Provider, Patient, and Caregiver Perspectives of a Co-Designed Integrated Care Model: A Qualitative Study within a Realist Evaluation

Abstract

Introduction: Timely and realistic evaluation is key to our ability to scale and spread integrated care models that seemingly benefit ill individuals who have difficulties accessing personalized care. North York Community Access to Resources Enabling Support (NYCARES) is an innovative, codesigned model of care intended to transition patients from hospital to home by improving care coordination through a single point of contact. Since NYCARES was designed, delivered, and adapted during the global COVID-19 pandemic and local health system transformation, there is a gap in understanding the key components of NYCARES as part of program theory development. Objectives/Methods: We aimed to identify and describe salient aspects of NYCARES from the perspectives of program participants. We conducted a qualitative study with three groups of individuals: service providers, patients, and their family/caregivers. Objectives were to understand their expectations of NYCARES, outcomes that matter, key program components and resources, what aspects of the program did and did not work, and what they considered barriers and facilitators. Four members of the Patient and Caregiver Health Council were consulted on how best to approach interviews with patients and their family/caregivers; they also provided feedback on the interview guide. Semi-structured interviews were conducted one-on-one or with patientcaregiver dyads. Interviews were audio-recorded, transcribed, and analyzed using a constant comparative approach with thematic analysis. Results: We will present the preliminary analysis of this qualitative data and discuss its relation to a larger realist evaluation of which it is part. Data collection is underway and a logic model has been drafted to propose an early program theory. Data analysis is anticipated to elucidate participant perspectives by understanding, comparing, and integrating the experiences of the three NYCARES groups. Results are anticipated to reveal key program components including areas of consonance and dissonance among participant groups. Being informed of ongoing study progress, members of the Patient and Caregiver Health Council will be consulted at key milestones for their interpretation of how NYCARES can better evolve to meet care and health system goals. These findings will contribute to a realist evaluation seeking to understand the relevant contexts, mechanisms of impact, and outcomes inherent in NYCARES. Conclusion: The diverse perspectives of three participant groups (providers, patients, family members/caregivers) will highlight key outcomes, resources, processes, barriers, and facilitators for this integrated care model. This understanding is necessary for the development of a program theory of NYCARES and critical for the realist evaluation. Involvement of Patient and Caregiver Health Council members adds unique interpretations of findings while building evaluation understanding and capacity in the local health system. Implications: This qualitative study enables a deeper understanding of implementation challenges and theory-in-practice in rapidly changing contexts. Having timely, realist evaluation from diverse participant perspectives can inform quality improvement efforts for ongoing and adaptive program iterations. [ABSTRACT FROM AUTHOR]