The development of a tool to monitor integrated care for childhood overweight and obesity in the Netherlands

Abstract

PurposeThe development of a national model has led municipalities in the Netherlands to implement integrated care for childhood overweight and obesity. To monitor how this approach is being implemented locally, an appropriate tool is required. This study presents a “Tool to monitor the local implementation of Integrated Care for Childhood Overweight and obesity” (TICCO).Design/methodology/approachA three-step study was conducted in order to adapt and refine a generic integrated care questionnaire into a tool that suits the specific characteristics and context of integrated care for childhood overweight and obesity. The three consecutive steps comprised the following: a focus group session that assessed the relevance and comprehensiveness of the original integrated care instrument; a pilot questionnaire for end users that evaluated the feasibility of the preliminary tool and a pilot questionnaire that determined the feasibility and potential limitations of this adapted tool.FindingsThe adaptation process resulted in a 47-element digital tool for professionals actively involved in providing integrated care for childhood overweight and obesity. The results highlighted differences pertaining to how individual respondents judged each of the elements. These variations were found across both municipalities and different domains of integrated care.Originality/valueThis article presents an adapted tool that seeks to both support local discussion in the interpretation of individual TICCO scores and identify potential areas for improvement in local integrated care for childhood overweight and obesity.

The development of the Dutch “National model integrated care for childhood overweight and obesity”

“…This instrument, a questionnaire to monitor local integrated care of childhood overweight and obesity (TICCO), has two versions: one version for professionals operating in a central position within integrated care practice (such as coordinating professionals and project leaders) and another for local executing professionals (such as youth nurses and general practitioners). The development of the TICCO is described in Koetsier et al 2020 [52] (3) An overview of possible reasons for municipalities to opt for the integrated care based on what participants learned in the learning community and national advisers with experience in supporting local realisation of the approach [53] (4) An overview of practical obstacles when locally developing integrated care and practice-based suggestions on how to tackle these [54] (5) A practice-based format for a stakeholder analysis in order to map out important organisations when realising the integrated care locally [55] (6) A practice-based format to draw up a project plan when realising the integrated care locally [56] (7) A practice-based overview of relevant activities and professionals to analyse when realising the integrated care locally [57] (8) A practice-based profile for a project leader that can help select the right person to fulfil this role locally [58] Page 10 of 17…”

Measurement Instruments for Integration within Children and Young People Healthcare Systems and Networks: A Rapid Review of the International Literature

“…The study selection process can be seen in Figure 1. Of the 15 studies, eight studies were conducted in the USA [23][24][25][26][27][28][29][30], three in the Netherlands [31][32][33], two in Canada [34,35], and one each in Brazil [36] and Japan [37]. All the studies were published post-2000.…”

“…Eight studies measured integration within systems designed for children with medical complexity [23-26, 28, 33, 35, 37], two for mental health [29,34], and one each for ADHD [27], cerebral palsy [31], overweight and obesity [32], chronic conditions [30] and non-specific health condition [36]. Five studies described the development of a measurement instrument [25,29,31,35,36], and 14 studies included a type of evaluation of a measurement instrument: feasibility (n = 4) [23,26,32,34], reliability (n = 6) [27,29,30,34,35,37], and content (n = 3) [29,32,33], construct (n = 6) [24,[27][28][29][30]37] and criterion (n = 1) [29] validity. A summary of included studies is presented in Data file 2 and the list of excluded studies presented in Data file 3.…”

“…Table 1 shows the range of instruments used to measure integration and the different outcomes measured. The most frequent type of assessment used was a questionnaire, most commonly designed to be completed by healthcare and other professionals involved in the integrated healthcare system (n = 7) [27,32,[34][35][36][37], or caregivers (n = 4) [25,26,29,30], with one questionnaire completed by CYP themselves [29]. Two instruments Simple administration method (from visit records)…”

“…The most frequent integration outcomes assessed were quality of care coordination [23-26, 28, 30, 31, 36] (measured by seven instruments) and quality of collaboration [27,[33][34][35]37] (six instruments). The remaining integration outcomes assessed were: continuity of care [29] (two instruments), completeness of care [30,36] (two instruments), structure of care [36], quality of communication [31], and local implementation of integrated care [32] (each measured by one instrument, respectively). Three instruments measured more than one outcome: the Primary Care Assessment Tool -Brazil [36] (quality of care coordination, completeness of care and structure of care), the Paediatric Integrated Care Survey [30] (quality of care coordination and completeness of care), and a framework for evaluation patient care communication [31] (quality of care coordination and quality of communication).…”