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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
arts and humanities
A realist evaluation of value-based care delivery in home care: The influence of actors, autonomy and accountability
Social Science and Medicine, Volume 206, Year 2018
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Description
The increasing demand for home care is occurring in tandem with the need for governments to contain health care costs, maximize appropriate resource utilization and respond to patient preferences for where they receive care. We describe the evaluation of the Integrated Client Care Project (ICCP), a government funded project designed to improve value for outcomes for patients referred to community wound care services in Ontario, Canada. We applied a realist evaluation methodology in order to unpack the influences of contextual and mechanistic choices on the intended outcomes of the ICCP implementation. We collected data through ethnographic methods including 36 months of field observation, 46 key informant interviews and contemporaneous document analysis. The findings presented here highlight how theoretical mechanisms were negatively impacted by strong contextual patterns and weak implementation which led to underwhelming outcomes. Autonomy of the participant organizations, lack of power within the implementation team to drive change, opacity of the goals of the program, and disregard for the impact of complex historical relations within the home care sector compounded to undermine the intended outcome. © 2018 Elsevier Ltd
Authors & Co-Authors
Webster, Fiona
Canada, Toronto
University of Toronto
Browne, Gina Bohn
Canada, Hamilton
Mcmaster University
Mittmann, Nicole
Canada, Toronto
Sunnybrook Health Sciences Centre
Zwarenstein, Merrick F.
Canada, Toronto
University of Toronto
Canada, London
Western University
Statistics
Citations: 14
Authors: 4
Affiliations: 6
Identifiers
Doi:
10.1016/j.socscimed.2018.04.006
ISSN:
02779536
Research Areas
Health System And Policy
Study Design
Ethnographic Study
Study Approach
Qualitative