Introduction
In Flanders, various initiatives aim to provide inclusive childcare for children with specific care needs, for example inclusion coaches, global individual support for young children and specific funding for inclusive childcare. Between 2018 and 2020, multifunctional centers (MFC) from the Flemish Agency for Persons with Disabilities (VAPH) and childcare organizations from the agency Growing Up (Flemish Agency for families and children) collaborated to explore ways to enhance inclusive childcare for children with severe multiple disabilities. The goal is to ensure all children, including those with complex care needs, can grow, play, and learn with peers, receiving necessary and high-quality care. In 2022 69 children younger than 3 years old received specialized daycare in a multifunctional center and could benefit from a collaboration between MFC and childcare.

Method
For children with more severe care needs, requiring disability-specific and medical support, collaboration is necessary. In a shared space, both day care and childcare services are provided. This approach ensures that highly specific needs can be addressed by qualified and paramedical staff while allowing children to engage in play and learning activities with their peers. This inclusive environment benefits not only children with specific care needs but also fosters understanding of an inclusive society for all children. This approach facilitates access to intensive support by lowering barriers and allows sharing expertise between paramedical staff and childcare workers.

Results
Harmonizing regulations between Agency Growing Up and VAPH was the initial step. Childcare facilities must be recognized by Agency Growing Up, adhering to regulations pertaining to personnel, infrastructure, etc. Therefore, this integrated childcare must also adhere to these regulations. The differences lie in how the funding is organized. Funding for childcare will be obtained from Agency Growing Up for at least two-thirds of the children, while funding for up to one-third will be obtained through the VAPH, such as in the case of a multifunctional center. This approach makes it possible to recruit both general caregivers and more specialized personnel, such as nurses and paramedics. Two organizations from different agencies, each with their own set of regulations, collaborate seamlessly. Staff members from both organizations work together in the same location, providing care for the same children.
Ganspoel, a MFC, has already taken initial steps. They searched for a childcare provider willing to establish a group childcare facility in collaboration with them. Together, they plan to offer 24 spaces, 8 of which will be specially reserved for children with (multiple) disabilities. Infrastructure is another challenge for Ganspoel. The building will be designed to allow for flexible grouping when necessary, with ample space for adapted materials for the children. The rooms are designed to facilitate monitoring of sleeping children. In addition, the building will also accommodate other projects. We aim to implement an integrated project, including additional partners and facilities in-house, such as a regional office of the child health clinic.
The presentation will focus on challenges and solutions in achieving integrated childcare for young children with disabilities, exploring both policy and practice perspectives.

This abstract outlines the implementation of evidenced-based design methodologies to develop an Integrated Service Delivery (ISD) model for the Irish Health Service Executive (HSE) Health Regions.
The initiative is a response to the Sláintecare reform and the Health Regions Implementation Plan, aiming to establish regional and local organisational structures that support and enable integrated care provision for the population of the Republic of Ireland, including health and social care service users, providers, and communities.
This initiative, aligned with co-production principles from the Health Services Change Guide and Public Service Design Principles, involves collaboration between the HSE Health Regions Programme Team, HSE Organisation Development and Design Team, and the Department of Health in Ireland. Ninety-eight individuals, comprising HSE staff, managers, partner agencies, policymakers, renowned Integrated Care experts, and patient advocacy groups, participated in a co-design methodology to evaluate high-level structural options for Integrated Service Delivery in Health Regions. The initiative aims to leverage the insights of those receiving and delivering services to inform integrated care practices.
The initiative employed evidence-based design methods, primarily guided by People’s Needs Defining Change – Health Services Change Guide (2018) and national government-endorsed design principles aligned with IFIC principles of Integrated Care. The project team strategically integrated these frameworks, conducting a comparative analysis to establish a robust evidence base for the design process.
Discover- Define -Empathise Three ISD workstream group events facilitated collaborative exploration of the Irish health service design challenge. Analyses of outputs identified patterns/user needs in alignment with IFIC Nine Pillars of Integrated Care.
Design-Ideate- Key stakeholder groups participated in individual and small group meetings over a 6 month period to generate solution-focused ISD options. Forums sought wider representation and feedback from GPs, Chief Academic Officer’s, frontline staff, service user partners and Chief Officer Groups.
Deliver-Prototype - Iterate- Frontline workshops tested and evaluated ISD structures with operational and clinical representation. The Department of Health's Irish Government Economic and Evaluation Service (IGEES) employed a rigorous Multi-Criteria Analysis, aligning with the Better Regulation Toolbox. The ISD workstream group completed the options appraisal process and a preferred ISD model was selected.
The evidence-based methodology outlined was applied in the practical development of advanced structural options for Integrated Service Delivery (ISD) within the Health Regions. The Multi-Criteria Options Appraisal not only produced a preferred high-level structural design for ISD but also generated valuable qualitative and quantitative data to guide forthcoming iterations of the design process and ultimately support final decision making on the model.
This initiative serves as a guiding blueprint for Integrated Service Delivery (ISD) model design for international stakeholders. It offers valuable insights for navigating ISD complexities and structures to support this. Inclusive engagement with diverse stakeholders, guided by co-production principles, underscores the significance of crafting solutions resonating with unique community needs. This approach aligns with the IFIC pillars of Shared Values and Vision, People as Partners in Care, System-wide Governance and Leadership, and Transparency of Progress, Results, and Impact.
Detailed design of the preferred model for ISD and implementation due to commence from June 2024.

