Reported barriers to evaluation in chronic care: experiences in six European countries

Cécile Knai, Ellen Nolte, Matthias Brunn, Arianne Elissen, Annalijn Conklin, Janice Pedersen Pedersen, Laura Brereton, Antje Erler, Anne Frølich, Maria Flamm, Birgitte Fullerton, Ramune Jacobsen, Robert Krohn, Zuleika Saz-Parkinson, Bert Vrijhoef, Karine Chevreul, Isabelle Durand-Zaleski, Fadila Farsi, Antonio Sarría-Santamera, Andreas Soennichsen

    23 Citationer (Scopus)

    Abstract

    Introduction: The growing movement of innovative approaches to chronic disease management in Europe has not been matched by a corresponding effort to evaluate them. This paper discusses challenges to evaluation of chronic disease management as reported by experts in six European countries. Methods: We conducted 42 semi-structured interviews with key informants from Austria, Denmark, France, Germany, The Netherlands and Spain involved in decision-making and implementation of chronic disease management approaches. Interviews were complemented by a survey on approaches to chronic disease management in each country. Finally two project teams (France and the Netherlands) conducted in-depth case studies on various aspects of chronic care evaluation. Results: We identified three common challenges to evaluation of chronic disease management approaches: (1) a lack of evaluation culture and related shortage of capacity; (2) reluctance of payers or providers to engage in evaluation and (3) practical challenges around data and the heterogeity of IT infrastructure. The ability to evaluate chronic disease management interventions is influenced by contextual and cultural factors. Conclusions: This study contributes to our understanding of some of the most common underlying barriers to chronic care evaluation by highlighting the views and experiences of stakeholders and experts in six European countries. Overcoming the cultural, political and structural barriers to evaluation should be driven by payers and providers, for example by building in incentives such as feedback on performance, aligning financial incentives with programme objectives, collectively participating in designing an appropriate framework for evaluation, and making data use and accessibility consistent with data protection policies.

    OriginalsprogEngelsk
    TidsskriftHealth Policy
    Vol/bind110
    Udgave nummer2-3
    Sider (fra-til)220-8
    Antal sider9
    ISSN0168-8510
    DOI
    StatusUdgivet - maj 2013

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