Unfortunately for us researchers a big and complex project like Project Integrate can generally not be boiled down to one big question with one big answer that can be discovered in one big attempt. A big and complex project needs to be broken down into many small (but still complex) parts. And these parts need to be broken down further. Applying a common framework to local context thus essentially boils down to taking a big picture and breaking it into a lot of tiny pieces – or into a puzzle, if you will – and concentrating on a few of them.
For our part of Project Integrate, we focus on the jigsaw pieces with diabetes mellitus type 2 on them. For our case study, we identified two care groups who are considered the leaders of the field of integrated diabetes care in the Netherlands, namely Zio Maastricht and DoH Eindhoven. Fortunately for us these care groups were interested both in a closer examination of and an external perspective on their own efforts as well as the current integrated care developments in other countries and regarding other conditions. Because care groups are essentially networks of different care professionals involved in the delivery of integrated diabetes care, contacting the care group turned out to be an ideal entry point for reaching the broad range of professionals we intended to approach for the interviews. Parallel to the interviews, we are currently also focusing on a document study as well as a literature review. Most documents are provided by the care groups themselves, whereas some of the interviewees are also willing to provide some. The main obstacle for the literature study is the fact that there seems to be a lot of disagreement around the definition of integrated care and which care interventions actually constitute integrated care. While it is desirable to have a rather specific search, this holds the risk of missing a lot of relevant integrated care studies simply because they might not be labelled as such. Eventually, the aim is to strike a balance between precision and inclusiveness while at the same time ensuring comparability to the reviews conducted by the other case study leaders.
Which, coming back to the puzzle analogy, sometimes feels like working on your own puzzle while simultaneously keeping in mind the progress of several other puzzles, trying for them to look similar to your own but not to mix up the different jigsaw pieces. At this point, you might sometimes get the feeling that every night someone sneaks into our office and shakes up the puzzle box or cuts out additional pieces. Obviously, this makes the puzzle more complex and harder to solve, but probably also a lot more rewarding once you piece it all back together.
Loraine Busetto, Katrien Luijkx & Bert Vrijhoef, Tilburg University, The Netherlands