A Structured Process Description of a Pragmatic Implementation Project: Improving Integrated Care for Older Persons in Residential Care Homes

Abstract

Evaluation of the implementation of integrated care can differ from trial-based research due to complexity. Therefore, we examined whether a theory-based method for process description of implementation can contribute to improvement of evidence-based care. MOVIT, a Dutch project aimed at implementing integrated care for older vulnerable persons in residential care homes, was used as a case study. The project activities were defined according to implementation taxonomy and mapped in a matrix of theoretical levels and domains. Project activities mainly targeted professionals (both individual and group). A few activities targeted the organizational level, whereas none targeted the policy level, or the patient, or the “social, political, and legal” domains. However, the resulting changes in care delivery arrangement had consequences for professionals, patients, organizations, and the social, political, and legal domains. A structured process description of a pragmatic implementation project can help assess the fidelity and quality of the implementation, and identify relevant contextual factors for immediate adaptation and future research. The description showed that, in the MOVIT project, there was a discrepancy between the levels and domains targeted by the implementation activities and those influenced by the resulting changes in delivery arrangement. This could have influenced, in particular, the adoption and sustainability of the project.

Setting Priorities to Inform Assessment of Care Homes’ Readiness to Participate in Healthcare Innovation: A Systematic Mapping Review and Consensus Process

“…One study noted the related challenges of synthesising data from the multiple data sources within a care home [55]. Other studies described the benefits of engaging in pre-intervention work or adapting to current processes to ensure consistent documentation of care [40,79].…”

“…Fifty-six papers from 48 studies met our inclusion criteria ( Figure 1). These included 36 RCTs [24-59] and 20 process evaluations or qualitative explorations of implementation [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79]. We found studies from 10 countries: the United Kingdom (13), the United States (11), Australia (8), the Netherlands (5), Norway (3), Belgium, New Zealand, Canada (all 2), China (1), and France (1).…”

“…Low GP participation or resistance from GPs [29,34,47,61,63,69,[77][78][79]81], limited opportunities for formal communications in multidisciplinary team meetings [27,28,60,72,73], and poor communication within the organisation [55,68,73] were factors reported to be barriers to implementation. One study recognised the need in future work to address how group dynamics and peer pressure facilitates (or not) the adoption of the intervention and the possible benefits of preparatory coaching to build staff confidence in their practices [30].…”

Advancing Pediatric Palliative Care In A Low-Middle Income Country: A Descriptive Analysis of the Implementation, A challenging But Not Impossible Task

“…A theory-based method was applied to describe the implementation process of our program. The approach is explained in detail elsewhere (26). The matrix combines two frameworks: rst, the levels of organization in uenced by implementation (27), and second, the domains of implementation (28).…”

“…The matrix combines two frameworks: rst, the levels of organization in uenced by implementation (27), and second, the domains of implementation (28). These combined frameworks provide a comprehensive matrix where de ned project activities can be positioned according to their intended target domain and level, to facilitate a structured description of the project (26,27). Different sources of information were cross-referenced in a database to improve the quality of the information.…”