Background: In the World Health Report 2000, Spain ranked 7th out of 191 countries regarding health systems performance. According to WHO's world health statistics, in 2015 life expectancy at birth in Spain was 82.8, the third highest in the world. The Spanish state is made up of the central state and 17 decentralized autonomous communities, responsible for payment with public funds as well as healthcare budgeting, and organization of the delivery of services. The right to health protection for all citizens, the right of universal access to health care, and a strong primary care are common elements in all the regions. Added to this, in the last years, the Strategy of Care for People with Chronic Diseases, has represented the strategic framework to drive the development of integrated initiatives in most of the regions in Spain. These three regions were selected as being within the most advanced in the implementation of new innovative integrated care initiatives. Objectives: To explore, identify, describe and analyze the main innovative integrated care initiatives implemented in the three regions that could be translated to the United States. To develop several case studies about integrated care initiatives with tangible results.

An introduction: The Strategy of Care for People with Chronic Diseases (SCPCD) is one of the main strategies in the Madrid Region. This strategy proposes some key elements for its application in each territory in order to achieve a better integrated-care, elements that include interventions that have proven to be effective and efficient as well as the adaptation of the care model to the needs of the patients.The Westernarea of Madrid, in particular, the area of influence of "Rey Juan Carlos" Hospital, is a territory where continuity of care and the integration of services has become a priority.It is the Madrid areawith the highest percentage of patients with high level of risk. The institutionalized population in nursing homes constitutes 2.5% of the total population and it is estimated that 4% of the population has complex chronic diseases. It is considered as one of the most advanced area in the application of new care routes and tools and also with initiatives such as a social and health plan for the integration between the hospital and social services and nursing homes.

Miquel Gómez; professional experience in an integrated care model Discussion: The survey that we have used was created by the research team to measure the professional experience related to the implementation of an integrated care model in a territory. There are only a few works in this field. Conclusions: Factors that favor implementation: the existence of a common strategic framework shared by the leaders involved, the continuous communication and in multiple ways, the existence of outcomes that respond to the needs, the continuous and visible improvement, the motivation and professional implication and the computer tools, which aid the implementation. Barriers to transformation: the existence of diverse IT structures and resources, sometimes the discrepancy between priorities and objectives, resistance to change, shortage of time to introduce changes, lack of cultural change. The results have been very useful to improve the integrated initiatives in this territory and in another like this. Limitations: The survey was designed and tested in the same territory. Suggestion for future research: We are extending the sample of participants and going to use the survey in another territories.

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