Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 23;20(1):971.
doi: 10.1186/s12913-020-05775-5.

Advancing integrated care evaluation in shifting contexts: blending implementation research with case study design in project SUSTAIN

Jenny Billings  1 , Simone R de Bruin  2 , Caroline Baan  2 , Giel Nijpels  3
Affiliations

Advancing integrated care evaluation in shifting contexts: blending implementation research with case study design in project SUSTAIN

Jenny Billings et al. BMC Health Serv Res. .

Abstract

Background: 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.

Conclusions: 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.

Keywords: Case study design; Implementation research; Integrated care evaluation; Process and outcome measures.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Evidence Integration Triangle [19]
Fig. 2
Fig. 2
Multiple Embedded Case study design showing data sources and planned samples per site and overall in 14 sites
Fig. 3
Fig. 3
Data collection and Feedback plan
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Billings J. Improving the evidence base. In: Leichsenring K, Billings J, Nies H, editors. Long-term care in Europe: improving policy and practice. Basingstoke: Palgrave Macmillan; 2013. pp. 299–324.
    1. Nuño Solinís R, Stein KV. Measuring integrated care – the quest for disentangling a Gordian knot. Int J Integr Care. 2016;16(3):18. doi: 10.5334/ijic.2525. - DOI - PMC - PubMed
    1. Tsasis P, Evans JM, Owen S. Reframing the challenges to integrated care: a complex-adaptive systems perspective. International Journal of Integrated Care. 2012;12(5). 10.5334/ijic.843. - PMC - PubMed
    1. Shaw S, Rosen R, Rumbold B. What is integrated care? Nuffield trust; 2011. https://www.nuffieldtrust.org.uk/files/2017-01/what-is-integrated-care-r... Accessed 15th Nov 2018.
    1. De Bruin SR, Versnel N, Lemmens LC, Molema CCM, Schellevis FG, Nijpels G, et al. Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review. Health Policy. 2012;107:108–145. doi: 10.1016/j.healthpol.2012.06.006. - DOI - PubMed

LinkOut - more resources