Background:
Integrated youth services (IYS) provide low-barrier, accessible, interdisciplinary mental health and substance use (MHSU) services to youth in order to improve their social and health outcomes. Foundry, an IYS in British Columbia, Canada, launched virtual services in 2020, along with the Foundry BC app, to provide accessible services to all youth ages 12-24. Services include virtual counselling, peer support, physical/sexual health care, and work/study support. Using the app, youth have a choice of audio, video, or chat sessions with an integrated care team. Despite the promising growth of the service at Foundry, an evaluation of the service has not yet taken place.

Objective:
The objectives of our study were to 1) measure the extent to which the demographic and health profiles of youth who accessed Foundry BC app and in-person services differed; 2) understand the extent to which youth who accessed the Foundry BC App engaged in scheduling and receiving sessions with service providers; and 3) compare the types of services and rates of registrations in physical Foundry centres to those accessed Foundry BC app.

Methods:
Data on young people accessing Foundry services across physical centres and Foundry Virtual BC who have completed the Foundry health survey were analyzed for this study. Descriptive statistics analytics were used to understand trends and compare data in registrations and health outcomes. Chi-square tests were used to determine whether demographic categories are associated with the type of service selected.

Results:
Preliminary data analysis is currently underway, and results will be presented at ICIC24. Initial assessment of the data indicates a promising exponential trend in registration in the app-based virtual service compared to physical centre registration, along with differing demographic profiles. Future analysis on service type and service utilization pattern will identify distinct mHealth service needs in IYS and establish guidelines to inform future service design and improvement.

Significance
This study is producing knowledge on the sociodemographic and health characteristics associated with youth mobile health (mHealth) service use, allowing the refinement of targeted care and quality improvements to the service itself. The feasibility and sustainability of growth of the service also suggests the value added of the App being integrated as a core service option for youth in Canada. The integration of mHealth services also serve as a potential solution to reduce health inequities especially in remote, indigenous and other vulnerable population. The implications of this research extend to the broader field of integrated care in various global setting, offering a valuable perspective on leveraging technology to improve accessibility and effectiveness of care.

Introduction
Severe health issues, such as increased death rates, traumatic injuries, and a variety of acute and chronic diseases, are closely linked to homelessness. Homeless people seeking medical treatment face obstacles due to systemic problems in healthcare and social systems, including stigma, language hurdles, and a lack of understanding about accessible and affordable healthcare. The number of homeless people in Ireland has increased by 77.8% in the last year (1), resulting in a serious healthcare issue. St. James's Hospital, Dublin, has been leading the way in addressing this issue since 2016 by offering inclusive health services that promote trauma-informed care and integrated care in Ireland. It is suggested to work with homeless individuals and key stakeholders to implement an electronic case management system to promote care continuity and coordination across time and space. This digital platform facilitates smooth coordination, monitoring, and exchange of data regarding the treatment of homeless people across multiple stakeholders, ensuring integrated care. The PhD study intends to investigate user needs for this system in acute care to enhance inclusive health services.

