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The international project TICC (Transforming Integrated Care in the Community) will implement innovative models of home and community-based care in Belgium, the United Kingdom and France, based on the success factors of the Buurtzorg integrated nurse-led model. The goal is to make social care more cost-effective and to make it more in line with the holistic needs of the ageing population. By redesigning the patient tracking system, the aim is to improve communication between nurses, other care professionals and the client.