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

Abstract

BackgroundAn integrated care pathway in geriatric rehabilitation was developed to improve coordination and continuity of care for community-living older adults in the Netherlands, who go through the process of hospital admission, admission to a geriatric rehabilitation facility and discharge back to the home situation. This pathway is a complex intervention and is focused on improving communication, triage and transfers of patients between the hospital, geriatric rehabilitation facility and primary care organisations. A process evaluation was performed to assess the feasibility of this pathway.MethodsThe study design incorporated mixed methods. Feasibility was assessed thru if the pathway was implemented according to plan (fidelity and dose delivered), (b) if patients, informal caregivers and professionals were satisfied with the pathway (dose received) and (c) which barriers and facilitators influenced implementation (context). These components were derived from the theoretical framework of Saunders and colleagues. Data were collected using three structured face-to-face interviews with patients, self-administered questionnaires among informal caregivers, and group interviews with professionals. Furthermore, data were collected from the information transfer system in the hospital, patient files of the geriatric rehabilitation facility and minutes of evaluation meetings.ResultsIn total, 113 patients, 37 informal caregivers and 19 healthcare professionals participated in this process evaluation. The pathway was considered largely feasible as two components were fully implemented according to plan and two components were largely implemented according to plan. The timing and quality of medical discharge summaries were not sufficiently implemented according to plan and professionals indicated that the triage instrument needed refinement. Healthcare professionals were satisfied with the implementation of the pathway and they indicated that due to improved collaboration, the quality of care provision improved. Although patients and informal caregivers were also satisfied with the care provision in the pathway, they indicated that the care organisations involved should pay more attention towards providing information about their treatment.ConclusionsThis process evaluation showed that patients, informal caregivers and professionals are fairly satisfied with the care provision in the pathway and professionals reported that collaboration improved. Extra attention should be paid to the components in the pathway that were not implemented according to plan.Trial registration ISRCTN90000867 Registered 7 April 2016.

An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems

“…Also, training older adults to restart social activities or other hobbies once discharged and returned home, is not regarded as a main goal of geriatric rehabilitation, though it is likely to influence overall quality of life. A last explanation for the lack of effects on QALYs is that a process evaluation conducted alongside this study (described elsewhere [ 40 ]) showed that not all five key pathway components were fully implemented according to plan. This indicates that there is still room for improvement, for instance in the provision of information to patients and their informal caregivers, and in the quality and timing of medical discharge summaries.…”

Building Consensus on an Integrated Care Pathway in Geriatric Rehabilitation: A Modified Delphi Study Among Professional Experts

“…If it appears that these elements are not feasible in practice, the pathway should be adjusted accordingly. The process evaluation of this study already proved feasibility of the key elements of the pathway (Everink, Haastregt, Maessen, Schols, & Kempen, 2017). Finally, the utility of the pathway in regular care was evaluated using an effectiveness and costeffectiveness evaluation.…”

The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study

“…This is also shown by the difference in score on the FAI after 3 months. Furthermore, in addition to the effects on these functional outcome measures, the economic evaluation executed alongside this study showed that implementation of the pathway resulted in a shorter length of stay in the hospital and the geriatric rehabilitation facility [ 20 ]. As a consequence, large cost savings were achieved.…”

“…Finally, a process evaluation executed alongside this study (described elsewhere) showed that this care pathway is a promising start, but there seems to be room for optimization as well [ 20 ].…”