[Integrated health and social care for older people in "real life contexts" : Multilevel multiple case studies as a method for analyzing complex care trajectories].

BACKGROUND

The care of older people is often characterized by cross-sectoral support and care arrangements in which health and social services are closely intertwined. As such arrangements frequently fail in practice, analyzing complex care trajectories is important to foster more user-centered care systems. To date, suitable research designs for this purpose are limited.

OBJECTIVE

Drawing on established approaches to case study methodology and the authors' own empirical preliminary work, this paper presents a qualitative case study design to empirically reconstruct care trajectories.

MATERIAL AND

METHODS

The paper outlines the methodology of a multilevel multiple case study in which care trajectories are conceptualized as case constellations. These emerge from interactive practices involving the individuals concerned as well as professional and informal caregivers (microlevel), they are embedded in organizations and in local and professional networks (mesolevel) and are shaped by broader contextual conditions (macrolevel). The design combines interviews, documents, socio-spatial and network analyses, evaluated using reflexive thematic analysis and cross-case generalization.

RESULTS

Biographical, professional and institutional perspectives are systematically integrated. Through the multiperspective reconstruction of actual care practices, context-dependent conditions of care delivery can be identified.

CONCLUSION

Multilevel multiple case studies offer new opportunities for analyzing care settings. They place high demands on field access, data integration and research ethics. Case studies expand the methodological toolkit for health services research.