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Table 3 Other challenges associated with evaluating Models of Care

From: Models of care for musculoskeletal health: a cross-sectional qualitative study of Australian stakeholders’ perspectives on relevance and standardised evaluation

Key theme Summary description Illustrative quote
System constraints Implementation of a MoC into an existing system may be unfeasible due to constraints within the current system. For example, some of the aspects of the MoC might need system enablers in place (e.g. new IT infrastructure), so implementation and subsequent evaluation cannot proceed successfully until system changes are completed. Additionally system design constraints, such as the split health funding models between the Australian Commonwealth and State/Territory governments, also presents as a significant barrier to evaluation across settings. “So I think they’re all external constraints and it’s around the purchasing plan. So this is the amount of activity you will do and you know, this is the dollars that are attached to that because it’s worth you know, X number of dollars to – episode of care or service event and then it depends very much on the types of service models that the area health services or the local health network are wanting to implement. So depending on what the service models are, what the funding sources are, what the purchasing plans say, it’s really hard to do a pre and a post evaluation…”(SME 18)
Cost of evaluation It was emphasised that evaluations can be resource intensive, depending on the study design, governance and data collection arrangements. SMEs indicated that external funding and partnership with Universities are ideally needed to assist with the collection of data (particularly an issue in the primary healthcare sector). One of the biggest issues we have in evaluating in general practice is that they don’t get paid for this sort of work…I actually get quite frustrated that it always ends up coming down to a dollar figure, but general practice isn’t paid to stop it’s work and to write an evaluation or to do a survey…one of the things that worked very well…they incentivised general practice to participate pre and post. It’s not a lot but to ensure that their nurse will be able to collect the information…” (SME 22)
Ensuring adequate involvement of stakeholders within the evaluation process SMEs emphasised the need to ensure adequate involvement of stakeholders within evaluation processes in order to obtain a comprehensive understanding of issues relating to implementation and outcomes. Challenges in engaging stakeholders in evaluations included: "I think quite often people jump to a solution and think they know the answer…we actually firstly need to have all the right people in the room, and when I say the right people, I don’t just mean the best clinicians, I also mean management of front line and I mean people who have a state wide role in funding and planning and some consumers.” (SME 16)
Ensuring all relevant stakeholders are involved, given diversity and complexity of healthcare settings relevant to musculoskeletal health, particularly in the private community setting.
Getting stakeholders to understand the need to build evaluation into the entire process of a MoC; i.e. from inception to implementation.
Achieving a cohesive understanding of terminology relating to MoCs across diverse stakeholders in different sectors of the care continuum.
  1. SME subject matter expert
  2. MoC model of care