Ahmed Anam, van den Muijsenbergh Maria Etc, Vrijhoef Hubertus Jm
Panaxea b.v., Amsterdam, The Netherlands.
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
Int J Integr Care. 2021 Dec 8;21(4):30. doi: 10.5334/ijic.5682. eCollection 2021 Oct-Dec.
In a previous rapid realist review (RRR), an initial programme theory (PT) was established giving insight into the interrelatedness of context items, mechanisms, programme-activities, and outcomes that influence integrated care programmes (ICPs) for community-dwelling frail older people. As ICPs need to be tailored to their local setting, the objective of this study is to assess consensus on the relevance of the items identified in the RRR for the Dutch setting, and refine the PT, where appropriate.
A two-round e-Delphi study was carried out among Dutch experts to determine the relevance of 71 items.
Consensus on relevance was reached on 57 out of 71 items (80%). Items added to refine the PT included: increasing number of older people, decreasing access to hospital beds, well-designed ICP implementation processes, case management, having a clear portfolio of patients, the role of the government, aligning existing health and social care systems, management and monitoring of care activities, strong relationship between older person and healthcare providers (HCP), and providing continuous feedback to HCPs.
The initial PT was refined for the Dutch setting. Items on which no consensus was found, need to be further investigated on the reason behind it.
在之前的一项快速实证综述（RRR）中，建立了一个初始项目理论（PT），该理论深入探讨了影响社区居住体弱老年人综合护理项目（ICP）的背景因素、机制、项目活动和结果之间的相互关联性。由于ICP需要根据当地情况进行调整，本研究的目的是评估RRR中确定的项目对于荷兰情况的相关性的共识，并在适当情况下完善PT。
在荷兰专家中开展了两轮电子德尔菲研究，以确定71个项目的相关性。
71个项目中有57个（80%）达成了相关性共识。为完善PT而增加的项目包括：老年人数量增加、医院床位可及性降低、精心设计的ICP实施流程、病例管理、拥有明确的患者组合、政府的作用、整合现有卫生和社会护理系统、护理活动的管理和监测、老年人与医疗保健提供者（HCP）之间的紧密关系以及向HCP提供持续反馈。
初始PT针对荷兰情况进行了完善。未达成共识的项目需要进一步调查其背后的原因。
