Development of the COMIC Model for the comprehensive evaluation of integrated care interventions

Abstract

Objective To develop a model for the comprehensive evaluation of integrated care interventions that provides insights into when, why and how successful outcomes can be achieved. Methods A preliminary model was developed based on the Context + Mechanism + Outcome Model and further developed based on its application to a literature review, two case studies and an expert questionnaire. The COMIC Model for studying the Context, Outcomes and Mechanisms of Integrated Care interventions interventions assumes that an intervention is introduced using certain mechanisms (categorised according to the Chronic Care Model), which are met with particular context factors (described by barriers and facilitators and categorised according to the Implementation Model), which combined, contribute to specific outcomes (categorised by the WHO dimensions of quality of care). Results Application of the COMIC model to the literature review and expert questionnaires did not allow for statements to be made about the relationships between mechanisms, context and outcomes. Application to the two case studies made it possible to (1) comprehensively analyse the mechanisms, context and outcomes of the specific case, (2) to make the relationships between the mechanisms, context and outcomes within each case visible, and (3) to compare the two cases to each other in a systematic way that added value to the analysis. Discussion Using the COMIC Model makes it possible to comprehensively study the interplay of the mechanisms, context and outcomes of integrated care interventions and thereby provides insights into when, why and how integrated care contributes to improved outcomes.