How Context and Program Conditions (CPC) affect collaboration in Integrated Care: using the CPC-framework and Structural Equation Modelling to examine conditions for interprofessional collaboration in Danish Primary Care.

Introduction: Increasing demand for interprofessional collaboration has raised the interest in the influence of different conditions. However, we know little about the magnitude of interactions between conditions. This is important, as it enables identifying the most important conditions. This paper aims to develop and adapt an existing framework based on a study of homecare services for elderly in Denmark. Theory: The Context and Program Conditions for interprofessional collaboration in integrated care (CPC)-framework conceptualises relationships between program and context conditions at professional and organisational levels; and measures the interrelationships between the conditions in addition to the conditions influence on the quality and effectiveness of communication. Program conditions directly relate to the collaboration model, while context conditions surround the collaboration. Methods: This was a sequential mixed-methods study, conducted between August and December 2021 in Herning and Holstebro municipality. A pilot-study helped to validate the adapted questionnaires. Subsequently, a multilevel cross-sectional survey study was conducted. The study focused on interprofessional collaboration between home care and home nursing units. The study population was all frontline staff in the units, and their managers. To analyse data CBSEM was used, based on prior hypothesised relationships and indexes. Results: Preliminary results indicate that the questionnaires have appropriate psychometric properties and satisfy the assumptions of the CPC-framework. This makes the CPC-framework well-suited for assessing how different types of conditions influence the quality and effectiveness of communication in interprofessional collaborations in a Danish primary care setting. Discussions: Our study stresses the importance of interactions between different types and levels of conditions on a broad scale. Additionally, our study argues that there exists no single, 'goldenstandard' framework for examining conditions for collaborations in integrated care. However, it is not conducive either to develop a unique framework each time a researcher examines a new setting. Instead, the goal should be to design a flexible framework with explicit aims and measurement strategies. This is to ensure the validity and reliably of studies each time the framework is applied to a new setting. Conclusions: The CPC-framework can be used as a diagnostic tool to identify the most important conditions for primary care collaborations in Denmark, and subsequently to help improve existing interprofessional collaborations. Lessons learned: This study demonstrated how to identify the most important conditions in an analytically stringent way. This can help leaders to identify and work with conditions as part of their continuous efforts to sustain collaborations in integrated care initiatives. Limitations: Although this study has tested the CPC-framework for its reliability and validity, future studies using the framework should follow the same measurement strategy. Further, we can expect there are additional paths and variables in the final SEM-model (e.g. patient and system level conditions). We have excluded these variables for valid analytical reasons, but the interpretation of results should have this in mind. Future research: Future research should help consolidate the literature on conditions, by further exploring how different types of conditions across analytical levels interact with each other and affect outcome-measures in different types of collaborations and settings. [ABSTRACT FROM AUTHOR]