Method
The overall study design will be concurrent mixed methods research. The study is organised into four phases, beginning with a review of the literature on user needs, trauma-informed care, and homelessness. This stage is enhanced by observations by patient rounding made at St. James's Hospital and knowledge gained from already-existing platforms like Socrates (2) and the Combined Homelessness and Information Network (3). In the second phase, an anonymous global online survey will be conducted to investigate best practices for trauma-informed acute healthcare. It aims to comprehend how these principles can be incorporated into electronic case management. Semi-structured interviews with users and key stakeholders are conducted in the third phase to determine the user needs. The final phase engages Focus Groups with users and key stakeholders to validate findings, refine recommendations, and shape the electronic case management system for outlines and implementation roadmap. A dialogue has been initiated with the Patient and Public Partnership (PPP) peers in Ireland to facilitate their collaboration in the research.

Expected Contribution
This current study holds the potential to improve care coordination for the homeless with the goal of reducing care fragmentation and advancing integrated care. An understanding of the user needs of this system in an acute care setting in Ireland is anticipated to result in a considerable improvement of the overall experience of homeless individuals. The study's findings will support St. James's Hospital's efforts to provide accessible healthcare services to address this healthcare issue. It is also anticipated that completing the PhD thesis will facilitate the application of research findings in acute healthcare settings both nationally and globally.

References
1.Focus Ireland. Latest Figures [Internet]. Donate - Focus Ireland. 2023. Available from: https://www.focusireland.ie/knowledge-hub/latest-figures/
2.CHAIN [Internet]. Homeless Link. Available from: https://homeless.org.uk/what-we-do/streetlink-and-chain/chain/
3.SNPC Medical Record Network [Internet]. SafetyNet. [cited 2023 Nov 21]. Available from: https://www.primarycaresafetynet.ie/copy-of-mobile-health-screening-uni

As a response to winter pressures, the Trust via it’s Enhanced Care at Home (ECAH) / Hospital at Home (H@H) services wishes to collaborate with care homes to support residents through timely clinical decision-making. This is about identifying the ‘softer signs’ of deterioration and providing a clinical alternative by using Tytocare for clinical consultation and examination, whilst connecting the relevant clinical decision-makers to provide alternatives to acute care, as appropriate.

We are collaborating with 30 Care Homes within the Trust to enhance the clinical decision-making for each resident linking individuals, the H@H/ECAH services, Consultants, GPs, the care home staff and families remotely.

It is envisaged that the introduction of TytoCare as a clinical examination and communication solution will help save resources through physical examinations/consultations carried out remotely for care home residents and improve user experience by reducing the need for emergency care through earlier clinical decision-making supported by the H@H and ECAH services.

The Trust reviewed its Emergency Department (ED) attendances and identified Homes by rank order of attendances over the last year. Each Home received an introductory phone-call with a follow-up email and an invitation to participate. This was followed up with a face-to-face visit and demonstration of the technology.

Phase one of the project was about getting 30 units utilised and linking the Homes to the appropriate service initially for further training support and utilizing the technology. Phase two is about traction and getting the Homes and the H@H and ECAH teams collaborating and blending the technology into clinical practice.

Monthly engagement meetings are underway to address the management of the deteriorating resident; reaching out for help earlier; staff training; experiences and ideas to promote usage of the technology and services as an alternative to ED attendance.

Working to a project plan and introducing Tyto virtual consultations, our project focuses on:-

1. Early identification of the deteriorating resident leading to
prompter action
2. Enabling virtual consultations and examinations with
clinical teams, avoiding hospital visits, reducing hospital
admissions, and travelling for clinical teams
3. Enhancing the clinical decision-making for each resident
linking residents, the H@H/ECAH services, consultants,
GPs, care home staff and families remotely.

Early outcomes:-
1. The ability, confidence & trust to provide an accurate
clinical diagnosis remotely
2. Reduction in travel time & transport
3. Improved workforce planning & capacity
4. Better access & continuity of care
5. Enhancing relationships between the Trust and Care
Homes.

