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Health services research
Protocol
Protocol for a mixed methods realist evaluation of regional District Health Board groupings in New Zealand
  1. Tim Stokes1,
  2. Carol Atmore1,
  3. Erin Penno1,
  4. Lauralie Richard1,
  5. Emma Wyeth2,
  6. Rosalina Richards3,
  7. Fiona Doolan-Noble1,
  8. Andrew R Gray4,
  9. Trudy Sullivan5,
  10. Robin Gauld6
  1. 1 Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  2. 2 Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  3. 3 Va’a o Tautai, Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
  4. 4 Biostatistics Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
  5. 5 Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  6. 6 Otago Business School, University of Otago, Dunedin, New Zealand
  1. Correspondence to Professor Tim Stokes; tim.stokes{at}otago.ac.nz

Abstract

Introduction Achieving effective integration of healthcare across primary, secondary and tertiary care is a key goal of the New Zealand (NZ) Health Strategy. NZ’s regional District Health Board (DHB) groupings are fundamental to delivering integration, bringing the country’s 20 DHBs together into four groups to collaboratively plan, fund and deliver health services within their defined geographical regions. This research aims to examine how, for whom and in what circumstances the regional DHB groupings work to improve health service integration, healthcare quality, health outcomes and health equity, particularly for Māori and Pacific peoples.

Methods and analysis This research uses a mixed methods realist evaluation design. It comprises three linked studies: (1) formulating initial programme theory (IPT) through developing programme logic models to describe regional DHB working; (2) empirically testing IPT through both a qualitative process evaluation of regional DHB working using a case study design; and (3) a quantitative analysis of the impact that DHB regional groupings may have on service integration, health outcomes, health equity and costs. The findings of these three studies will allow refinement of the IPT and should lead to a programme theory which will explain how, for whom and in what circumstances regional DHB groupings improve service integration, health outcomes and health equity in NZ.

Ethics and dissemination The University of Otago Human Ethics Committee has approved this study. The embedding of a clinician researcher within a participating regional DHB grouping has facilitated research coproduction, the research has been jointly conceived and designed and will be jointly evaluated and disseminated by researchers and practitioners. Uptake of the research findings by other key groups including policymakers, Māori providers and communities and Pacific providers and communities will be supported through key strategic relationships and dissemination activities. Academic dissemination will occur through publication and conference presentations.

  • organisation of health services
  • realist evaluation
  • health policy

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-030076

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    Footnotes

    • Contributors CA, RG and TSt jointly conceived the study. TSt, CA, RG, EP, LR, ARG, FD-N, EW, RR and TSu developed the study protocol. TSt led the writing of the manuscript with input from EP and LR. ARG wrote the statistical methods section and TSu the economic evaluation component for study 3. All authors reviewed and critiqued the manuscript and approved the final published version.

    • Funding This study is funded by the New Zealand Health Research Council (HRC Project Grant 18/138).

    • Competing interests None declared.

    • Ethics approval University of Otago Human Ethics Committee (D18/393, D18/394 and HD18/100).

    • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

    • Patient consent for publication Not required.