Eyre Laura, George Bethan, Marshall Martin
Department of Primary Care and Population Health, University College London, Sir Ludwig Guttman Health Centre, London, UK.
Tower Hamlets GP Care Group, London, UK.
BMJ Open. 2015 Nov 6;5(11):e009567. doi: 10.1136/bmjopen-2015-009567.
The integration of health and social care in England is widely accepted as the answer to fragmentation, financial concerns and system inefficiencies, in the context of growing and ageing populations with increasingly complex needs. Despite an expanding body of literature, there is little evidence yet to suggest that integrated care can achieve the benefits that its advocates claim for it. Researchers have often adopted rationalist and technocratic approaches to evaluation, treating integration as an intervention rather than a process. Results have usually been of limited use to practitioners responsible for health and social care integration. There is, therefore, a need to broaden the evidence base, exploring not only what works but also how integrated care can most successfully be implemented and delivered. For this reason, we are carrying out a formative evaluation of the Waltham Forest and East London Collaborative (WELC) integrated care pioneer programme. Our expectation is that this will add value to the literature by focusing on the processes by which the vision and objectives of integrated care are translated through phases of development, implementation and delivery from a central to a local perspective, and from a strategic to an operational perspective.
The qualitative and process-oriented evaluation uses an innovative participative approach-the Researcher-in-Residence model. The evaluation is underpinned by a critical ontology, an interpretive epistemology and a critical discourse analysis methodology. Data will be generated using interviews, observations and documentary gathering.
Emerging findings will be interpreted and disseminated collaboratively with stakeholders, to enable the research to influence and optimise the effective implementation of integrated care across WELC. Presentations and publications will ensure that learning is shared as widely as possible. The study has received ethical approval from University College London's Research Ethics Committee and has all appropriate NHS governance clearances.
在人口不断增长且老龄化、需求日益复杂的背景下，英格兰的健康与社会护理整合被广泛认为是解决碎片化、财务问题和系统效率低下的答案。尽管相关文献不断增多，但几乎没有证据表明整合式照护能够实现其倡导者所宣称的益处。研究人员在评估时往往采用理性主义和技术官僚主义方法，将整合视为一种干预而非一个过程。研究结果通常对负责健康与社会护理整合的从业者用处有限。因此，有必要拓宽证据基础，不仅要探究哪些措施有效，还要研究如何最成功地实施和提供整合式照护。出于这个原因，我们正在对沃尔瑟姆森林和东伦敦协作组织（WELC）的整合式照护先锋项目进行形成性评估。我们期望这将通过关注从中央到地方、从战略到运营的各个发展、实施和交付阶段，将整合式照护的愿景和目标转化的过程，为相关文献增添价值。
这项定性且注重过程的评估采用了一种创新的参与式方法——驻场研究员模式。该评估以批判本体论、诠释认识论和批判话语分析方法为基础。将通过访谈、观察和文件收集来生成数据。
新出现的研究结果将与利益相关者共同解读和传播，以使该研究能够影响并优化WELC范围内整合式照护的有效实施。报告和出版物将确保尽可能广泛地分享经验教训。该研究已获得伦敦大学学院研究伦理委员会的伦理批准，并具备所有适当的英国国家医疗服务体系治理许可。
