9	27	1–4	2.18	0.35	2.77	0.49	2.43	0.43	1.74	0.52	2.59	0.64	3.07	0.50	2.46	0.34
10	35	1–4	1.59	0.42	2.50	0.49	2.18	0.37	1.44	0.38	2.40	0.71	2.71	0.53	2.13	0.26
11	35	1–4	1.69	0.38	1.92	0.51	1.92	0.40	1.21	0.28	1.36	0.51	2.60	0.59	1.78	0.29
12	28	1–4	2.46	0.57	2.73	0.63	2.32	0.51	1.76	0.57	2.07	0.73	3.17	0.51	2.42	0.42
13	50	1–4	1.74	0.33	2.17	0.57	2.00	0.39	1.46	0.42	1.45	0.52	2.52	0.47	1.89	0.29
14	32	1–4	1.67	0.36	1.82	0.47	1.83	0.50	1.19	0.26	1.91	0.50	2.41	0.52	1.81	0.27
15	15	1–4	1.79	0.43	2.02	0.71	1.97	0.56	1.36	0.50	2.07	0.56	2.62	0.43	1.97	0.35
16	12	1–4	2.08	0.50	2.07	0.62	1.89	0.23	1.14	0.17	1.67	0.44	2.44	0.57	1.88	0.27
17	32	1–4	2.38	0.53	2.13	0.59	1.97	0.55	1.76	0.44	2.34	0.57	2.49	0.64	2.18	0.38
18	22	1–4	1.53	0.23	1.91	0.25	1.86	0.25	1.17	0.22	2.11	0.49	2.11	0.38	1.78	0.14
19	20	1–4	2.04	0.50	2.18	0.77	2.16	0.46	1.47	0.40	2.38	0.58	2.91	0.66	2.19	0.45
20	44	1–4	1.85	0.41	1.80	0.41	1.86	0.50	1.23	0.21	1.95	0.63	2.19	0.58	1.81	0.28
21	31	1–4	1.74	0.39	1.97	0.48	2.08	0.58	1.32	0.30	1.69	0.53	2.61	0.56	1.90	0.31
22	22	1–4	1.95	0.41	1.97	0.54	2.02	0.62	1.35	0.44	1.86	0.64	2.51	0.51	1.94	0.38
23	29	1–4	1.73	0.40	2.20	0.50	1.98	0.49	1.25	0.27	1.29	0.47	2.54	0.58	1.83	0.30
24	20	1–4	1.75	0.46	2.47	0.50	2.07	0.28	1.43	0.39	1.95	0.39	2.82	0.37	2.08	0.24
Total	634	1–4	1.91	0.49	2.23	0.64	2.05	0.49	1.45	0.45	1.97	0.70	2.66	0.59	2.05	0.39
			F(23,610) = 9.29***		F(23,610) = 10.11***		F(23,610) = 4.93***		F(23,610) = 10.10***		F(23,610) = 11.52***		F(23,610) = 7.56***		F(23,610) = 14.31***

[i] ^*p < 0.05; **p < 0.01; ***p < 0.001.

CI: Clinical Integration, PI: Professional Integration, OI: Organizational Integration, FI: Functional Integration, SI: System Integration, NI: Normative Integration, TI: Total Integration.

Integration profiles of Maternity Care Networks and birth centres (sorted by total integration score).*
*CI: Clinical Integration, PI: Professional Integration, OI: Organizational Integration, FI: Functional Integration, SI: System Integration, NI: Normative Integration.

Table 4

Mean, SD, Range and Cronbach’s α for each dimension of integration for MCN-IQ and DBC-IQ.

Dimension	MCN-IQ (n = 634)					DBC-IQ (n = 56)
Dimension	Number of items	Mean	SD	Range	Cronbach’s α	Number of items	Mean	SD	Range	Cronbach’s α
Clinical integration	4	1.91	0.49	2.50	0.44	4	2,59	0,47	1,75	0.53
Professional integration	4	2.23	0.64	3.00	0.55	4	2,82	0,77	3,00	0.53
Organizational integration	3	2.05	0.49	2.50	0.36	4	2,68	0,70	2,75	0.63
Functional integration	3	1.45	0.45	2.33	0.40	4	2,31	0,76	2,75	0.62
System integration	2	1.97	0.70	3.00	0.14	4	2,54	0,47	2,00	0.28
Normative integration	4	2.66	0.59	2.75	0.66	4	3,41	0,48	1,75	0.62
Total					0.82					0.86

Table 5

Integration characteristics of birth centres.

