Why do evaluations of integrated care not produce the results we expect?

IF 0.8 Q4 NURSING
S. Kumpunen, N. Edwards, T. Georghiou, G. Hughes
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引用次数: 29

Abstract

A number of evaluations of models of integrated care have not produced the expected result of reduced hospital admissions, and in some cases have even found people receiving integrated care services using hospitals more than matched controls. We tested three hypotheses for these surprising results with a group of 50 integrated care experts in a seminar: (1) problems with the model; (2) problems of implementation; and (3) problems of evaluation. Our group of experts did not rule out any of these hypotheses and came up with some advice as to manage these issues. For example, model designers should rigorously test the underlying logic; commissioners should seek out advice from experts and patients/professionals; and evaluators should choose outcomes wisely, use mixed methods approaches, and provide regular feedback loops to implementation sites. Evaluating integrated care is a skilled task that requires multiple approaches in terms of the design and implementation of the models. National research funders or other appropriate bodies might consider developing an advisory service to provide support to local systems planning evaluations.
为什么综合护理的评估不能产生我们期望的结果?
对综合护理模式的一些评估并没有产生减少住院人数的预期结果,在某些情况下,甚至发现接受综合护理服务的人使用的医院比对照组更合适。在一次研讨会上,我们与50名综合护理专家一起测试了这些令人惊讶的结果的三个假设:(1)模型存在问题;(2) 执行问题;(3)评价问题。我们的专家小组没有排除这些假设中的任何一个,并就如何处理这些问题提出了一些建议。例如,模型设计者应该严格测试底层逻辑;委员应向专家和患者/专业人士寻求建议;评估人员应明智地选择结果,采用混合方法,并定期向实施地点提供反馈。评估综合护理是一项技术性任务,需要在模型的设计和实施方面采用多种方法。国家研究资助者或其他适当机构可以考虑开发一项咨询服务,为地方系统规划评估提供支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
14.30%
发文量
15
期刊介绍: The International Journal of Care Coordination (formerly published as the International Journal of Care Pathways) provides an international forum for the latest scientific research in care coordination. The Journal publishes peer-reviewed original articles which describe basic research to a multidisciplinary field as well as other broader approaches and strategies hypothesized to improve care coordination. The Journal offers insightful overviews and reflections on innovation, underlying issues, and thought provoking opinion pieces in related fields. Articles from multidisciplinary fields are welcomed from leading health care academics and policy-makers. Published articles types include original research, reviews, guidelines papers, book reviews, and news items.
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