Advancing integrated care evaluation in shifting contexts: Blending implementation research with case study design in Project SUSTAIN.

Abstract

BackgroundDespite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat ‘illusive’ impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015-2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators.ConclusionsLessons learned and recommendations for advancing integrated care evaluation are put forward that focus on the status of integrated care as a complex intervention and a process. The use of implementation research methods and case study design are recommended as an additional evaluation approach for researchers to consider, alongside suggested ways of improving methods of data collection with frail populations and cost analysis.

Ten-Year Evaluation of the Population-Based Integrated Health Care System “Gesundes Kinzigtal”

“…If one considers the results of our evaluation in comparison to the international literature, one must first of all point out that there is no standard concept for integrated care and, therefore, different implementation strategies exist (5,(22)(23)(24). Failure to take this into consideration could lead to incorrect conclusions and generalizations about the effectiveness of integrated care (24).…”

A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent

“…The latter helped ensure that the improvement plan was evidence-based; the evaluation used practical measures for rapid feedback and was based on a partnership approach highlighting local contextual factors. The case study design enabled a detailed and intensive examination of the project's operation, using a set of qualitative and quantitative data collection tools to gather data from different sources (see Billings et al, 2018Billings et al, , 2020. The lead author here was a participant observer in the steering group which met fifteen times; she conducted eleven interviews with service users (four as dyad interviews with carers), ten with professionals and managers, and kept detailed field notes throughout.…”

“…The lead author here was a participant observer in the steering group which met fifteen times; she conducted eleven interviews with service users (four as dyad interviews with carers), ten with professionals and managers, and kept detailed field notes throughout. An analytical process that triangulated multiple data sources enabled an initial explanatory model to be built about the implementation of the plan (see Billings et al, 2020). Ethics approval for this project was granted by the Health Research Authority Social Care Research Ethics Committee (ref 16/IEC08/0045).…”