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Coming home after good @HealthFdn @NuffieldTrust meeting on challenges of evaluating #integratedcare - sense we have known most of these challenges for many years but no sea change yet in what is commissioned! @IFICInfo
A few key takeaways for me - 1. Need to look at theory of change to support design, implementation and evaluation - implementation science weak - we don’t really look into how things work at an operational level & therefore blind to understanding reasons behind impact
Then 2. Continued obsession with integrated care as code for a demand management tool in A&E despite lack of logic and evidence to such assumptions
And 3. Need to be much more granular in understanding how behaviours are influenced - ie. of people in receipt of care to support their needs and give them more power and control, of professionals and staff and their capacity, skills and effectiveness in working together ...
And 4. The dominance of health & medicine as the lens for #integratedcare vs. Social care, public health, community health, etc. that focus on different solutions and more grounded in tackling root causes
5. Unrealistic expectations and timeframes that lack appreciation of the long-term journey required - discovery not design - therefore evaluation embedded in the process, not outside of it
6. To better define the needs being addressed, with the community, the resources that are then needed, the logic and purpose of new models of care that address these & metrics that go with them, in an ongoing process of learning ...
7. There’s no such thing as usual care when dealing with complexity, and there is always significant variation in ways and means used to address it. Evaluations must embrace and make sense of this complexity - a methodological & practical ‘three pipe’ problem, esp. economic eval!
