Introduction: Notwithstanding care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of integrated care lacks specificity and clarity. This article presents a literature review to identify mechanisms for achieving integrated care objectives.

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Integrated care is seen as an important new method towards more demand-driven and costconscious health systems. In November 2013, a 4-year, multidisciplinary and multi-method research project on integrated care in Flanders (Belgium) was launched: CORTEXS-Integrating Care. The €3 million project focuses on long term care. CORTEXS strives to combine high quality innovative basic research with a strategic utilization of the research results. The research agenda covers three domains: To develop concepts of integrated care that meet the requirements of availability, quality, feasibility, patient empowerment and job quality; To optimize the work processes and design of care organizations in terms of care quality, job quality, and productivity; To identify the conditions that foster (or impede) effective organizational coordination, normative integration and implementation of high quality care concepts. Especially the innovative

Background: For some time now, integrated care has been put forward to create a more demand-driven, patientcentred and cost-effective care system. Various conceptual frameworks have been developed to shed light on the complex concept. However, they lack insight into the mechanisms driving integrated care in practice. The aim of this paper is to gain insight into how integrated care is realised in practice. Methods: Six cooperation projects in Flanders were compared on five integration mechanisms. A content analysis of secondary sources on each of the cases and semi-structured interviews with representatives of these cases was conducted. The data were analysed using comparison tables. Results: Six cases representing five cooperation models in the Flemish health and social care were analysed for the presence of integrated care mechanisms. Six of the 22 mechanisms are present in all case examples. Half of the identified mechanisms concern the integration of professionals. Integrated care in these Flemish cases refers mainly to organising a case meeting, appointing a case manager and dividing the tasks between care professionals. Integration of support is less developed. Conclusions: The bottom-up approach to study the practical implementation of mechanisms is a fruitful approach, since it brings into light the complex realities and practicalities of the mechanisms of integration and how they are shaped by local actors in local contexts. The approach shows how Flemish and Belgian policy makers are struggling to scaling up these integration models, whilst at the same time responding to local conditions and needs.

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