What can a participatory approach to evaluation contribute to the field of integrated care?
What can a participatory approach to evaluation contribute to the field of integrated care?
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DOI：
10.1136/bmjqs-2016-005777
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发表时间：
2017-07-01
影响因子：
5.4
通讯作者：
Marshall, Martin
中科院分区：
文献类型：
--
作者：
Eyre, Laura;Farrelly, Michael;Marshall, Martin
许多国家认为，更好地整合卫生部门内的保健以及保健与社会保健之间的保健，是解决资源减少、人口结构变化和保健质量参差不齐等长期问题的一个重要途径。目前关于一体化努力的有效性的研究证据既不支持那些促进和设计一体化护理方案的人的热情，也不支持试图在实地一体化护理的从业人员的日益努力。在本文中，我们提出了一种方法论的基础上，参与性研究的原则，试图解决这一挑战。探索性方法的特点是希望使用社会科学方法来解决实际问题，并承诺研究人员与相关利益攸关方进行实质性和持续的合作。我们描述了我们如何应用一个新兴的参与式研究的实用模式，研究人员在居住模式，以评估在英国的大规模综合护理计划。我们建议，这一方法以多种方式增加方案的价值：让利益攸关方参与使用既定证据，并享受严格评价其工作的好处;为当地利益攸关方提供他们不熟悉或在制定和执行方案时没有充分考虑的见解;挑战既定的心态和规范。虽然仍然有很多要了解的好处和挑战，在卫生部门应用参与式方法，我们展示了如何使用这种方法有可能帮助从业者更有效地整合护理在他们的日常实践中，并帮助推进综合护理的学术研究。
Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge. Participatory approaches are characterised by a desire to use social science methods to solve practical problems and a commitment on the part of researchers to substantive and sustained collaboration with relevant stakeholders. We describe how we applied an emerging practical model of participatory research, the researcher-in-residence model, to evaluate a large-scale integrated care programme in the UK. We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms. While there is still much to learn about the benefits and challenges of applying participatory approaches in the health sector, we demonstrate how using such approaches have the potential to help practitioners integrate care more effectively in their daily practice and help progress the academic study of integrated care.