title: Partners for the optimal organisation of the healthcare continuum for high users of health and social services: protocol of a developmental evaluation case study design.
abstract: BACKGROUND
  Case management allows us to respond to the complex needs of a vulnerable clientele through a structured approach that promotes enhanced interaction between partners. Syntheses on the subject converge towards a need for a better description of the relationships between programmes and their local context, as well as the characteristics of the clienteles and programmes that contribute to positive impacts. The purpose of this project is thus to describe and evaluate the case management programmes of four health and social services centres in the Saguenay-Lac- Saint-Jean region of Québec, Canada, in order to inform their improvement while creating knowledge on case management that can be useful in other contexts.
  
  
  METHODS
  This research relies on a multiple embedded case study design based on a developmental evaluation approach. We will work with the case management programme for high users of hospital services of each centre. Three different units of analysis will be interwoven to obtain an in-depth understanding of each case, that is: (1) health and social services centre and local services network, (2) case management programme and (3) patients who are high users of services. Two strategies for programme evaluation (logic models and implementation analysis) will guide the mixed data collection based on qualitative and quantitative methods. This data collection will rely on: (1) individual interviews and focus groups; (2) participant observation; (3) document analysis; (4) clinical and administrative data and (5) questionnaires. Description and comparison of cases, and integration of qualitative and quantitative data will be used to guide the data analysis.
  
  
  BACKGROUND
  The study protocol was approved by the Ethics Research Boards of the four health and social services centres (HSSCs) involved. Findings will be disseminated by publications in peer-reviewed journals, conferences, and policy and practice partners in local and national government.
authors.affiliation: Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hudon
authors.affiliation: Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada.
authors.forename: Maud-Christine
authors.initials: MC
authors.lastname: Chouinard
authors.affiliation: Agence de la santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada.
authors.forename: Martine
authors.initials: M
authors.lastname: Couture
authors.affiliation: Department of Community Health, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Astrid
authors.initials: A
authors.lastname: Brousselle
authors.affiliation: Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada.
authors.forename: Eva Marjorie
authors.initials: EM
authors.lastname: Couture
authors.affiliation: Department of Community Health, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Dubois
authors.affiliation: Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, Québec, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Fortin
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Freund
authors.affiliation: Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Loignon
authors.affiliation: Médiamed Technologies, Mont-Saint-Hilaire, Québec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Mireault
authors.affiliation: Departement of Family Medicine, Université McGill, Montréal, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pluye
authors.affiliation: Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Roberge
authors.affiliation: Departement of Family Medicine, Université McGill, Montréal, Québec, Canada.
authors.forename: Charo
authors.initials: C
authors.lastname: Rodriguez
mesh_terms: D002170:Canada; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005500:Follow-Up Studies; D006801:Humans; D015397:Program Evaluation / Q000379:methods*; D036301:Qualitative Research; D012107:Research Design; D012947:Social Work / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: Case study; Frequent users