A Realist Evaluation of Local Networks Designed to Achieve More Integrated Care.

Abstract:

Introduction:Not surprisingly given their multi-component nature, initiatives to improve integrated care often evolve to find the best way to bring about change. This paper provides an example of how an evaluation evolved alongside such an initiative designed to better integrate care across primary, community and hospital services in South Auckland, New Zealand. Theory and methods:Using the explanatory power of a realist evaluative approach, theories of new ways of working that might be prompted by the initiative were explored in: (i) interviews with stakeholders in 2012 and 2015, (ii) online surveys of general practices and local care organisations, and (iii) a purposive sample of ten general practices. Results:The results highlighted the institutional contexts that led to difficulties in implementing population health initiatives. They also revealed that changes in work practices focussed mostly on activities that improved the coordination of care for individuals at risk of hospital admissions. Discussion:Multi-component complex interventions can vary in their delivery and be vulnerable to one or more components not being implemented as originally intended. In the case of this intervention, the move towards strengthening local relationships arose when contractual arrangements stalled. Realist evaluative approaches offer a logic that helps unpick the complexity of the relationships and politics in play, and uncover the assumptions made by those developing, implementing and assessing health service changes. Conclusion:Given the multi-component and evolving nature of initiatives seeking to better integrate care, the realist evaluative emphasis on surfacing early the theories to explain how change is expected to occur helps overcome the challenge of evaluating "a moving target".

journal_name

Int J Integr Care

authors

Middleton L,Rea H,Pledger M,Cumming J

doi

10.5334/ijic.4183

subject

Has Abstract

pub_date

2019-04-05 00:00:00

pages

4

issue

2

issn

1568-4156

journal_volume

19

pub_type

杂志文章
  • The organisation of interagency training to safeguard children in England: a case study using realistic evaluation.

    abstract:BACKGROUND:Joint training for interagency working is carried out by Local Safeguarding Children Boards in England to promote effective local working to safeguard and promote the welfare of children. PURPOSE:This paper reports on the findings of the outputs and outcomes of interagency training to safeguard children in ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.548

    authors: Patsios D,Carpenter J

    更新日期:2010-11-16 00:00:00

  • The Manage Care Model - Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes.

    abstract:Background:Most current care models are disease- or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. Meth...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.4646

    authors: Timpel P,Lang C,Wens J,Contel JC,Schwarz PEH,MANAGE CARE Study Group.

    更新日期:2020-04-22 00:00:00

  • Implementation, Mechanisms of Effect and Context of an Integrated Care Intervention for Vulnerable Families in Central Sydney Australia: A Research and Evaluation Protocol.

    abstract:Introduction:In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.4217

    authors: Eastwood JG,Woolfenden S,Miller E,Shaw M,Garg P,Liu H,De Souza DE,Ettema RGA

    更新日期:2019-07-25 00:00:00

  • Integrated primary care in Germany: the road ahead.

    abstract:PROBLEM STATEMENT:Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. Wh...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.311

    authors: Schlette S,Lisac M,Blum K

    更新日期:2009-04-20 00:00:00

  • Suitability of a Programme for Improving Interprofessional Primary Care Team Meetings.

    abstract:Introduction:Primary care is increasingly being confronted with complex health care demands stemming from both biomedical and psychosocial problems of people with chronic diseases. Interprofessional collaboration is needed to enhance person-centredness and coordinate care provision in an efficient manner, which should ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.4179

    authors: van Dongen JJJ,van Bokhoven MA,Goossens WNM,Daniëls R,van der Weijden T,Beurskens A

    更新日期:2018-12-13 00:00:00

  • Patient Privacy and Integrated Care: The Multidisciplinary Health Care Team.

    abstract::This article explores legislative provisions in relation to patient privacy in the context of integrated health and social care and the development of multidisciplinary health care teams that include practitioners from private sector and government agencies in the health, education, child protection, family welfare, d...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.5591

    authors: Eastwood J,Maitland-Scott I

    更新日期:2020-11-19 00:00:00

  • Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care.

