title: Collaboration processes and perceived effectiveness of integrated care projects in primary care: a longitudinal mixed-methods study.
abstract: BACKGROUND
  Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness.
  
  
  METHODS
  A longitudinal mixed-methods study design based on two data sources (surveys and interviews) was used to identify the perceived degree of integration and patterns in collaboration among 42 ICPs in primary care in The Netherlands. We used cluster analysis to identify distinct subgroups of ICPs based on the final perceived degree of integration from a professional, organisational and system perspective. With the use of ANOVAs, the subgroups were contrasted based on: 1) changes in collaboration processes over time (shared ambition, interests and mutual gains, relationship dynamics, organisational dynamics and process management) and 2) final perceived effectiveness (i.e. rated success) at the professional, organisational and system levels.
  
  
  RESULTS
  The ICPs were classified into three subgroups with: 'United Integration Perspectives (UIP)', 'Disunited Integration Perspectives (DIP)' and 'Professional-oriented Integration Perspectives (PIP)'. ICPs within the UIP subgroup made the strongest increase in trust-based (mutual gains and relationship dynamics) as well as control-based (organisational dynamics and process management) collaboration processes and had the highest overall effectiveness rates. On the other hand, ICPs with the DIP subgroup decreased on collaboration processes and had the lowest overall effectiveness rates. ICPs within the PIP subgroup increased in control-based collaboration processes (organisational dynamics and process management) and had the highest effectiveness rates at the professional level.
  
  
  CONCLUSIONS
  The differences across the three subgroups in terms of the development of collaboration processes and the final perceived effectiveness provide evidence that united stakeholders' perspectives are achieved through a constructive collaboration process over time. Disunited perspectives at the professional, organisation and system levels can be aligned by both trust-based and control-based collaboration processes.
authors.affiliation: Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Wisselweg 33, 1314 CB, Almere, The Netherlands. p.valentijn@jvei.nl.|Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands. p.valentijn@jvei.nl.
authors.forename: Pim P
authors.initials: PP
authors.lastname: Valentijn
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. d.ruwaard@maastrichtuniversity.nl.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ruwaard
authors.affiliation: Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands. vrijhoef_hubertus@nuhs.edu.sg.|Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. vrijhoef_hubertus@nuhs.edu.sg.
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. debont@bmg.eur.nl.
authors.forename: Antoinette
authors.initials: A
authors.lastname: de Bont
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands. r.y.arends@utwente.nl.
authors.forename: Rosa Y
authors.initials: RY
authors.lastname: Arends
authors.affiliation: Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Wisselweg 33, 1314 CB, Almere, The Netherlands. m.bruijnzeels@jvei.nl.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bruijnzeels
mesh_terms: D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D017598:Efficiency, Organizational; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D017146:Models, Organizational; D009426:Netherlands; D010465:Perception; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D035502:Trust