KITE-Toronto Rehabilitation Institute, University Health Network, Bickle Centre, 550 University Avenue, Suite 236B, Toronto, Ontario, M5G 2A2, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada.
BMC Health Serv Res. 2021 Mar 6;21(1):204. doi: 10.1186/s12913-021-06206-9.
There is a growing number of older adults with cognitive impairment (CI) that require inpatient rehabilitation, and as such patient centred rehabilitation models have been developed. However, implementing evidence-based models without attending to the fit of the model to the new context could lead to an unsuccessful outcome. Researchers collaborated with administrators and staff in one rural site to adapt a patient centred rehabilitation model of care in the Canadian province of Ontario. This paper reports on the contextual factors that influenced the implementation of the model of care.
The study takes a case study approach. One rural facility was purposefully selected for its interest in offering rehabilitation to persons with CI. Four focus group discussions were conducted to explore healthcare professionals' perceptions on the contextual factors that could affect the implementation of the rehabilitation model of care in the facility. Twenty-seven professionals with various backgrounds were purposively sampled using a maximum diversity sampling strategy. A hybrid inductive-deductive approach was used to analyze the data using the Context and Implementation of Complex Interventions (CICI) Framework.
Across the domains of the CICI framework, three domains (political, epidemiological, and geographical) and seven corresponding sub-domains of the context were found to have a major influence on the implementation process. Key elements within the political domain included effective teamwork, facilitation, adequate resources, effective communication strategies, and a vision for change. Within the epidemiological domain, a key element was knowing how to tailor rehabilitation approaches for persons with CI. Infrastructure, an aspect of the geographical domain, focused on the facility's physical layout that required attention.
The CICI framework was a useful guide to identify key factors within the context that existed and were required to fully support the implementation of the model of care in a new environment. The findings suggest that when implementing a new program of care, strong consideration should be paid to the political, epidemiological, and geographical domains of the context and how they interact and influence one another.
认知障碍（CI）的老年患者数量不断增加，需要住院康复治疗，因此已经开发了以患者为中心的康复模式。然而，如果在实施证据基础模型时不考虑模型与新环境的适配性，可能会导致结果不理想。研究人员与安大略省一个农村地点的管理人员和工作人员合作，调整了以患者为中心的康复护理模式。本文报告了影响护理模式实施的背景因素。
本研究采用案例研究方法。选择了一家农村机构，该机构对为 CI 患者提供康复治疗感兴趣。进行了四次焦点小组讨论，以探讨医疗保健专业人员对可能影响机构中康复护理模式实施的背景因素的看法。采用最大差异抽样策略，根据背景确定了 27 名具有不同背景的专业人员进行抽样。使用混合归纳演绎方法，使用复杂干预措施的背景和实施（CICI）框架分析数据。
在 CICI 框架的所有领域中，发现三个领域（政治、流行病学和地理）和七个对应的背景子领域对实施过程有重大影响。政治领域的关键要素包括有效的团队合作、促进、充足的资源、有效的沟通策略和变革愿景。在流行病学领域，一个关键要素是了解如何为 CI 患者量身定制康复方法。地理领域的一个方面是基础设施，侧重于需要关注的设施的物理布局。
CICI 框架是一个有用的指南，可以确定存在的背景中的关键因素，这些因素对于在新环境中全面支持护理模式的实施是必需的。研究结果表明，在实施新的护理方案时，应充分考虑背景的政治、流行病学和地理领域以及它们如何相互作用和影响。
