scholarly journals A realist evaluation of local networks designed to achieve more integrated care

2021 ◽  
Author(s):  
Lesley Middleton ◽  
H Rea ◽  
Megan Pledger ◽  
Jacqueline Cumming
Keyword(s):  
Integrated Care ◽  
Hospital Admissions ◽  
Explanatory Power ◽  
Complex Interventions ◽  
Realist Evaluation ◽  
Integrate Care ◽  
Local Networks ◽  
New Ways Of Working ◽  
Contractual Arrangements ◽  
General Practices

© 2019 The Author(s). Introduction: Not surprisingly given their multi-component nature, initiatives to improve integrated care often evolve to find the best way to bring about change. This paper provides an example of how an evaluation evolved alongside such an initiative designed to better integrate care across primary, community and hospital services in South Auckland, New Zealand. Theory and methods: Using the explanatory power of a realist evaluative approach, theories of new ways of working that might be prompted by the initiative were explored in: (i) interviews with stakeholders in 2012 and 2015, (ii) online surveys of general practices and local care organisations, and (iii) a purposive sample of ten general practices. Results: The results highlighted the institutional contexts that led to difficulties in implementing population health initiatives. They also revealed that changes in work practices focussed mostly on activities that improved the coordination of care for individuals at risk of hospital admissions. Discussion: Multi-component complex interventions can vary in their delivery and be vulnerable to one or more components not being implemented as originally intended. In the case of this intervention, the move towards strengthening local relationships arose when contractual arrangements stalled. Realist evaluative approaches offer a logic that helps unpick the complexity of the relationships and politics in play, and uncover the assumptions made by those developing, implementing and assessing health service changes. Conclusion: Given the multi-component and evolving nature of initiatives seeking to better integrate care, the realist evaluative emphasis on surfacing early the theories to explain how change is expected to occur helps overcome the challenge of evaluating “a moving targetA..

scholarly journals A realist evaluation of local networks designed to achieve more integrated care

2021 ◽  
Author(s):  
Lesley Middleton ◽  
H Rea ◽  
Megan Pledger ◽  
Jacqueline Cumming
Keyword(s):  
Integrated Care ◽  
Hospital Admissions ◽  
Explanatory Power ◽  
Complex Interventions ◽  
Realist Evaluation ◽  
Integrate Care ◽  
Local Networks ◽  
New Ways Of Working ◽  
Contractual Arrangements ◽  
General Practices

© 2019 The Author(s). Introduction: Not surprisingly given their multi-component nature, initiatives to improve integrated care often evolve to find the best way to bring about change. This paper provides an example of how an evaluation evolved alongside such an initiative designed to better integrate care across primary, community and hospital services in South Auckland, New Zealand. Theory and methods: Using the explanatory power of a realist evaluative approach, theories of new ways of working that might be prompted by the initiative were explored in: (i) interviews with stakeholders in 2012 and 2015, (ii) online surveys of general practices and local care organisations, and (iii) a purposive sample of ten general practices. Results: The results highlighted the institutional contexts that led to difficulties in implementing population health initiatives. They also revealed that changes in work practices focussed mostly on activities that improved the coordination of care for individuals at risk of hospital admissions. Discussion: Multi-component complex interventions can vary in their delivery and be vulnerable to one or more components not being implemented as originally intended. In the case of this intervention, the move towards strengthening local relationships arose when contractual arrangements stalled. Realist evaluative approaches offer a logic that helps unpick the complexity of the relationships and politics in play, and uncover the assumptions made by those developing, implementing and assessing health service changes. Conclusion: Given the multi-component and evolving nature of initiatives seeking to better integrate care, the realist evaluative emphasis on surfacing early the theories to explain how change is expected to occur helps overcome the challenge of evaluating “a moving targetA..

scholarly journals A realist evaluation of local networks designed to achieve more integrated care

