Realist evaluation of a pilot intervention implementing interprofessional and interinstitutional processes for...

Area of Science:

• Healthcare Management
• Health Services Research
• Interprofessional Collaboration

Background:

• Fragmented healthcare practices pose challenges to seamless patient transitions.
• Effective communication and shared decision-making are crucial for continuity of care.
• Interprofessional and interinstitutional processes require careful design and evaluation.

Purpose of the Study:

• To evaluate the implementation of transitional interprofessional and interinstitutional shared decision-making processes (IIPs).
• To understand the contextual factors influencing the success of IIPs between short-stay units and primary care.
• To identify facilitators and barriers for effective IIP implementation.

Main Methods:

• Realist evaluation design employed between 2018 and 2019.
• Qualitative data collection through interviews with patients, primary care professionals, and short-stay unit staff.
• Theory testing to understand implementation mechanisms.

Main Results:

• Patient stays in short-stay units (SSU) with committed facilitators enhanced perceived appropriateness and implementation of IIPs.
• Contextual elements like patient needs complexity, prior collaboration, and inpatient stay purpose influenced IIP appropriateness.
• IIIPs were implemented within a context of fragmented practices.

Conclusions:

• Facilitator commitment and supportive organizational structures are essential for successful IIP implementation.
• Tailoring IIPs to specific patient needs and contextual factors is crucial for optimizing appropriateness.
• Sustained, proactive efforts are necessary to overcome fragmentation and enhance interprofessional collaboration.