Measuring Integrated Care - Methodological Reflections from Monitoring and Evaluation Process of the PHC Plus Pilot...

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• Integrated care is crucial for enhancing health system performance.
• Evidence on measurement properties of integrated care instruments is limited.
• This study addresses the need for robust evaluation frameworks in primary healthcare (PHC) reform.

Purpose of the Study:

• To present the Monitoring and Evaluation Framework (M&EF) used in Poland's coordinated primary care pilot program (PHC Plus).
• To offer an M&E concept for countries initiating care integration or PHC reforms.
• To evaluate the impact of integrated care on patient outcomes, experience, care fragmentation, and spending.

Main Methods:

• The M&EF was based on a Theory of Change, focusing on four key aspects.
• Data were collected from the National Health Fund database and survey questionnaires.
• The framework aimed to monitor changes in health outcomes, patient experience, care fragmentation, and healthcare spending.

Main Results:

• The M&EF enabled monitoring of patient health outcomes, experience, literacy, care fragmentation, and healthcare spending.
• Data quality issues and the pandemic limited some planned analyses.
• The M&E process provided valuable insights supporting broader PHC reform in Poland, informing policy and scaling up the pilot.

Conclusions:

• The M&E process identified scalable interventions and fostered understanding and acceptance of PHC reforms.
• Existing evaluation tools may not fully suit PHC integration characteristics; revised, multidimensional approaches are needed.
• A simplified, phased M&EF is recommended for sustainability, emphasizing multi-level measurement and active data sharing.