Abstract
Introduction:Studying implementation of integrated models of community-based primary health care requires a “whole systems” multidisciplinary approach to capture micro, meso and macro factors. However, there is, as yet, no clear operationalization of a “whole systems” approach to guide multidisciplinary research programs. Theoretical frameworks and approaches from diverse academic traditions specify different aspects of the health system in more depth. Enabling analysis across the system, when data and ideas are captured using different taxonomies, requires that we map terms and constructs across the models.Theory and methods:This paper uses concept mapping techniques to compare and contrast the theoretical frameworks and approaches used in the iCOACH project including: Ham’s Ten Characteristics of the High-Performing Chronic Care System (capturing patient/carer and provider perspectives), the Organizational Context and Capabilities for Integrating Care framework (capturing the organizational perspective), and the Health Policy Monitor framework (capturing the policy system perspective). The aim of the paper is to link concepts across different theoretical framework to guide the iCOACH study.Results:A concept map was developed that identifies 8 overarching concepts across the heuristic models. A preliminary analysis of one of these overarching concepts, care coordination, demonstrates how different perspectives will assign different meanings, values, and drivers of seemingly similar ideas. For patients and carers care coordination is about having a responsive team of health care providers. Building relationships in teams that exist within and across different organizations is essential for providers to achieve care coordination, where managers and policy makers see care coordination as being more about creating linkages and addressing systems gaps.Discussion and conclusion:This work represents a first step towards development of a fully formed conceptual framework that includes key domains, concepts, and mechanisms of implementing integrated community-based primary health care.
Highlights
Studying implementation of integrated models of community-based primary health care requires a “whole systems” multidisciplinary approach to capture micro, meso and macro factors
While outcomes related to Chronic Care Model (CCM) [4] and implementation of CCM [3] have been explored, there is limited understanding of factors facilitating the adoption of the CCM in integrated community-based primary health care (ICBPHC) settings to appropriately care for patients with complex
Linking together multiple episodes of care offered by providers across the health system has been identified as central to supporting patient-centredness [7]
Summary
Studying implementation of integrated models of community-based primary health care requires a “whole systems” multidisciplinary approach to capture micro, meso and macro factors. Steele Gray et al: Mapping for Conceptual Clarity care needs With their multiple co-occurring chronic illnesses and social complexity [5], this patient population is most in need of a patient-centred approach to chronic disease management [6, 7], strategies to address multi-morbidity have mainly focused on formal health service provision through general practice and secondary care that are often fragmented with poor coordination of care [8,9,10,11]. Core components of patient-centredness, such as integration of medical and non-medical care, coordination and continuity [12] are supported through integrated models
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