2019 ◽  
Vol 19 (4) ◽  
pp. 632
Author(s):  
Harry Rea ◽  
Jacqueline Cumming ◽  
Megan Pledger ◽  
Lesley Middleton
Keyword(s):  
Integrated Care ◽  
Realist Evaluation ◽  
Local Networks

scholarly journals A realist evaluation of local networks designed to achieve more integrated care

2021 ◽  
Author(s):  
Harry Rea ◽  
Jacqueline Cumming ◽  
Megan Pledger ◽  
Lesley Middleton
Keyword(s):  
Integrated Care ◽  
Realist Evaluation ◽  
Local Networks

No description supplied

scholarly journals A Realist Evaluation of Local Networks Designed to Achieve More Integrated Care

2019 ◽  
Vol 19 (2) ◽  
Author(s):  
Lesley Middleton ◽  
Harry Rea ◽  
Megan Pledger ◽  
Jacqueline Cumming
Keyword(s):  
Integrated Care ◽  
Realist Evaluation ◽  
Local Networks

scholarly journals A realist evaluation of local networks designed to achieve more integrated care

2021 ◽  
Author(s):  
Harry Rea ◽  
Jacqueline Cumming ◽  
Megan Pledger ◽  
Lesley Middleton
Keyword(s):  
Integrated Care ◽  
Realist Evaluation ◽  
Local Networks

No description supplied

scholarly journals Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

2021 ◽  
Author(s):  
Aoife Watson ◽  
Donna McConnell ◽  
Vivien Coates
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Integrated Care ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Community Based Interventions ◽  
Community Based ◽  
Integrated Care Pathways ◽  
Effective Community ◽  
Balance Of Care

Abstract Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

scholarly journals Combining Realist approaches and Normalization Process Theory to understand implementation: a systematic review

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Sonia Michelle Dalkin ◽  
Rebecca J. L. Hardwick ◽  
Catherine A. Haighton ◽  
Tracy L. Finch
Keyword(s):  
Systematic Review ◽  
Health Management ◽  
Explanatory Power ◽  
Family Health ◽  
Realist Evaluation ◽  
Normalization Process Theory ◽  
Process Theory ◽  
Scientific Realist ◽  
Health Database ◽  
Normalization Process

Abstract Background Realist approaches and Normalization Process Theory (NPT) have both gained significant traction in implementation research over the past 10 years. The aim of this study was therefore to explore how the approaches are combined to understand problems of implementation, to determine the degree of complementarity of the two approaches and to provide practical approaches for using them together. Methods Systematic review of research studies combining Realist and NPT approaches. Realist methodology is concerned with understanding and explaining causation, that is, how and why policies, programmes and interventions achieve their effects. NPT is a theory of implementation that explains how practices become normalised. Databases searched (January 2020) were ASSIA, CINAHL, Health Research Premium Collection via Proquest (Family Health Database, Health & Medical Collection, Health Management Database, MEDLINE, Nursing & Allied Health Database, Psychology Database, Public Health Database) and PsycARTICLES. Studies were included if the author(s) stated they used both approaches: a scientific Realist perspective applying the principles of Pawson and Tilley’s Realist Evaluation or Pawson’s Realist Synthesis and Normalization Process Theory either solely or in addition to other theories. Two authors screened records; discrepancies were reviewed by a third screener. Data was extracted by three members of the team and a narrative synthesis was undertaken. Results Of 245 total records identified, 223 unique records were screened and 39 full-text papers were reviewed, identifying twelve papers for inclusion in the review. These papers represented eight different studies. Extent and methods of integration of the approaches varied. In most studies (6/8), Realist approaches were the main driver. NPT was mostly used to enhance the explanatory power of Realist analyses, informing development of elements of Contexts, Mechanisms and Outcomes (a common heuristic in realist work). Authors’ reflections on the integration of NPT and Realist approaches were limited. Conclusions Using Realist and NPT approaches in combination can add explanatory power for understanding the implementation of interventions and programmes. Attention to detailed reporting on methods and analytical process when combining approaches, and appraisal of theoretical and practical utility is advised for advancing knowledge of applying these approaches in research. Systematic review registration Not registered.

scholarly journals Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028744 ◽  
Author(s):  
Geraldine McDarby ◽  
Breda Smyth
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Ambulatory Care Sensitive Conditions ◽  
Hospital System ◽  
Bed Days ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.

