The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis

摘要: Background The Multispecialty Community Provider (MCP) model was introduced to the NHS as a primary care-led, community-based integrated care provide better quality, experience and value for local populations. Objectives three main objectives were (1) articulate underlying programme theories MCP of care; (2) identify sources theoretical, empirical practice evidence test theories; (3) explain how mechanisms used in different contexts contribute outcomes process variables. Design There phases: identification from logic models vanguards, prioritising key investigation; appraisal, extraction analysis against best-fit framework; realist reviews prioritised theory components maps remaining components. Main outcome measures quadruple aim addressed population health, cost-effectiveness, patient staff experience. Data Searches electronic databases with forward- backward-citation tracking, identifying research-based practice-derived evidence. Review methods A synthesis identify, refine following components: community-based, co-ordinated is more accessible; place-based contracting payment systems incentivise shared accountability; fostering relational behaviours builds resilience within communities. Results Delivery requires professional service user engagement, which dependent on building trust empowerment. These are generated if values incentives new ways working aligned there opportunities training development. Together, these can facilitate accountability at individual, community system levels. base relating was, most part, limited by initiatives that relatively or not formally evaluated. Support varies, moderate support enhanced involvement care, weak models. Strengths limitations project benefited close relationship national leads, reflecting proximity research team decision-makers. Our use change could present static position what dynamic change. Conclusions Providers be described complex adaptive (CASs) and, such, connectivity, feedback loops, learning adaptation CASs play critical role their design. Implementation further reinforced paying attention contextual factors influence behaviour change, order working. Future work set evidence-derived ‘key ingredients’ has been compiled inform design delivery future iterations health-based care. Suggested priorities include impact workforce, effects longer-term contracts sustainability capacity, conditions needed successful continuous improvement learning, carers empowerment participation might resilience. Study registration This study registered PROSPERO CRD42016039552. Funding National Institute Health Research Services programme.