Obtaining and transferring adequate evidence for integrated care. Problem: In many countries health and social care are too often fragmented and subsequently result in deficiencies in service delivery, causing low responsiveness of the health system, low satisfaction of patients with health services, low job-satisfaction, suboptimal health outcomes, and inefficient use of resources. Integrated care initiatives are being developed around the world to drive forward transformation of health systems to achieve accessible, quality, effective and sustainable health care. However, despite attempts by the Evidence-based medicine movement to emphasize the importance of using evidence to inform healthcare practice, the quality of research providing evidence supporting integrated care initiatives remains unsatisfactorily. This is partly caused by the use of traditional evaluation efforts that focus on outcomes and illustrate an oversimplification of the environment and the complex initiatives. The linkage between changes in services and service outcomes is problematic because most patient or service user outcomes do not emerge from linear cause and effect chains. Current methods and measures of quality in health care provide limited information about the effectiveness of complex interventions within uncontrolled, context-rich settings, and do not clarify the underlying mechanisms governing the components of integrated care. Objective: To achieve a successful transformation towards more integrated care systems, adequate insights are needed into what factors contribute to the progress and success of integrated care initiatives. Possible solution: What is needed are multi-method approaches to evaluation, such as realist research (RR), which captures the complexity of integrated care as reflected in its multiple components and dynamic nature with a view to understanding what works, for whom, and under what conditions. Since the use of comprehensive evaluation approaches, such as RR, is relatively new to scientist in the field of integrated care, it is important to raise awareness on the shortcomings of current evaluation approaches and the need for new comprehensive evaluation approaches. Not only among scientists, but also among doctors, policymakers, and the public. Next to obtaining adequate evidence on integrated care initiatives, it is important to transfer the findings to a wider audience to achieve a wide scale change in health systems. In order not to make the same mistake by having a too narrow perspective on the process of knowledge transfer, as is currently the case, it is important to regard the transfer process as a complex process of interaction and collaboration. Understanding context and the diverse types of knowledge have been observed to be more and more important in affecting behaviour change. Furthermore, evaluation of these complex knowledge translation interventions must be part of the knowledge transfer process, to collect lessons to understand what works, for whom, and under what conditions.
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