Technology, such as Tyto, as a clinical communication solution can bring clinical examinations and decision making outside the clinical environment into the person’s own Home supported by non-hospital based healthcare professionals.

We are working on the need to build up evidence linked to confidence in using the Tyto system. We wish to continually improve, develop and scale-up using PDSA methodology (plan, do, study and act) in our service delivery and transformation to support residents in their own Home, who do not require to be in hospital.

The Enhanced Community Care (ECC) programme of reform in Ireland represents a population-based approach to the expansion of primary and community care and, importantly, its integration with the acute hospital sector, providing health services closer to people’s homes and reducing pressure on acute hospitals.
The community dietetic service in Cork Kerry Community Healthcare always had established pathways for referrals from dietetic colleagues in Cork University Hospital, (CUH). However, the original transfer system e.g. paper transfers, via post or email, was not efficient or user-friendly and could result in a lack of information at times.
The Covid-19 pandemic created an urgency in terms of providing services in the community. During the pandemic, the dietitian teams in Cork Kerry Community Healthcare and CUH worked together with colleagues in IT on an initiative to create a dietetic discharge process via the iCM portal (an existing IT system used by both acute and community services.)
Objectives of the initiative:
• Improve the quality of referrals by ensuring all relevant information included.
• Reduce duplication of information by having the document on a system available to both acute and community dietetic services.
• Improve hospital transfer rates out to community dietetics.
• See patients in a more timely fashion in community.
Measurable outcomes:
• There was a 50% reduction in the time taken by acute dietitians to complete the transfer form as the new system eliminated transcribing of details such as patient name, address, GP, next of kin and medical record number as the iCM system extracts this information.
• A higher level of relevant clinical information (e.g. from doctors, SLTs) is now shared with community dietitians as iCM extracts this information.
• In 2020, 37 transfers per month were processed. This went up to 98 transfers per month in 2021 and increased again in 2022 to 115 transfers per month. Projections suggest transfers will be in excess of 125 per month in 2023.
• The increased transfer rate out to community reduced the need for some acute outpatient clinics and supports the overall aim of Slaintecare by providing health services closer to people’s homes.
Next steps:
The move to use of the iCM system has been hugely successful in terms of increasing the efficiency of the dietetic transfer process. This has resulted in significant increases in referrals to community dietitians. It takes a significant amount of community dietetic time to process referrals (approximately five minutes per referral) so the next step is to consider automating the process. The Community Nutrition and Dietetic Service submitted a proposal to participate in ‘Chat23’ and were successful in securing a place. Only six out of >70submissions were accepted. Chat23 was a 1-day hackathon that brought together HSE frontline staff and their eHealth colleagues to focus on ways to improve workflows and resolve specific task-related pressure points or bottlenecks across the health service, through the innovative deployment of intelligent workflow automation and AI technologies. We are currently awaiting further feedback on the viability of automating the process (from eHealth).

