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How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)

BACKGROUND: Stroke Early Supported Discharge (ESD) involves provision of responsive and intensive rehabilitation to stroke survivors at home and it is recommended as part of the stroke care pathway. Core components have been identified to guide the delivery of evidence-based ESD, however, service pr...

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Autores principales: Chouliara, Niki, Cameron, Trudi, Byrne, Adrian, Lewis, Sarah, Langhorne, Peter, Robinson, Thompson, Waring, Justin, Walker, Marion, Fisher, Rebecca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052830/
https://www.ncbi.nlm.nih.gov/pubmed/36978068
http://dx.doi.org/10.1186/s12913-023-09290-1
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author Chouliara, Niki
Cameron, Trudi
Byrne, Adrian
Lewis, Sarah
Langhorne, Peter
Robinson, Thompson
Waring, Justin
Walker, Marion
Fisher, Rebecca
author_facet Chouliara, Niki
Cameron, Trudi
Byrne, Adrian
Lewis, Sarah
Langhorne, Peter
Robinson, Thompson
Waring, Justin
Walker, Marion
Fisher, Rebecca
author_sort Chouliara, Niki
collection PubMed
description BACKGROUND: Stroke Early Supported Discharge (ESD) involves provision of responsive and intensive rehabilitation to stroke survivors at home and it is recommended as part of the stroke care pathway. Core components have been identified to guide the delivery of evidence-based ESD, however, service provision in England is of variable quality. The study sought to understand how and in what conditions the adoption of these components drives the delivery of responsive and intensive ESD services in real world settings. METHODS: This qualitative study was part of a wider multimethod realist evaluation project (WISE) conducted to inform large-scale ESD implementation. Overarching programme theories and related context–mechanism–outcome configurations were used as a framework to guide data collection and analysis. Six case study sites were purposively selected; interviews and focus groups with ESD staff members were conducted and analysed iteratively. RESULTS: We interviewed 117 ESD staff members including clinicians and service managers. Staff highlighted the role of certain core components including eligibility criteria, capacity, team composition and multidisciplinary team (MDT) coordination in achieving responsive and intensive ESD. Regardless of the geographical setting, adhering to evidence-based selection criteria, promoting an interdisciplinary skillset and supporting the role of rehabilitation assistants, allowed teams to manage capacity issues and maximise therapy time. Gaps in the stroke care pathway, however, meant that teams had to problem solve beyond their remit to cater for the complex needs of patients with severe disabilities. Adjusting MDT structures and processes was seen as key in addressing challenges posed by travel times and rural geography. CONCLUSIONS: Despite variations in the wider service model of operation and geographical location, the adoption of core components of ESD helped teams manage the pressures and deliver services that met evidence-based standards. Findings point to a well-recognised gap in service provision in England for stroke survivors who do not meet the ESD criteria and emphasise the need for a more integrated and comprehensive stroke service provision. Transferable lessons could be drawn to inform improvement interventions aimed at promoting evidence-based service delivery in different settings. TRIAL REGISTRATION: ISRCTN: 15,568,163, registration date: 26 October 2018.
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spelling pubmed-100528302023-03-30 How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE) Chouliara, Niki Cameron, Trudi Byrne, Adrian Lewis, Sarah Langhorne, Peter Robinson, Thompson Waring, Justin Walker, Marion Fisher, Rebecca BMC Health Serv Res Research Article BACKGROUND: Stroke Early Supported Discharge (ESD) involves provision of responsive and intensive rehabilitation to stroke survivors at home and it is recommended as part of the stroke care pathway. Core components have been identified to guide the delivery of evidence-based ESD, however, service provision in England is of variable quality. The study sought to understand how and in what conditions the adoption of these components drives the delivery of responsive and intensive ESD services in real world settings. METHODS: This qualitative study was part of a wider multimethod realist evaluation project (WISE) conducted to inform large-scale ESD implementation. Overarching programme theories and related context–mechanism–outcome configurations were used as a framework to guide data collection and analysis. Six case study sites were purposively selected; interviews and focus groups with ESD staff members were conducted and analysed iteratively. RESULTS: We interviewed 117 ESD staff members including clinicians and service managers. Staff highlighted the role of certain core components including eligibility criteria, capacity, team composition and multidisciplinary team (MDT) coordination in achieving responsive and intensive ESD. Regardless of the geographical setting, adhering to evidence-based selection criteria, promoting an interdisciplinary skillset and supporting the role of rehabilitation assistants, allowed teams to manage capacity issues and maximise therapy time. Gaps in the stroke care pathway, however, meant that teams had to problem solve beyond their remit to cater for the complex needs of patients with severe disabilities. Adjusting MDT structures and processes was seen as key in addressing challenges posed by travel times and rural geography. CONCLUSIONS: Despite variations in the wider service model of operation and geographical location, the adoption of core components of ESD helped teams manage the pressures and deliver services that met evidence-based standards. Findings point to a well-recognised gap in service provision in England for stroke survivors who do not meet the ESD criteria and emphasise the need for a more integrated and comprehensive stroke service provision. Transferable lessons could be drawn to inform improvement interventions aimed at promoting evidence-based service delivery in different settings. TRIAL REGISTRATION: ISRCTN: 15,568,163, registration date: 26 October 2018. BioMed Central 2023-03-28 /pmc/articles/PMC10052830/ /pubmed/36978068 http://dx.doi.org/10.1186/s12913-023-09290-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Chouliara, Niki
Cameron, Trudi
Byrne, Adrian
Lewis, Sarah
Langhorne, Peter
Robinson, Thompson
Waring, Justin
Walker, Marion
Fisher, Rebecca
How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)
title How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)
title_full How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)
title_fullStr How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)
title_full_unstemmed How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)
title_short How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)
title_sort how do stroke early supported discharge services achieve intensive and responsive service provision? findings from a realist evaluation study (wise)
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052830/
https://www.ncbi.nlm.nih.gov/pubmed/36978068
http://dx.doi.org/10.1186/s12913-023-09290-1
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