Generating “evidence-based guidelines” in integrated care programs: translations and requalifications

The Belgian government program “Integreo” is a large policy plan that aims at implementing integrated care for patients with multiple chronic conditions. Integrated health services are defined by WHO as: “the management and delivery of health services so that people receive a continuum of preventive and curative services according to their needs over time and across different levels of the health system”. In practice,14 pilot projects will implement integrated care programs in local settings, involving various healthcare professionals to change the organization of care provision in specific networks.
“Evidence-based guidelines” in care provision is presented as a key component of the policy plan. Yet it remains somewhat under-defined and problematic. Integrated care calls for patient-centered multidisciplinary coordination, while many “evidences” emanate from monodisciplinary settings, focusing on one pathology. According to policy documents, evidence-based guidelines should be assessable by standardized indicators, but they should also be adapted to the context in order to be operational and clear. Thus, to generate guidelines and change practices, evidences have to go through multiple translations among different groups of stakeholders: scientists, government authorities, healthcare practitioners. Furthermore, once established, evidence-based guidelines might clash with other key components of integrated care such as patient involvement. As part of the scientific team evaluating the pilot projects, I will observe the implementation of the policy plan and the interactions between its stakeholders. I will investigate how "evidence-based guidelines" unfold in the policy plan, in different settings and groups, allowing me to draw insightful conclusions about the requalification of knoweldgeS.