    abstract:INTRODUCTION:A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care com...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.2944

    authors: Kuluski K,Ho JW,Hans PK,Nelson M

    更新日期:2017-07-21 00:00:00

  • Integrated care: a position paper of the WHO European Office for Integrated Health Care Services.

    abstract::The WHO European Office for Integrated Health Care Services in Barcelona is an integral part of the World Health Organizations' Regional Office for Europe. The main purpose of the Barcelona office is within the integration of services to encourage and facilitate changes in health care services in order to promote heal...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:

    authors: Gröne O,Garcia-Barbero M,WHO European Office for Integrated Health Care Services.

    更新日期:2001-01-01 00:00:00

  • A literature review to explore integrated care for older people.

    abstract:PURPOSE:This paper reports on some of the findings of a literature review commissioned to explore integrated care for older people. METHODS:The process of revising included finding and selecting literature from multidisciplinary sources, and encompassed both published papers and 'grey' literature, i.e. material which ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.119

    authors: Reed J,Cook G,Childs S,McCormack B

    更新日期:2005-01-01 00:00:00

  • Quality improvement in depression care in the Netherlands: the Depression Breakthrough Collaborative. A quality improvement report.

    abstract:BACKGROUND:Improving the healthcare for patients with depression is a priority health policy across the world. Roughly, two major problems can be identified in daily practice: (1) the content of care is often not completely consistent with recommendations in guidelines and (2) the organization of care is not always int...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.314

    authors: Franx G,Meeuwissen JA,Sinnema H,Spijker J,Huyser J,Wensing M,de Lange J

    更新日期:2009-06-15 00:00:00

  • Organizational Context Matters: A Research Toolkit for Conducting Standardized Case Studies of Integrated Care Initiatives.

    abstract:INTRODUCTION:The variable success of integrated care initiatives has led experts to recommend tailoring design and implementation to the organizational context. Yet, organizational contexts are rarely described, understood, or measured with sufficient depth and breadth in empirical studies or in practice. We thus lack ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.2502

    authors: Evans JM,Grudniewicz A,Gray CS,Wodchis WP,Carswell P,Baker GR

    更新日期:2017-06-27 00:00:00

  • Measuring the degree of integration for an integrated service network.

    abstract:BACKGROUND:Integration involves the coordination of services provided by autonomous agencies and improves the organization and delivery of multiple services for target patients. Current measures generally do not distinguish between agencies' perception and expectation. We propose a method for quantifying the agencies' ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.835

    authors: Ye C,Browne G,Grdisa VS,Beyene J,Thabane L

    更新日期:2012-09-18 00:00:00

  • Research in Integrated Care: The Need for More Emergent, People-Centred Approaches.

    abstract::The International Foundation for Integrated Care (IFIC) recently celebrated its 20th International Conference (ICIC20) through a virtual event that brought together patients and carers, academics, care professionals, NGOs, policy-makers and industry partners from across the global integrated care community [1]. The In...

    journal_title:International journal of integrated care

    pub_type: 社论

    doi:10.5334/ijic.5627

    authors: van der Vlegel-Brouwer W,van Kemenade E,Stein KV,Goodwin N,Miller R

    更新日期:2020-10-21 00:00:00

  • What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs.

    abstract:BACKGROUND:Disease management programs (DMP) aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes ma...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.675

    authors: van Dijk CE,Verheij RA,Swinkels IC,Rijken M,Schellevis FG,Groenewegen PP,de Bakker DH

    更新日期:2011-10-01 00:00:00

  • Service Integration Across Sectors in Europe: Literature and Practice.

    abstract:Introduction:To meet the needs of vulnerable people, the integration of services across different sectors is important. This paper presents a preliminary review of service integration across sectors in Europe. Examples of service integration between social services, health, employment and/or education were studied. A f...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.3107

    authors: van Duijn S,Zonneveld N,Lara Montero A,Minkman M,Nies H

    更新日期:2018-04-19 00:00:00

  • Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures.

