TY - JOUR
AU - T. Ling
AU - N. Fahy
AU - J. Dawney
A1 - 
AB - There is global interest in integrated care, often associated with how to improve system efficiency, strengthen clinical and cost-effectiveness, avoid gaps in patient care, and improve patient experiences and outcomes, through improved coordination across services. Despite considerable activity in both delivering and evaluating integrated care, evaluations have not greatly helped to understand how to 'do' it better. Evaluations of integrated care have often arrived at similar conclusions, frequently including the generic finding that results are patchy and context dependent. In this article, we explore and discuss these challenges to evaluation, how these challenges are understood in recent key publications, and suggest an alternative perspective. We explore technical inadequacies of evaluations (concerning definitions, metrics, and timing) as well as deeper problems (such as integrated care being dynamic and relational, and operating across multiple, larger systems). In re-framing how to evaluate integrated care, we propose an approach that involves a recursive evaluation architecture. This draws on systems thinking. This approach also recognises that we can better understand evaluations of integrated care as co-producing knowledge and applying this to learning and adaptation.
AD - RAND Europe, Eastbrook, Shaftesbury Road, Cambridge CB2 8BF, United Kingdom. Electronic address: tling@randeurope.org.; RAND Europe, Eastbrook, Shaftesbury Road, Cambridge CB2 8BF, United Kingdom.
AN - 40897593
BT - Health Policy
C5 - General Literature
DA - Aug 20
DO - 10.1016/j.healthpol.2025.105418
DP - NLM
ET - 20250820
JF - Health Policy
LA - eng
N2 - There is global interest in integrated care, often associated with how to improve system efficiency, strengthen clinical and cost-effectiveness, avoid gaps in patient care, and improve patient experiences and outcomes, through improved coordination across services. Despite considerable activity in both delivering and evaluating integrated care, evaluations have not greatly helped to understand how to 'do' it better. Evaluations of integrated care have often arrived at similar conclusions, frequently including the generic finding that results are patchy and context dependent. In this article, we explore and discuss these challenges to evaluation, how these challenges are understood in recent key publications, and suggest an alternative perspective. We explore technical inadequacies of evaluations (concerning definitions, metrics, and timing) as well as deeper problems (such as integrated care being dynamic and relational, and operating across multiple, larger systems). In re-framing how to evaluate integrated care, we propose an approach that involves a recursive evaluation architecture. This draws on systems thinking. This approach also recognises that we can better understand evaluations of integrated care as co-producing knowledge and applying this to learning and adaptation.
PY - 2025
SN - 0168-8510
SP - 105418
ST - Reframing the evaluation of integrated care; examples from the NHS in England
T1 - Reframing the evaluation of integrated care; examples from the NHS in England
T2 - Health Policy
TI - Reframing the evaluation of integrated care; examples from the NHS in England
U1 - General Literature
U3 - 10.1016/j.healthpol.2025.105418
VO - 0168-8510
Y1 - 2025
ER -