Giroux Catherine M, Contandriopoulos Damien, Bussières André, Ahmed Sara, Letts Lori, Boruff Jill, Starr Lisa, Thomas Aliki
McGill University, Faculty of Medicine and Health Sciences, Montreal, Canada.
Centre De Recherche Interdisciplinaire En Réadaptation, Montreal, Canada.
J Eval Clin Pract. 2025 Jun;31(4):e70144. doi: 10.1111/jep.70144.
RATIONALE/OBJECTIVES: Canadian healthcare is facing an aging population, an increasing prevalence of chronic disease and related disability, and rising healthcare costs. Integrating innovative rehabilitation models of care may help bolster health systems by shifting to a longer-term approach to addressing health and wellbeing. However, little is known about how these care models may look and what is needed to ensure their effective operationalization in practice.
This realist-inspired narrative review explored how, when, and in what circumstances innovative models of care have been successfully implemented and sustained in rehabilitation. The peer-reviewed and grey literature was searched and subsequently screened by title, abstract, and full text. Data extracted from included articles focused on identifying contexts, mechanisms, and outcomes. A numerical analysis of quantitative data and a conventional content analysis of qualitative abstractions was conducted.
Twenty-six documents published between 2014 and 2021 were uncovered predominantly from Australia and Canada. Overall, for new care models to be successfully implemented and sustained, they need to: (1) have clearly articulated goals, (2) have access to short- and long-term funding, (3) align with key legislative changes to optimise buy-in, (4) take a multidisciplinary approach that is supported by management, and (5) include educational and outreach strategies that can be implemented amongst all interested parties.
The heterogeneity of studies and limitations in their reporting precluded the identification of context-mechanism-outcome configurations typically found in realist reviews. Future implementation research should draw on relevant reporting guidelines to report their findings.
原理/目标：加拿大医疗保健系统正面临人口老龄化、慢性病及相关残疾患病率不断上升以及医疗成本不断增加的问题。整合创新的康复护理模式可能有助于通过转向更长期的方法来解决健康和福祉问题，从而加强卫生系统。然而，对于这些护理模式可能是什么样子以及在实践中确保其有效实施需要什么，人们知之甚少。
本受现实主义启发的叙述性综述探讨了创新护理模式在何时、何种情况下以及如何在康复中成功实施并持续下去。对同行评审文献和灰色文献进行搜索，随后按标题、摘要和全文进行筛选。从纳入文章中提取的数据重点在于确定背景、机制和结果。对定量数据进行了数值分析，对定性摘要进行了常规内容分析。
共发现2014年至2021年间发表的26份文献，主要来自澳大利亚和加拿大。总体而言，新的护理模式要成功实施并持续下去，需要：（1）有明确阐述的目标；（2）获得短期和长期资金；（3）与关键立法变革保持一致以优化支持；（4）采取多学科方法并得到管理层支持；（5）包括可在所有相关方中实施的教育和推广策略。
研究的异质性及其报告中的局限性妨碍了识别现实主义综述中常见的背景 - 机制 - 结果配置。未来的实施研究应借鉴相关报告指南来报告其研究结果。
