Context matters when implementing patient centred rehabilitation models for persons with cognitive impairment: a case...

Area of Science:

• Geriatric Rehabilitation
• Healthcare Management
• Implementation Science

Background:

• Growing population of older adults with cognitive impairment (CI) necessitates effective inpatient rehabilitation.
• Patient-centered rehabilitation models are being developed, but successful implementation hinges on contextual fit.
• This study focuses on adapting a patient-centered model in a rural Canadian setting.

Purpose of the Study:

• To report on the contextual factors influencing the implementation of a patient-centered rehabilitation model of care.
• To adapt an evidence-based model to a specific rural context in Ontario, Canada.
• To identify key contextual elements for successful model implementation.

Main Methods:

• Case study approach utilizing one rural rehabilitation facility.
• Four focus groups with 27 healthcare professionals using purposive maximum diversity sampling.
• Data analyzed using a hybrid inductive-deductive approach with the Context and Implementation of Complex Interventions (CICI) Framework.

Main Results:

• The CICI framework identified political, epidemiological, and geographical domains as highly influential.
• Key political factors included teamwork, resources, communication, and vision for change.
• Epidemiological factors involved tailoring rehabilitation for CI, and geographical factors highlighted infrastructure needs.

Conclusions:

• The CICI framework effectively guided the identification of contextual factors for model implementation.
• Successful implementation of new care models requires attention to political, epidemiological, and geographical domains.
• Understanding the interplay between these domains is essential for adapting care models to new environments.