Search

Background: Within the Learning Health System (LHS) model, learning routines, including evaluation, allow for continuous incremental change to take place. Within these learning routines, evaluation assists in problem identification, data collection, and data transformation into contextualized information, which is then re-applied to the LHS environment. Evaluation that catalyzes learning and improvement may also contribute to health innovation sustainability. However, there is little consensus as to why certain evaluations seem to support learning and sustainability, while others impede it. This realist synthesis seeks to understand the contextual factors and underlying mechanisms or drivers that best support health systems learning and sustainable innovation. Methods: This synthesis will be guided by Pawson and colleagues' 2005 and Emmel and colleagues' 2018 guidelines for conducting realist syntheses. The review process will encompass five steps: (1) scoping the review, (2) building theories, (3) identifying the evidence, (4) evidence selection and appraisal, and (5) data extraction and synthesis. An Expert Committee comprised of leaders in evaluation, innovation, sustainability, and realist methodology will guide this synthesis. Review findings will be reported using the RAMESES guidelines. Discussion: The use of a realist review will allow for exploration and theorizing about the contextual factors and underlying mechanisms that make evaluations 'work' (or 'not work') to support learning and sustainability. Depending on results, we will attempt to synthesize findings into a series of recommendations for evaluations with the intention to support health systems learning and sustainability. Finalized results will be presented at national and international conferences, as well as disseminated via a peer-reviewed publication. Systematic review registration: This realist synthesis protocol has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero/ ID 382690). [ABSTRACT FROM AUTHOR]

Introduction: In a world where the prevalence of chronic conditions is increasing, the importance of a strong primary care system cannot be underestimated. One of the suggested strategies for person-centered integration of care is to explicitly focus on the patients' goals; or in other words a focus on goal-oriented care (GOC). To make GOC more applicable, it is important to build an understanding on how it should be provided in practice. Therefore, it is vital to not only learn from literature, but foremost of primary healthcare professionals themselves on how they operationalize GOC. Aims, objectives, theory or methods: This study explored how primary healthcare professionals operationalize GOC in their practice. Therefore, professionals were recruited in different primary care settings in Ottawa (Canada), Vermont (USA), and Flanders (Belgium). A two-step approach of a deductive and inductive analysis was used to analyze the in-depth interviews. Firstly - with the aim to validate the literature - the theoretical framework that emerged from the concept analysis on GOC, was used as a lens for the deductive analysis. Secondly, an inductive thematic analyses following Sundler was performed to expand the theoretical knowledge with insights from practice. All interviews were audio taped and transcribed verbatim. Highlights or results or key findings: When looking at the data trough a deductive lens, the theoretical framework - presenting a stepwise approach of GOC with the phases of goal-elicitation, goal-setting, and goal-evaluation and the patients' needs and preferences as a common thread - could be confirmed. However such a linear approach in one-on-one interactions, as emerged from the literature, could not be determined. The dynamic and iterative character of GOC should be more emphasized. The inductive analysis revealed three main themes that were not described in the concept analysis: 1) involving the patients, 2) interprofessional collaboration, and 3) the use of tools or guidance. The participants involved their patients by communicating in a constructive dialogue and informing them about their health status. Interprofessional collaboration allowed the participants to bring all different expertise - who could support the patients to work towards their goals - together. Finally, participants used tools to support the process of eliciting and setting patients' personal goals. Conclusions:The findings validated the theoretical framework emerged from the literature. Besides this validation, we learn from practice that professionals made use of tools to support goalelicitation, goal-setting, and to prepare interprofessional meetings. All this with the overall aim to encourage patients to actively take part in their care. Implications for applicability/transferability, sustainability, and limitations: This study allowed us to go beyond the theoretical knowledge of GOC and build on experiences of primary healthcare professionals from different disciplines, settings, and countries. This is needed to gain a full understanding on GOC and explore the elements that go along with providing GOC. [ABSTRACT FROM AUTHOR]

