Chronic Disease Prevention and Management Programs in the Province of Quebec: Results and Challenges of a Realist Synthesis
Abstract
CONTEXT Chronic diseases pose a significant challenge to all health care systems. In 2011, the Quebec Health Research Fund in partnership with the Ministry of health and social services of this province and private donations... [ view full abstract ]
CONTEXT
Chronic diseases pose a significant challenge to all health care systems. In 2011, the Quebec Health Research Fund in partnership with the Ministry of health and social services of this province and private donations launched a research grant program aimed at evaluating primary care-based chronic disease prevention and management (CDPM) initiatives promoting the integration of CDPM services and focusing on changing clinical practices. Seven CDPM programs in different regions of the Province of Quebec (Canada), based on the Chronic Care Model (CCM), received funding to support and evaluate their implementation.
OBJECTIVES
This session will present results of a RS aimed at analyzing and synthesizing qualitative and quantitative evaluation data from these programs, to identify their successful mechanisms and failures,and their contexts, with the specific aim to answer the following questions: Do these projects work? How? With whom? Under what circumstances and contexts? Challenges in the involvement stakeholders and synthesis of various evaluation materials will also be discussed.
METHODS
The RS includes five main phases: 1) clarifying the scope of the synthesis and initial program theories with leaders of all programs and decision makers; 2) searching the evidence from the evaluation results produced by the programs; 3) appraising the quality of the data; 4) extracting the data; and 5) synthesizing the data. The operational process of the RS consists of the following activities: 1) Content and activity description (purpose, concepts, quality criteria); 2) Active involvement of program leaders; 3) Material preparation; 4) Preliminary data exploration; 5) Program analysis; 6) Interviews with program leaders; 7) Evaluation and feedback; 8) Data analysis; 9) Report and dissemination.
RESULTS
Six of the funded CDPM programs were included in the RS. Twenty-four main CMO (context-mechanism-outcome) configurations related to the CCM that are linked to positive or negative outcomes in these CDPM programs were identified. Those that seem most important because they were observed in many programs and related to outcomes for patients, providers and organisations were found in four domains of CCM: 1) Organization of health care system; 2) Organization of services; 3) Self-management support; 4) Decision support and evidence-based practice. Some variations in the outcomes of programs were linked to specific contextual factors. Strategies to support the involvement of program leaders throughout the data collection and analysis and in knowledge transfer were effective. Some challenges were encountered during the RS such as the diversity of the evaluation methods used.
CONCLUSION
This RS allowed us to combine the results of the different initiatives and to reveal promising mechanisms and implementation strategies. These results are particularly relevant to inform the deployment of the Quebec Ministry of health and social services reform of CDPM services or of other health care systems trying to improve services for patients with long-term conditions.
Authors
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Maud-Christine Chouinard
(Université du Québec à Chicoutimi)
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Martin Fortin
(Université de Sherbrooke)
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Boubacar-Bayero Diallo
(Université de Sherbrooke)
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Mireille Lambert
(Université de Sherbrooke)
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Aline Ramond
(Université de Sherbrooke)
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Bouhali Tarek
(Université de Sherbrooke)
Topic Areas
Please select one of the following:: Realist synthesis , Please select a maximum of two themes from the following list:: Exploring 'Mechanisms' , Please select a maximum of two themes from the following list:: Designing Realist Evaluati
Session
OS-11 » Realism in Action IV (09:45 - Wednesday, 5th October, Frobisher Room 2)
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