			CI		PI		OI		FI		SI		NI		TI
BC	N	Range	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD
1	2	1–4	2.83	0.24	3.38	0.18	2.88	0.18	2.50	0.35	2.70	0.14	4.00	0.00	3.05	0.07
2	1	1–4	2.25		2.00		1.50		3.33		2.33		3.50		2.49
3	4	1–4	2.19	0.38	2.06	0.72	2.00	0.41	1.56	0.38	2.65	0.47	3.31	0.77	2.30	0.45
4	2	1–4	2.13	0.18	3.13	0.53	3.13	0.18	1.63	0.18	2.40	0.28	4.00	0.00	2.73	0.16
5	3	1–4	2.67	0.29	2.33	0.95	2.50	1.09	2.17	0.63	2.73	0.46	3.75	0.43	2.69	0.62
6	1	1–4	2.75		2.75		2.50		2.00		2.60		3.75		2.73
7	3	1–4	2.83	0.29	2.36	0.13	1.92	0.38	2.11	0.54	2.47	0.31	2.92	0.38	2.43	0.09
8	3	1–4	2.50	0.25	3.42	0.14	3.42	0.29	2.56	0.51	2.62	0.20	3.25	0.50	2.96	0.21
9	3	1–4	3.17	0.58	3.58	0.72	3.50	0.66	3.25	0.43	3.07	0.58	3.50	0.43	3.34	0.57
10	3	1–4	2.08	0.58	2.58	0.29	2.58	0.38	1.50	0.66	2.33	0.12	3.25	0.66	2.39	0.34
11	2	1–4	2.13	0.18	2.50	1.06	2.71	1.47	2.13	0.53	2.70	0.99	3.88	0.18	2.67	0.68
12	3	1–4	2.42	0.29	2.08	0.14	2.92	0.63	1.42	0.52	2.18	0.55	3.17	0.29	2.36	0.30
13	2	1–4	2.75	0.00	3.00	0.94	3.13	0.18	2.38	0.53	2.71	0.06	3.50	0.35	2.91	0.34
14	2	1–4	2.50	0.35	2.50	0.71	1.88	0.18	1.88	0.88	1.98	0.32	4.00	0.00	2.45	0.18
15	2	1–4	2.13	0.18	2.88	0.88	2.63	0.88	1.88	1.24	2.10	0.71	2.88	0.53	2.41	0.74
16	2	1–4	3.00	0.00	3.25	0.71	2.63	0.88	3.13	0.53	2.35	0.21	3.46	0.29	2.97	0.44
17	2	1–4	2.38	0.88	3.13	0.53	2.63	0.53	1.88	0.18	2.30	0.14	3.38	0.18	2.61	0.06
18	2	1–4	2.25	0.35	1.54	0.29	2.00	0.35	2.38	0.88	2.88	0.18	3.13	0.53	2.36	0.10
19	5	1–4	3.10	0.14	3.75	0.31	3.25	0.56	3.35	0.29	2.61	0.56	3.25	0.40	3.22	0.19
20	3	1–4	2.97	0.46	2.50	0.66	2.33	0.29	2.56	0.10	2.34	0.59	3.44	0.27	2.69	0.31
21	1	1–4	2.00		3.00		2.75		2.50		3.00		3.50		2.79
22	3	1–4	2.75	0.50	2.83	0.88	2.58	0.52	2.08	0.88	2.13	0.31	2.92	0.63	2.55	0.57
23	2	1–4	2.75	0.35	3.75	0.00	3.38	0.18	3.13	0.18	3.40	0.28	3.75	0.00	3.36	0.07
Total	56	1–4	2.59	0.47	2.82	0.77	2.68	0.70	2.31	0.76	2.54	0.47	3.41	0.48	2.73	0.45
			F(22,35) = 1.80		F(22,35) = 2.13*		F(22,35) = 2,08*		F(22,35) = 5.58***		F(22,35) = 1.38		F(222,35) = 1.21		F(22,35) = 1.81

[i] ^*p < 0.05; **p < 0.01; ***p < 0.001.

CI: Clinical Integration, PI: Professional Integration, OI: Organizational Integration, FI: Functional Integration, SI: System Integration, NI: Normative Integration, TI: Total Integration.

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DOI: https://doi.org/10.5334/ijic.2522 | Journal eISSN: 1568-4156

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Language: English

Submitted on: Sep 1, 2016

Accepted on: May 24, 2017

Published on: Jun 21, 2017

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

integrated care,

questionnaire,

psychometric properties,

validity,

birth care

© 2017 Inge C. Boesveld, Pim P. Valentijn, Marit Hitzert, Marieke A.A. Hermus, Arie Franx, Raymond G. de Vries, Therese A. Wiegers, Marc A. Bruijnzeels, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 17 (2017): Issue 2

An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study

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