Implementing a care pathway for elderly patients, a comparative qualitative process evaluation in primary care

Abstract

BackgroundIn Central Norway a generic care pathway was developed in collaboration between general hospitals and primary care with the intention of implementing it into everyday practice. The care pathway targeted elderly patients who were in need of home care services after discharge from hospital. The aim of the present study was to investigate the implementation process of the care pathway by comparing the experiences of health care professionals and managers in home care services between the participating municipalities.MethodsThis was a qualitative comparative process evaluation using data from individual and focus group interviews. The Normalization Process Theory, which provides a framework for understanding how a new intervention becomes part of normal practice, was applied in our analysis.ResultsIn all of the municipalities there were expectations that the generic care pathway would improve care coordination and quality of follow-up, but a substantial amount of work was needed to make the regular home care staff understand how to use the care pathway. Other factors of importance for successful implementation were involvement of the executive municipal management, strong managerial focus on creating engagement and commitment among all professional groups, practical facilitation of work processes, and a stable organisation without major competing priorities. At the end of the project period, the pathway was integrated in daily practice in two of the six municipalities. In these municipalities the care pathway was found to have the potential of structuring the provision of home care services and collaboration with the GPs, and serving as a management tool to effect change and improve knowledge and skills.ConclusionThe generic care pathway for elderly patients has a potential of improving follow-up in primary care by meeting professional and managerial needs for improved quality of care, as well as more efficient organisation of home care services. However, implementation of this complex intervention in full-time running organisations was demanding and required comprehensive and prolonged efforts in all levels of the organisation. Studies on implementation of such complex interventions should therefore have a long follow-up time to identify whether the intervention becomes integrated into everyday practice.

Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial

“…One reason can be that implementation of complex interventions, requiring behavioural changes for the health personnel involved, takes time and require targeted efforts before the intervention is settled in the organisation [32]. This became evident in our previous implementation study [13] where we found that enthusiasm and positive attitude to the intervention was not sufficient for a successful implementation. Considerable efforts were needed to make the home care professionals understand their responsibilities in PaTH and how to assess the patients by using the checklists.…”

Process evaluation of an integrated care pathway in geriatric rehabilitation for people with complex health problems

“…Experiences with such a pathway have not previously been described. Furthermore, very few studies of integrated care interventions across the hospital – primary care continuum performed a detailed process evaluation [24]. A study by Rosstad and colleagues showed that the pathways improved collaboration between professionals but that implementation was demanding and required a lot of work [24].…”

“…Furthermore, very few studies of integrated care interventions across the hospital – primary care continuum performed a detailed process evaluation [24]. A study by Rosstad and colleagues showed that the pathways improved collaboration between professionals but that implementation was demanding and required a lot of work [24]. A study focusing on providers’ perceptions of delivering integrated care found that professionals’ bottom-up involvement during implementation is key to success [25].…”

Facilitating holistic continuity of care for older patients: Home care nurses’ experiences using checklists

“…Hence, facilitating seamless patient pathways is crucial to improving experiences of continuity of care and delivering coordinated high‐quality care for the increasing group of frail older patients residing in the community (Endelin et al, ; Neiterman, Wodchis, & Bourgeault, ; Pellett, ). Research has shown that one means to facilitate holistic pathways and continuity of care for older patients is to implement person‐focused checklists (Røsstad et al, ; Røsstad, Garåsen, Steinsbekk, Sletvold, & Grimsmo, ).…”