Reimagining a Realist Evaluation Research in Entrepreneurship Skills Development and the Idea of University Education

2021 ◽  
Vol 12 (1) ◽  
pp. 133-133
Author(s):  
Valile Valindawo M. Dwayi
Keyword(s):  
Explanatory Power ◽  
Evaluation Research ◽  
Realist Evaluation ◽  
University Education ◽  
Skills Development ◽  
Research Approach ◽  
Espoused Values ◽  
Innovation And Technology ◽  
Sustainability Challenges

This article reports on the evaluation researchproject, which focussed on the viability and sustainability challenges in one particular case of a university over a period of five years. Such a university remains categorised as structurally disadvantaged despite almost thirty years into constitutional democracy in South Africa. As such, the research project was conducted against the complexity of the university transformation project, which take place against the enduring social ills as high unemployment rate, increasing inequalities and abject poverties especially from the enduring legacy of the old racist apartheid system. The role of university education in such a context becomes the reflexive imperative in consideration of university, not only as the public good and equity, but for social justice and equity discourses. Such discourses need to be made more loud than is presently the case. The research therefore focussed on the role of entrepreneurship skills development, which then were juxtaposed with the espoused values of of science, innovation and technology as the key performance indicators for the academic project. As such, the article will revolve around the main argument that scholarship of engagament in univeristy spaces, where entrepreneurship skills development ought to be the enabling system, need to be reimagined in terms of the contemporary research disciplines. Critical realist philosophy, and the realist social theory as the explanatory program, provide the alternative research approach to the mainstream approaches due to their explanatory power for for transcendentalism and based on retroductive arguemnts about the social world. Such an approach does not only foreground the contemporary debates in social sciences, and the emerging fields of study within it, but also help to elaborate on the purist positions that tend to be promoted in some business science fields and their inadvertent pragmatic and black box logic. Keywords: Viability, Sustainability, Entrepreneurship skills development, Historically disadvantaged universities, realist evaluative research

scholarly journals From summative to developmental

2019 ◽  
Vol 27 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Carolyn Steele Gray ◽  
James Shaw
Keyword(s):  
Integrated Care ◽  
Design Thinking ◽  
Complex Interventions ◽  
Service Design ◽  
Lessons Learned ◽  
Portal System ◽  
Contextual Influences ◽  
Content Type ◽  
Advantages And Disadvantages ◽  
Patient Reported

Purpose Models of integrated care are prime examples of complex interventions, incorporating multiple interacting components that work through varying mechanisms to impact numerous outcomes. The purpose of this paper is to explore summative, process and developmental approaches to evaluating complex interventions to determine how to best test this mess. Design/methodology/approach This viewpoint draws on the evaluation and complex intervention literatures to describe the advantages and disadvantages of different methods. The evaluation of the electronic patient reported outcomes (ePRO) mobile application and portal system is presented as an example of how to evaluate complex interventions with critical lessons learned from this ongoing study. Findings Although favored in the literature, summative and process evaluations rest on two problematic assumptions: it is possible to clearly identify stable mechanisms of action; and intervention fidelity can be maximized in order to control for contextual influences. Complex interventions continually adapt to local contexts, making stability and fidelity unlikely. Developmental evaluation, which is more conceptually aligned with service-design thinking, moves beyond these assumptions, emphasizing supportive adaptation to ensure meaningful adoption. Research limitations/implications Blended approaches that incorporate service-design thinking and rely more heavily on developmental strategies are essential for complex interventions. To maximize the benefit of this approach, three guiding principles are suggested: stress pragmatism over stringency; adopt an implementation lens; and use multi-disciplinary teams to run studies. Originality/value This viewpoint offers novel thinking on the debate around appropriate evaluation methodologies to be applied to complex interventions like models of integrated care.

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