Abstract
Background: Chronic obstructive pulmonary disease (COPD) is the most common chronic medical condition leading to hospitalization and is also the most expensive at an estimated 30% higher cost than the next leading cause, with an estimated 1 in 10 people in Saskatchewan (SK) living with COPD.
Approach: The SK Transforming Health with Integrated Care (THINC) implementation science team (IST) has undertaken this evaluation with the primary goal of providing insight to the Saskatchewan Health Authority (SHA) to optimize COPD care in SK through the use of provincial clinical networks (PCN) including an integrated care pathway (ICP), delivered by the SHA. The goal of PCNs is to provide effective coordination and integration of service delivery in a team-based care model to improve both patient and provider outcomes. The IST, co-led by patient partners and comprised of researchers, SHA policymakers and knowledge users, healthcare providers, and health system collaborators aims to provide a realist evaluation of the implementation of the COPD ICP delivery within PCNs. A realist approach allows for the evaluation of how, why, under what circumstances, and for whom the ICP works (or does not work). With 38 primary health networks in SK with diverse populations and demographics, and varying levels of maturity, this approach will provide timely and relevant information for the SHA to optimize delivery to a local context and ensure sustainability.
Results: In the first phase of this evaluation project, the IST undertook realist training for all team members, including patient partners, taking the first step to increase capacity within the IST. Following initial training, the IST iteratively developed initial program theories for both patients and healthcare providers based on a realist literature review to explain how, why, under what circumstances, and for whom integrated clinical pathways work. In the current phase of this research, the initial program theories will be refined iteratively through discussions with the various groups impacted (patients, policy-makers and healthcare providers). These final program theories will be essential in the understanding of the pathway implementation and will provide valuable information for successful scaling and can also be translated to the implementation of PCNs for other domains in the future.
Implications: Due to the early establishment of a team governance charter, and developing and fostering relational equity, the IST has successfully navigated a dynamic healthcare system while focusing on the primary goal of this research, to improve healthcare quality and outcomes for both patients and healthcare providers. Through the use of a realist methodology that is rooted in patient-centered care, the SHA is better poised to provide inclusive, responsive care in a sustainable, adaptable way. This research will serve as a template to address further chronic disease management in our province.