Sustainability of an outcome measure in outpatient stroke rehabilitation: A realist evaluation.
Rationale: Only half of newly implemented evidence‐based practices are sustained. Though poor sustainment can lead to negative consequences for clinical teams, organizations and patients, the causal explanations of sustainment are largely unknown. Aims and Objectives: We aimed to ascertain how (mech...
| Publicado en: | Journal of Evaluation in Clinical Practice Vol. 30; no. 4; pp. 559 - 575 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Jun2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=177466576&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 177466576 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13561294 EV1 jtl: Journal of Evaluation in Clinical Practice issn: 13561294 maglogo: Y pubinfo: dt: Jun2024 vid: 30 iid: 4 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 177466576 174946620 175432519 177466576 177466576 10.1111/jep.13972 177466576 ppf: 559 ppct: 16 formats: tig: atl: Sustainability of an outcome measure in outpatient stroke rehabilitation: A realist evaluation. aug: au: Ataman, Rebecca Ahmed, Sara Berta, Whitney Thomas, Aliki affil: School of Physical and Occupational Therapy, McGill University, Montréal Québec,, Canada sug: subj: Environmental Sustainability Outcome Assessment Stroke Rehabilitation Outpatient Service Human Questionnaires Quantitative Studies Surveys Descriptive Statistics Qualitative Studies Interviews Medical Practice, Evidence-Based Implementation Science Program Evaluation Decision Making ab: Rationale: Only half of newly implemented evidence‐based practices are sustained. Though poor sustainment can lead to negative consequences for clinical teams, organizations and patients, the causal explanations of sustainment are largely unknown. Aims and Objectives: We aimed to ascertain how (mechanisms) and in what circumstances (context) a newly implemented outcome measure in rehabilitation was sustained or not (outcome). Methodology: Informed by an integrated knowledge translation approach, we conducted a realist evaluation using a mixed method, embedded single case study design with data collection up to 18 months following the implementation of the Mayo‐Portland Adaptability Inventory ‐ version 4 (MPAI‐4), a rehabilitation outcome measure. Quantitative data (survey and patient charts) was analysed using descriptive statistics, then integrated with qualitative data (interviews with 10 key informants) and analysed using inductive and deductive retroduction. We integrated the data to develop a case description and ultimately, to refine the programme theory to better understand the sustainability of the MPAI‐4. Results: We linked context, mechanisms and outcomes, and also emphasized sustainability strategies in 18 explanations of how sustainability works. These explanations provide evidence for four overarching patterns: (1) implementation and sustainability phases are interconnected, (2) outcomes build on each other recursively, with patient benefits as the keystone outcome, (3) sustainment is achieved to varying levels across different sustainability outcomes [e.g., high level (e.g., rate of MPAI‐4 scoring: 77.7%) to low level (e.g., rate of MPAI‐4 application to clinical decision‐making: 3.7%)] and (4) the work of sustaining the MPAI‐4 is shared amongst different stakeholders. Conclusion: Implementation teams can draw from this programme theory to improve the sustainment of outcomes measures while researchers could continue to refine the theory. Continued investigation of sustainability, including diverse and continuous sustainability outcomes, is needed to understand how to maintain improvements in quality of care and patient outcomes. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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