Integrated care as a priority of the Basque Strategy for Chronic Diseases: the Bidasoa Integrated Healthcare Organisation

CONTEXT: The Basque Department of Health released in 2010 the “Strategy for tackling the challenge of chronicity in the Basque Country”. One of its five priority policies is contributing to the continuity of care for chronic patients. A key strategic project is the development of new integration initiatives and pilots projects in the public Basque Health System. Five different integration projects are already in place, with the Bidasoa Integrated Healthcare Organisation as the flagship project. AIM: The creation of the Bidasoa Integrated Healthcare Organisation as a public brand new organisation in January 2011 aims at integrating three primary care centres and their regional hospital of reference, covering a total population of 86,235 citizens. CASE DESCRIPTION: The Bidasoa integration process is characterised by its shared leadership, with converging top-down and bottom-up initiatives, and collaboration between top-management and clinicians. The initiatives for integration are operating simultaneously at different levels: strategic (integrated strategic plan), financial (common budget and capitation payment), managerial (integrated clinical management agreements), processes (integrated care pathways, development of transitional care nursing, creation of polipathology unit), tools (stratification of the population, unification of electronic health record), and research (development of action-research pilots).