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

• Published in: Health policy (Amsterdam) Vol. 110; no. 2; pp. 220 - 228
• Main Authors: Knai, Cécile, Nolte, Ellen, Brunn, Matthias, Elissen, Arianne, Conklin, Annalijn, Pedersen, Janice Pedersen, Brereton, Laura, Erler, Antje, Frølich, Anne, Flamm, Maria, Fullerton, Birgitte, Jacobsen, Ramune, Krohn, Robert, Saz-Parkinson, Zuleika, Vrijhoef, Bert, Chevreul, Karine, Durand-Zaleski, Isabelle, Farsi, Fadila, Sarría-Santamera, Antonio, Soennichsen, Andreas
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.05.2013; Elsevier
• Subjects: Austria; Barriers; Biological and medical sciences; Case studies; Chronic care; Chronic disease; Chronic Disease - therapy; Chronic sickness; Chronically ill; Cultural influence; Culture; Data protection; Delivery of Health Care - organization & administration; Delivery of Health Care - standards; Denmark; Diseases; Europe; Evaluation; Evaluation Studies as Topic; Experts; Financial incentives; France; Germany; Health administration; Humans; Information technology; Internal Medicine; Management; Medical sciences; Miscellaneous; Netherlands; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Health Care; Shortages; Spain; Stakeholder; Europe; Denmark; Austria; Netherlands; France; Germany; Spain; Evaluation; Chronic care; Chronic disease; Europe; Barriers; Chronic; Accessibility; Barrier; Care
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2013.01.019

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.