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The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

Mirella MN Minkman1*, Robbert P Vermeulen2, Kees TB Ahaus3 and Robbert Huijsman4

Author Affiliations

1 Vilans, National Center of Excellence for Long-term care, PO Box 8228, 3503 RE Utrecht, The Netherlands

2 Thorax Center, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands

3 University of Groningen, Faculty of Economics and Business, Research Center on Healthcare Organization & Innovation. University Medical Center Groningen Landleven 5, 9747 AD, Groningen, The Netherlands

4 Erasmus University Rotterdam, Institute of Health Policy and Management, PO Box 1738, 3000 DR Rotterdam, The Netherlands

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BMC Health Services Research 2011, 11:177  doi:10.1186/1472-6963-11-177

Published: 30 July 2011



Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia.


Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests.


The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities.


Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices.