Abstract Body

Background and purpose
In close collaboration between science and practice, the Dutch TARGET program was developed. TARGET aims to offer more integrated and personalized primary care for chronically ill, and simultaneously lower professionals’ workload, by amongst others optimizing opportunities for referral. As first step towards learning how and why TARGET works in a realist evaluation (RE), this study elicited the hypothesized functioning of TARGET, i.e. the initial program theory (IPT).

Methods
A phased process was employed to elicit the IPT, using a combination of abstract theories on integrated care, insights from scientific studies that underpin TARGET, and interviews with seven experts in RE.

Results
For professionals and patients, a separate but linked IPT was formulated. For professionals, we hypothesized: IF the program offers professionals support to identify chronically ill with complex needs, engage in a person-centered needs assessment with these patients, and enhance their network, THEN they are enabled to engage in person-centered, cooperative healthcare with the right target population and strengthen their network, BECAUSE professionals’ confidence (e.g. to identify patients with complex needs) and mutual trust is increased, in a context where all involved parties have sufficient resources for integrated care. We expect long-term goals, such as reduced work pressure, to be achieved stepwise.

Conclusions
The current study underlines the complexity of TARGET and the potential importance of enhancing confidence and mutual trust – in both professionals and patients – for the program to be successful. By evaluating programs like TARGET according to RE principles, the ‘black box’ of integrated care functioning can be gradually opened.