Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada.
BMJ Open. 2024 Aug 12;14(8):e083783. doi: 10.1136/bmjopen-2023-083783.
Case management (CM) is among the most studied effective models of integrated care for people with complex needs. The goal of this study is to scale up and assess CM in primary healthcare for people with complex needs.
The research questions are: (1) which mechanisms contribute to the successful scale-up of CM for people with complex needs in primary healthcare?; (2) how do contextual factors within primary healthcare organisations contribute to these mechanisms? and (3) what are the relationships between the actors, contextual factors, mechanisms and outcomes when scaling-up CM for people with complex needs in primary healthcare? We will conduct a mixed methods Canadian interprovincial project in Quebec, New-Brunswick and Nova Scotia. It will include a scale-up phase and an evaluation phase. At inception, a scale-up committee will be formed in each province to oversee the scale-up phase. We will assess scale-up using a realist evaluation guided by the RAMESES checklist to develop an initial programme theory on CM scale-up. Then we will test and refine the programme theory using a mixed-methods multiple case study with 10 cases, each case being the scalable unit of the intervention in a region. Each primary care clinic within the case will recruit 30 adult patients with complex needs who frequently use healthcare services. Qualitative data will be used to identify contexts, mechanisms and certain outcomes for developing context-mechanism-outcome configurations. Quantitative data will be used to describe patient characteristics and measure scale-up outcomes.
Ethics approval was obtained. Engaging researchers, decision-makers, clinicians and patient partners on the study Steering Committee will foster knowledge mobilisation and impact. The dissemination plan will be developed with the Steering Committee with messages and dissemination methods targeted for each audience.
病例管理（CM）是针对具有复杂需求人群的综合护理中最具研究价值的有效模式之一。本研究旨在扩大和评估初级保健中针对复杂需求人群的 CM。
研究问题是：（1）哪些机制有助于在初级保健中成功扩大针对复杂需求人群的 CM？（2）初级保健组织内的哪些情境因素有助于这些机制？（3）在扩大初级保健中针对复杂需求人群的 CM 时，参与者、情境因素、机制和结果之间的关系是什么？我们将在魁北克、新不伦瑞克和新斯科舍省进行一项加拿大跨省的混合方法项目。它将包括扩大规模阶段和评估阶段。在开始时，每个省将成立一个扩大规模委员会来监督扩大规模阶段。我们将使用由 RAMESES 清单指导的实际评估来评估扩大规模，以制定关于 CM 扩大规模的初始方案理论。然后，我们将使用混合方法多案例研究（每个案例是一个地区干预措施的可扩展单元）来测试和完善方案理论，每个案例都将有 10 个案例。每个案例中的初级保健诊所将招募 30 名经常使用医疗服务的具有复杂需求的成年患者。定性数据将用于识别背景、机制和某些结果，以开发背景-机制-结果配置。定量数据将用于描述患者特征并衡量扩大规模的结果。
已获得伦理批准。让研究人员、决策者、临床医生和患者伙伴参与研究指导委员会，将促进知识转移和影响。指导委员会将制定传播计划，针对每个受众制定信息和传播方法。