Introduction: Information and communication technologies (ICTs) are recognized as a critical enablers of integrated primary care to support patients living with multiple chronic conditions. Although ICTenabled integrated primary care hold promises to support complex patients through team-based and continued care, critical implementation factors regarding what ICTs are available and how they enable the integrated model are yet to be mapped in the literature. This scoping review addresses this current knowledge gap in order to identify opportunities and gaps to help guide future implementation of the ICT-enabled integrated primary care model. Aims Objectives Theory or Methods: Objective: This study systematically scoped the literature on ICT-enabled integrated healthcare delivery models for patients with complex care needs to identify which technologies have been used in integrated primary care settings. Method: The Arksey and O'Malley method was used to guide this scoping review. Four electronic medical databases were accessed: MEDLINE, EMBASE, CINAHL, PsycINFO, collecting studies published between January 2000 - December 2020. Identified peer-reviewed articles were screened in two stages: 1) title and abstract screening; and 2) full-text review. Relevant studies were charted and analyzed using the Rainbow Model of Integrated Care and the eHealth enhanced Chronic Care model. Highlights or Results or Key Findings: A total of 46,736 articles were screened at the title and abstract level of which 37 met the eligibility criteria of the review. A large number of the studies originated from North America (62.5%) and used a quantitative method as a study design (51%). 70% of the studies used technology to enable professional and clinical level integration through clinical information sharing among a multidisciplinary team or across multiple organizations. There were fewer studies focused on the organization or system-level integration of care through technologies. A range of technologies was used in these models including web-based platforms, mobile applications, and telemonitoring being the most frequently used. Multiple implementation factors were identified that could enable or hinder the successful implementation of technologies including patient health/digital literacy and training; provider workload, attitudes, and beliefs; usability and interoperability of technologies; and system factors such as incentives, technical and human resource support. Conclusions: To maximize technological benefits in primary care, the literature suggests system-level support and favourable implementation climate are required. Future research is needed to explore how to integrate technologies at an organization and system level to create a health system that is wellprepared to optimize technologies to support patients. Implications for applicability/transferability sustainability and limitations: The study findings benefit system leaders in showing the implementation factors and the types of technologies they need to consider when applying technology to optimize their integrated care models. Due to time constraints, gray literature was excluded in the review which may limit the findings of the study. [ABSTRACT FROM AUTHOR]

Introduction: Discussions of integrated care have ranged in focus from large-scale health system transformations, to discrete interventions intended to enhance local continuity of care. Beyond these variations in scale and focus, literature on integrated care has used a variety of conceptual frameworks to explain various activities and elements necessary to achieve integrated care. Existing frameworks have helped to advance research and practice; yet the complexity of changing practice required to achieve integrated care across the policy, organizational, and clinical levels complicates efforts to represent or implement these innovations in straightforward ways. Aims Objectives Theory or Methods: In this paper, we present a novel strategy for conceptualizing integrated care as developing through a series of milestones observable at the organizational level. Based on analysis of four integrated care organizational case studies in Canada and New Zealand, we outline how this approach to conceptualizing integrated care both resolves the tension of crossing the macro, meso, and micro levels of analysis, and generates new practical insights to guide policy and practice. Methods consist of qualitative interviews, observation, and document analysis across cases, and qualitative data were analyzed temporally to identify milestones as indicated by participants over time. Highlights or Results or Key Findings: We define a milestone as the occurrence of a salient event that is perceived by respondents to facilitate or disrupt efforts towards the development of integrated care. We synthesize these events at the organizational level, suggesting that the organizational level of analysis is the most appropriate level to represent the significance of these milestones. Our analysis identified six categories of milestone: (1) Strategic relational milestones, referring to building relationships between stakeholders. (2) Strategic process change milestones, referring to efforts to improve quality in practice. (3) Structural (intra-organizational) milestones, referring to changes in organizational structure. (4) Structural (inter-organizational) milestones, referring to changes in the legal, operational, or leadership structures that facilitate relationships between organizations. (5) Environmental milestones, referring to changes in the social or natural environment. (6) Political milestones, referring to changes in the control and allocation of resources. Conclusions: Our results generate a new conceptual framework for understanding the achievement of integrated care as occurring through a series of milestones. This approach enhances the focus on achieving integrated care "in the wild", in the actual environments in which leaders, clinicians, policymakers, patients, and caregivers work to implement integrated care. Implications for applicability/transferability sustainability and limitations: Our model emphasizes two practical points. First, that there is no single series of sequential steps that must be taken to achieve integrated care. Second, that policy efforts to support integrated care ought to encourage organizations and their collaborators to work toward milestones that facilitate the development of integrated care. [ABSTRACT FROM AUTHOR]