ArticleInternational journal of integrated care2019
A Realist Evaluation of Local Networks Designed to Achieve More Integrated Care.
Article in International journal of integrated care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
8 citing papers in PubMed.
- Article
- [Realistic evaluation mechanisms in primary health care interventions in rural and marginal urban populationsMecanismos de avaliação realistas em intervenções de atenção primária à saúde em populações rurais e urbanas periféricas].Revista panamericana de salud publica = Pan American journal of public health · 2022Article
- Advancing integrated care evaluation in shifting contexts: blending implementation research with case study design in project SUSTAIN.BMC health services research · 2020Article
- (Dis)Integrated Care? Lessons from East London.International journal of integrated care · 2020Article
- Evaluating Large-Scale Integrated Care Projects: The Development of a Protocol for a Mixed Methods Realist Evaluation Study in Belgium.International journal of integrated care · 2020Article
- Relationships Among Structures, Team Processes, and Outcomes for Service Users in Quebec Mental Health Service Networks.International journal of integrated care · 2020Article
- Integrated Care in Aotearoa New Zealand 2008-2020.International journal of integrated careArticle
- Health and Social Care Reform in Scotland - What Next?International journal of integrated careArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionNot 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
methodsUsing 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.
resultsThe 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.
conclusionGiven 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 target".
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