Billings Jenny, de Bruin Simone R, Baan Caroline, Nijpels Giel
Centre for Health Service Studies, University of Kent, Canterbury, Kent, CT2 7NF, UK.
National Institute for Public Health and Environment, Antonie van Leeuwenhoeklaan 9, 3721, Bilthoven, MA, Netherlands.
BMC Health Serv Res. 2020 Oct 23;20(1):971. doi: 10.1186/s12913-020-05775-5.
Despite 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.
Lessons 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.
尽管有许多研究评估了综合护理的有效性，但证据仍然不一致。越来越多的评论指出，在捕捉综合护理举措和项目有些“难以捉摸”的影响的能力与最恰当的做法之间存在不匹配。本文聚焦于方法论，描述并批判性地审视了“可持续性”（SUSTAIN）项目的经验，该项目是一个由“地平线2020”资助的项目（2015 - 2019年），旨在增进对跨欧洲综合护理评估的认识和理解。“可持续性”项目试图改善七个国家针对老年人的综合护理举措，并最大限度地提高知识在欧洲范围内转移和应用的潜力。该方法借鉴了实施研究，采用了参与式证据整合三角模型（EIT），并纳入了混合方法、多重嵌入式案例研究设计。在四个关键项目领域（以人为主导、预防导向、安全和效率）内创建并测试了一套核心的定性和定量指标，以及背景和过程数据。本文批判性地讨论了整体方法，强调了EIT和案例研究设计的价值，并指出了与体弱老年人进行数据收集以及各站点利益相关者参与方面的挑战，以及制定核心指标集所面临的困难。
提出了关于推进综合护理评估的经验教训和建议，重点关注综合护理作为一种复杂干预措施和过程的现状。建议将实施研究方法和案例研究设计作为研究人员可考虑的额外评估方法，同时还提出了改善针对体弱人群的数据收集方法和成本分析的建议。
