The need for theory-based evaluation of care coordination initiatives: Considerations from the 2017 International Conference on Realist Research, Evaluation and Synthesis

Abstract

Research in the field of care coordination faces the challenge of providing transferable explanatory insights regarding what principles and initiatives work in practice and why. Such insights are crucial in developing effective solutions for global disease burdens. Realist research approaches have demonstrated potential to deliver stronger theoretical contributions of evaluation studies across fields of research. These were discussed at the International Conference for Realist Research, Evaluation and Synthesis in Brisbane (from 24 to 26 October 2017). This paper provides an overview and reflection on the conference by four participants. It focuses on (1) topical debates and challenges for the application of realistic methodology in health services research, as presented at the conference and (2) implied opportunities and challenges for (realist) evaluation of care coordination initiatives. Based on the reflections, future realist evaluation on evaluating complex care coordination initiatives is recommended.

Care pathways are complex interventions in complex systems: New European Pathway Association framework

“…21 Changes in the context should be included to understand why and how care pathways are working. 10 It could be an underlying condition for the effectiveness of care pathways and can help to understand why and how care pathways are working. It is important that the openness of the care context is evaluated before, during and after implementation.…”

“…Therefore, financial and legal constraints should also be taken into account and are thus system sensitive. 10 This framework will shed some light on the black box of care pathways and can give more information on why care pathways are not always working. The longitudinal follow-up of care pathways is important as the results on the first improvement priority will not be achieved immediately.…”

“…Rapid feedback increases the success of improvement interventions. 10,30,31 Implementation of the evidence-based key interventions should proceed according to the order of improvement priorities. These priorities can be based on a performance analysis or an importance-performance analysis.…”

“…First, care pathways are seen as complex interventions as they comprise separate elements which seem to be essential to the proper functioning of the intervention. They target multiple outcomes, involve multiple interventions 10 and the ‘active component’ is difficult to specifiy. 11 Second, care pathways are developed and implemented in complex organisations taken into account the external and internal context.…”

Special Issue: Realist research in health services research and care coordination

“…In their discussion paper, Vugts et al take a bird's eye's view of realism. 1 They report from the international conference on realist research, held in 2017, as participants but each with their unique viewpoint from their own background as researcher or consultant. Moreover, they offer their take on the future challenges and opportunities in the field, and how realism can contribute to tackling or taking advantage of these.…”