Population ageing and the economic crisis have put pressure on European health systems. Presently, it is not known what the best way is to respond to these challenges. In an increasing number of EU Member States, a diverse range of integrated care initiatives are being put in place as new models for safe and efficient, prevention-oriented care to an increasing number of older people. Evidence of the effectiveness of integrated care is, however, inconclusive. Also there is little knowledge of how to successfully implement integrated care and of how to transfer successful initiatives to other regions and health systems. Studies across the EU identify continuing structural, organisational and professional barriers to implementation. So, while integrated care is being rolled out and infrastructures are in place, improvements to existing initiatives are necessary to make them more patient-centred, prevention-oriented, efficient, and safe; hence this makes the focus of this proposal on integrated care for older people relevant.

Moreover, approaches are needed that actively and meaningfully engage all stakeholders and that optimally facilitate the transfer and uptake of best practice across contexts and countries. The overall aims of SUSTAIN are therefore twofold: 1. to improve established integrated care initiatives for older people living at home with multiple health and social care needs, ensuring they are patient-centred, prevention-oriented, efficient, and safe; 2. to ensure that improvements to the integrated care initiatives are applicable and adaptable to other health systems and regions in Europe. In seven countries, established integrated care initiatives will therefore be improved in co-creation with local stakeholders.

The implementation processes and overall evaluation will be guided by our multimethodological approach, the Evidence Integration Triangle. Overarching analyses will be undertaken to compare and integrate data from the different sites to robustly identify what works for whom, in what context and with what outcome. As such, we will obtain EU evidence on the applicability and adaptability of integrated care initiatives for older people living at home with multiple health and social care needs in relation to different European health systems and regions. Equally importantly, we will identify the steps that are necessary to realise improvement of existing initiatives. Project results will be translated to a roadmap targeted at policy-makers and decision-makers in care systems tasked with designing, establishing and maintaining systems of integrated care that focus on older people with complex needs. We will develop a mixed-methods interactive approach to explore the interests of policy-maker