[Realist protocol for implementing integrated care pathways in France (waiver 51 LFSS 2018)]

Area of Science:

• Real-world research evaluation
• Complex systems analysis
• Scientific methodology

Background:

• Real-world research often retains limitations of randomized trials.
• Classical methods assume linear cause-effect, struggling with complex systems.
• Controlling confounding factors is difficult in dynamic, interconnected environments.

Purpose of the Study:

• To propose an alternative evaluative technique for real-world research.
• To understand the "black box" between intervention and outcomes.
• To analyze actor reactions and contextual elements in complex systems.

Main Methods:

• Utilizing principles of critical realism.
• Developing an alternative evaluative protocol.
• Focusing on actor-centric analysis within their context.

Main Results:

• The proposed method offers a credible explanatory theory for complex interventions.
• It facilitates understanding of intervention mechanisms, target populations, and success factors.
• It addresses the "how," "for whom," "why," and "under what circumstances" of research outcomes.

Conclusions:

• Critical realism provides a suitable framework for evaluating complex real-world research.
• Shifting focus to actors and context enhances understanding of intervention dynamics.
• This approach moves beyond traditional methods to explain nuanced outcomes in complex systems.