Markle-Reid Maureen, Fisher Kathryn, Walker Kimberly M, Cameron Jill I, Dayler David, Fleck Rebecca, Gafni Amiram, Ganann Rebecca, Hajas Ken, Koetsier Barbara, Mahony Robert, Pollard Chris, Prescott Jim, Rooke Tammy, Whitmore Carly
School of Nursing, McMaster University, Hamilton, ON, Canada.
Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
J Multimorb Comorb. 2025 Feb 26;15:26335565251323748. doi: 10.1177/26335565251323748. eCollection 2025 Jan-Dec.
Older adults with stroke and multimorbidity experience frequent care transitions, which are often poorly coordinated and fragmented. We conducted a pragmatic randomized controlled trial (RCT) to test the implementation and effectiveness of the Transitional Care Stroke Intervention (TCSI), a 6-month, multi-component, evidence-informed intervention to support older adults with stroke and multimorbidity using outpatient stroke rehabilitation services. The TCSI was designed to support self-management, improve health outcomes, and enhance the quality and experience of care transitions.
To explore the facilitators and challenges to implementing the TCSI, from the perspective of healthcare providers (HCPs) (n = 12) and Managers (n = 3).
Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected from study documents, individual and group interviews conducted with HCPs and a Care Coordinator, and surveys from managers. Data were analyzed using thematic analysis.
Intervention implementation was facilitated by: a) strong collaborative and interdependent HCP team relationships, b) dedicated resources (funding, staffing) to support intervention delivery, c) training and ongoing support, customized to individual HCP needs, d) organizational readiness, strong leadership, and effective champions, e) structures to facilitate virtual information-sharing, and f) regular monitoring of intervention implementation. Implementation challenges included: a) COVID-19 related challenges (staff turnover, community service disruptions), b) poor communication with community service providers, c) documentation burden (intervention-related), and d) virtual care delivery.
This research enhances understanding of the diversity of factors influencing implementation of the TCSI, and the conditions under which implementation is more likely to succeed.
患有中风和多种疾病的老年人经常经历护理过渡，而这种过渡往往协调不善且支离破碎。我们开展了一项务实的随机对照试验（RCT），以测试过渡性护理中风干预（TCSI）的实施情况和有效性。TCSI是一项为期6个月的多组成部分、基于证据的干预措施，旨在利用门诊中风康复服务来支持患有中风和多种疾病的老年人。TCSI旨在支持自我管理、改善健康结果，并提高护理过渡的质量和体验。
从医疗保健提供者（HCPs，n = 12）和管理人员（n = 3）的角度，探讨实施TCSI的促进因素和挑战。
数据收集和分析以实施研究综合框架（CFIR）为指导。数据来自研究文件、与HCPs和一名护理协调员进行的个人及小组访谈，以及管理人员的调查。采用主题分析法对数据进行分析。
干预措施的实施得益于以下因素：a）HCP团队之间强大的协作和相互依存关系；b）用于支持干预措施实施的专用资源（资金、人员配备）；c）根据HCPs的个人需求定制的培训和持续支持；d）组织准备就绪、强有力的领导和有效的倡导者；e）便于虚拟信息共享的结构；f）对干预措施实施情况的定期监测。实施挑战包括：a）与新冠疫情相关的挑战（人员流动、社区服务中断）；b）与社区服务提供者沟通不畅；c）（与干预相关的）文件负担；d）虚拟护理服务。
本研究增进了对影响TCSI实施的因素多样性以及实施更有可能成功的条件的理解。