    abstract:Introduction:Current U.S. policy and payment initiatives aim to encourage health care provider accountability for population health and higher value care, resulting in efforts to integrate providers along the continuum. Providers work together through diverse organizational structures, yet evidence is limited regarding...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.4635

    authors: Heeringa J,Mutti A,Furukawa MF,Lechner A,Maurer KA,Rich E

    更新日期:2020-01-20 00:00:00

  • Policy change and policy dilemmas: interpreting the community services White Paper in England.

    abstract:CONTEXT:In 2006 the Labour Government in England published its long awaited White Paper on 'community services', following on from the 2005 Green Paper on the future of social care. The policy envisages an unprecedented shift of activity and resources from acute care to community settings, along with a much stronger fo...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.158

    authors: Hudson B

    更新日期:2006-08-17 00:00:00

  • Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research.

    abstract::This paper aims to identify problems in estimating and the interpretation of the magnitude of intervention-related change over time or responsiveness assessed with health outcome measures. Responsiveness is a problematic construct and there is no consensus on how to quantify the appropriate index to estimate change ov...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.65

    authors: Middel B,van Sonderen E

    更新日期:2002-01-01 00:00:00

  • Project INTEGRATE - a common methodological approach to understand integrated health care in Europe.

    abstract:BACKGROUND:The use of case studies in health services research has proven to be an excellent methodology for gaining in-depth understanding of the organisation and delivery of health care. This is particularly relevant when looking at the complexity of integrated healthcare programmes, where multifaceted interactions o...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.1980

    authors: Cash-Gibson L,Rosenmoller M

    更新日期:2014-12-15 00:00:00

  • Communication, Collaboration and Care Coordination: The Three-Point Guide to Cancer Care Provision for Aboriginal and Torres Strait Islander Australians.

    abstract:Aim:To explore health professionals' perspectives on communication, continuity and between-service coordination for improving cancer care for Indigenous people in Queensland. Methods:Semi-structured interviews were conducted in a purposive sample of primary health care (PHC) services in Queensland with Indigenous and ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.5456

    authors: de Witt A,Matthews V,Bailie R,Garvey G,Valery PC,Adams J,Martin JH,Cunningham FC

    更新日期:2020-06-08 00:00:00

  • An evaluation of a chronic disease prevention program in the Republika Srpska (RS) of Bosnia and Herzegovina.

    abstract:INTRODUCTION:In 2002 the Republika Srpska of Bosnia and Herzegovina adopted goals for reducing the burden of chronic disease through a new screening program in its publicly funded health centers ("Dom Zdravljas"). This study evaluated the first year of program implementation. METHODS:The evaluation used in-depth inter...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.227

    authors: Rodic R,Krajnovic V,Howell EM,Vukovic V,Bomestar N

    更新日期:2008-02-11 00:00:00

  • The path dependency theory: analytical framework to study institutional integration. The case of France.

    abstract:BACKGROUND:The literature on integration indicates the need for an enhanced theorization of institutional integration. This article proposes path dependence as an analytical framework to study the systems in which integration takes place. PURPOSE:PRISMA proposes a model for integrating health and social care services ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.544

    authors: Trouvé H,Couturier Y,Etheridge F,Saint-Jean O,Somme D

    更新日期:2010-06-30 00:00:00

  • The Integrated Dyspnea Clinic: An Evaluation of Efficiency.

    abstract:Introduction:Dyspnea is a common complaint and in 70 to 90% the origin is pulmonary or cardiovascular. However, referral to the "wrong" specialism could result in diagnostic- and treatment delay. Integrated care by a cardiologist and a pulmonologist could improve this. The aim of the present study was to evaluate wheth...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.3983

    authors: Rietbroek MV,Slats AM,Kiès P,de Grooth GJ,Chavannes NH,Taube C,Bonten TN

