title: Reported barriers to evaluation in chronic care: experiences in six European countries.
abstract: BACKGROUND
  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.
authors: London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H9SH, United Kingdom. Electronic address: cecile.knai@lshtm.ac.uk.
authors: Cécile
authors: C
authors: Knai
authors: Ellen
authors: E
authors: Nolte
authors: Matthias
authors: M
authors: Brunn
authors: Arianne
authors: A
authors: Elissen
authors: Annalijn
authors: A
authors: Conklin
authors: Janice Pedersen
authors: JP
authors: Pedersen
authors: Laura
authors: L
authors: Brereton
authors: Antje
authors: A
authors: Erler
authors: Anne
authors: A
authors: Frølich
authors: Maria
authors: M
authors: Flamm
authors: Birgitte
authors: B
authors: Fullerton
authors: Ramune
authors: R
authors: Jacobsen
authors: Robert
authors: R
authors: Krohn
authors: Zuleika
authors: Z
authors: Saz-Parkinson
authors: Bert
authors: B
authors: Vrijhoef
authors: Karine
authors: K
authors: Chevreul
authors: Isabelle
authors: I
authors: Durand-Zaleski
authors: Fadila
authors: F
authors: Farsi
authors: Antonio
authors: A
authors: Sarría-Santamera
authors: Andreas
authors: A
authors: Soennichsen
mesh_terms: D001317:Austria; D002908:Chronic Disease / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D003718:Denmark; D005069:Evaluation Studies as Topic; D005602:France; D005858:Germany; D006801:Humans; D009426:Netherlands; D011787:Quality of Health Care; D013030:Spain