Background: Singapore stands among the countries with the highest rates of diabetes-related lower extremity amputation (LEA) globally. Effective management of diabetic foot ulcer (DFU) is crucial for preserving patients’ limb function and alleviating the healthcare burden. Existing literature has demonstrated the promising impact of DFU care provided by multidisciplinary team (MDT) on lower limb salvage.
Since 2020, the Diabetic Foot in Primary and Tertiary (DEFINITE) Care programme, a comprehensive DFU care initiative integrating primary and tertiary care has been implemented. The programme is spearheaded by a MDT comprising more than 50 healthcare professionals, anchored by a core team of primary care physicians, endocrinologists/diabetologists, podiatrists, vascular surgeons, wound care nurses, and diabetic foot coordinators. This programme aims to provide integrated and coordinated to patients with DFU, with the goal of preventing DFU-related amputations and reducing the economic and disease burden associated with DFU within one of Singapore’s three regional health systems. This study seeks to evaluate the effectiveness of the DEFINITE Care programme in preventing minor and major LEA, increasing LEA-free survival, and optimizing inpatient healthcare utilization.
Methods: This historical control study compared the outcomes between DFU patients enrolled in the DEFINITE programme (n=2,798) from June 2020 to June 2021 and a historical control group (n=5,462) comprising DFU patients treated in the same regional health system between June 2016 and December 2017. One-to-one propensity score matching (PSM) with replacement was employed to ensure comparability in demographics and clinical factors between the DEFINITE and historical control cohorts. The study estimated the treatment effects of the DEFINITE programme on minor and major LEAs, mortality, LEA-free survival, inpatient admissions, and average length of stay (ALOS) in the subsequent 12 months.
Results: Patients in the DEFINITE cohort were, on average, younger (mean age: 65.7 vs. 71.6 years), comprised more males (61.4% vs. 53.8%), and included a higher proportion of non-Chinese individuals(44.2% vs. 34.6%) compared to the patients in the historical control cohort.
Following satisfactory 1:1 PSM, the DEFINITE cohort exhibited a 9.3% lower mortality (95% CI] -11.7 – -6.8%), a 5% higher LEA-free survival rate (95% CI: 2.4 – 7.7%), 1.0 fewer inpatient admissions (95% CI: -1.1 - -0.9), and a 5.5-day shorter ALOS (95% CI: -7.4 - -3.6). However, a 5.4% higher minor LEA rate (95% CI: 3.8 – 7.0%) was observed during the first 12 months of enrolment compared to the matched historical control cohort (all p-values<0.001). No significant difference in major LEA rate was observed between the two cohorts.
Conclusion: The study findings suggest potential benefits of the integrated and multidisciplinary DFU care programme, including an increased LEA-free survival rate and reduced inpatient care utilisation and mortality. However, results should be interpreted cautiously due to limitations in study design and data availability. The programme will be further expanded to benefit more patients with DFU or with risk of DFU.

Background
Ireland’s aging population represents a measure of success in improving health and extending life expectancy however, while many older people remain well, engaged and active well into later life and continue to make a major contribution to local communities and society, increasing age is associated with long-term medical conditions, frailty, dementia, disability, dependence and social isolation. Over the past four years, Cork Kerry Community Healthcare (CKCH) has recognised the need for age-attuned services as outlined in the National Clinical Program for Older Persons (NCPOP).
Aim
The CKCH Integrated Care Programme for Older Persons was established with the aim of deployment and testing of integrated care pathways, developing new roles and service models. More specifically, the integrated care hubs seek to improve the quality of life of older persons and their support networks by providing access to integrated care and support, specifically tailored to their needs and choices, thus supporting them to live well.
Highlights
There are three ICPOP hubs currently in operation in CHO4 (Kerry ICPOP, Cork South City and Cork North). There is uniformity in terms of policies, procedures, protocols, guidelines and clinical guidelines across all hubs. A number of pathways provided within each hub demonstrate a new ecosystem of care and reflect the transformational nature of change the health system is undergoing:
A. An Ambulatory care hub for Older Persons supporting primary care, Community Health Networks (CHNs) and hospital attendance/ admission avoidance.
B. Early Supported Discharge/Outreach providing rehabilitation in clients’ own home environment
C. Nursing Home Support Service which delivers equity access of care to all clients and reduces unnecessary conveyance to acute hospitals
D. GEMS/Frailty Front door follow up supporting acute hospital capacity issues through a discharge to assess model.
E. CHN interaction thus embedding integrative practices into primary care
F. Education & Research aimed at the development of an age attuned workforce and the development of services that are meeting the populations needs

Whilst difficulties continually exist in the implementation of the national vision, significant progress has been made, in overcoming these obstacles through a cohesion of efforts at CKCH CHO 4 level.

Implications for clinical practice
Plans for CHO4 ICPOP services include the progression of robust governance structures, the development of acute hospital in-reach, and progression of two further hubs in Cork.

Consideration is also to be given to the development of regional clinics for syncope, movement disorders and Memory Assessment and Support Services, the development of satellite clinics/residential care facility supports in areas such as West Cork/Kerry, the further development of Early Supported Discharge/Outreach teams into CHNs . Embedding of a research model and improved service user involvement to improved patient services also requires progressing.

Conclusions
Key learnings from scale up emphasise the critical importance of effective communication nationally/locally in operationalising a vision. Local relationships are invaluable. Unfortunately, effectiveness of the services may take time to manifest and there is a risk that effects are offset by changes to patient demographics. Clear governance pathways require ongoing development and are key to ongoing success