    更新日期:2018-12-31 00:00:00

  • "Partners rather than just providers…": A qualitative study on health care professionals' views on implementation of multidisciplinary group meetings in the North West London Integrated Care Pilot.

    abstract:INTRODUCTION:Multidisciplinary group meetings are one of the key drivers of facilitating integrated care. Health care professionals attending such groups have a key role in the success of these discussions and hence, in the forming of multi-professional integrated care. The study aimed to explore the professionals' exp...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.2019

    authors: Kassianos AP,Ignatowicz A,Greenfield G,Majeed A,Car J,Pappas Y

    更新日期:2015-09-02 00:00:00

  • A collaborative chain out of phase.

    abstract:INTRODUCTION:The aim of this study is to explore the obstacles to collaborations between nurses in hospital and municipal care in the discharge of hospital patients who need continuing care. METHODS:First, we conducted in-depth interviews of nurses in hospitals and nurses in municipal care. Second, we developed questi...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.858

    authors: Paulsen B,Romøren TI,Grimsmo A

    更新日期:2013-03-14 00:00:00

  • Does it matter who organises your health care?

    abstract:BACKGROUND:As the prevalence of long-term and multimorbid conditions is increasing, patients increasingly require consultations with multiple health care professionals and coordination of their care needs. METHODS:This study is based on a 2011 survey of older Australians which draws on sub-populations of people with d...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.1598

    authors: Dawda P,McRae IS,Yen L,Islam MM,Bagheri N,Jowsey T,Banfield M,Parkinson A

    更新日期:2015-05-14 00:00:00

  • Building a People-Centred Integrated Care Model in Urban China: A Qualitative Study of the Health Reform in Luohu.

    abstract:Introduction:China has adopted a people-centred integrated care model to reform its severely hospital-centric and fragmented delivery system. As a template of this model in urban China, the Luohu Hospital Group has generated considerable public and academic interest to scale it up. Methods:Guided by a policy triangle ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.4673

    authors: Liang D,Mei L,Chen Y,Zhou P,Yang X,Huang J

    更新日期:2020-03-16 00:00:00

  • Long-term care insurance and integrated care for the aged in Japan.

    abstract::By the introduction of a public, mandatory program of Long-Term Care Insurance (LTCI) on April 1, 2000, Japan has moved towards a system of social care for the frail and elderly. The program covers care that is both home-based and institutional. Fifty percent of the insurance is financed from the general tax and the o...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.39

    authors: Matsuda S,Yamamoto M

    更新日期:2001-01-01 00:00:00

  • Vertical integration and contractual network in the cardiovascular sector: the experience of the Italian region Emilia Romagna.

    abstract:OBJECTIVE:We analysed the integrated planning model adopted by the Italian region Emilia Romagna in year 2000 to cover the entire range of treatment of cardiovascular disease. This model, called "hub and spoke", provides for the transfer of patient care and treatment from peripheral units (the spokes) to central units ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.82

    authors: Ugolini C,Nobilio L

    更新日期:2003-01-01 00:00:00

  • Complex Care Needs in Multiple Chronic Conditions: Population Prevalence and Characterization in Primary Care. A Study Protocol.

    abstract:Background:Chronicity, and particularly complex care needs for people with chronic diseases is one of the main challenges of health systems. Objective:To determine the population prevalence of people with chronic diseases and complex care needs and to characterize these needs considering features of health and social ...

    journal_title:International journal of integrated care

    pub_type: 杂志文章

    doi:10.5334/ijic.3292

    authors: Iglesias FH,Celada CA,Navarro CB,Morales LP,Visus NA,Valverde CC,Dorado VM,Martínez Muñoz ML,Pueyo CB,Ramírez EL,Villaroel RM,Jordana NM,Bonet Simó JM,SABCOMP group.

    更新日期:2018-05-25 00:00:00