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What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol

BACKGROUND: Stroke Early Supported Discharge (ESD) is a service innovation that facilitates discharge from hospital and delivery of specialist rehabilitation in patients’ homes. There is currently widespread implementation of ESD services in many countries, driven by robust clinical trial evidence....

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Autores principales: Fisher, Rebecca, Chouliara, Niki, Byrne, Adrian, Lewis, Sarah, Langhorne, Peter, Robinson, Thompson, Waring, Justin, Geue, Claudia, Hoffman, Alex, Paley, Lizz, Rudd, Anthony, Walker, Marion
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567399/
https://www.ncbi.nlm.nih.gov/pubmed/31196123
http://dx.doi.org/10.1186/s13012-019-0908-0
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author Fisher, Rebecca
Chouliara, Niki
Byrne, Adrian
Lewis, Sarah
Langhorne, Peter
Robinson, Thompson
Waring, Justin
Geue, Claudia
Hoffman, Alex
Paley, Lizz
Rudd, Anthony
Walker, Marion
author_facet Fisher, Rebecca
Chouliara, Niki
Byrne, Adrian
Lewis, Sarah
Langhorne, Peter
Robinson, Thompson
Waring, Justin
Geue, Claudia
Hoffman, Alex
Paley, Lizz
Rudd, Anthony
Walker, Marion
author_sort Fisher, Rebecca
collection PubMed
description BACKGROUND: Stroke Early Supported Discharge (ESD) is a service innovation that facilitates discharge from hospital and delivery of specialist rehabilitation in patients’ homes. There is currently widespread implementation of ESD services in many countries, driven by robust clinical trial evidence. In England, the type of ESD service patients receive on the ground is variable, and in some regions, ESD is still not offered at all. This protocol presents a study designed to investigate the mechanisms and outcomes of implementing ESD at scale in real-world conditions. This will help to establish which models of ESD are most effective and in what context. METHODS: A realist evaluation approach composed of two interlinking work packages will be adopted to investigate how and why ESD works, for whom and in what circumstances. Work package 1 (WP1) will begin with a rapid evidence synthesis to formulate preliminary realist hypotheses. Quantitative analyses of historical prospective Sentinel Stroke National Audit Programme (SSNAP) data will be performed to evaluate service outcomes based on the degree to which evidence-based ESD has been implemented. Work package 2 (WP2) will involve the qualitative investigation of purposively selected case study sites featuring in WP1 and covering different regions in England. The perspectives of clinicians, managers, commissioners, and service users will be explored qualitatively. Cost implications of ESD models will be examined using a cost-consequence analysis. Cross-case comparisons and triangulation of the data sources from both work packages will be performed to test, revise, and refine initial programme theories and address research aims. DISCUSSION: This study will investigate whether and how current large-scale implementation of ESD is achieving the outcomes suggested by the evidence base. The theory-driven evaluation approach will highlight key mechanisms and contextual conditions necessary to optimise outcomes and allow us to draw transferable lessons to inform the effective implementation and sustainability of ESD in clinical practice. In addition, the methodological framework will progress the theoretical understanding of implementation and evaluation of complex rehabilitation interventions in stroke care. TRIAL REGISTRATION: ISRCTN: 15568163, registration date: 26 October 2018.
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spelling pubmed-65673992019-06-17 What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol Fisher, Rebecca Chouliara, Niki Byrne, Adrian Lewis, Sarah Langhorne, Peter Robinson, Thompson Waring, Justin Geue, Claudia Hoffman, Alex Paley, Lizz Rudd, Anthony Walker, Marion Implement Sci Study Protocol BACKGROUND: Stroke Early Supported Discharge (ESD) is a service innovation that facilitates discharge from hospital and delivery of specialist rehabilitation in patients’ homes. There is currently widespread implementation of ESD services in many countries, driven by robust clinical trial evidence. In England, the type of ESD service patients receive on the ground is variable, and in some regions, ESD is still not offered at all. This protocol presents a study designed to investigate the mechanisms and outcomes of implementing ESD at scale in real-world conditions. This will help to establish which models of ESD are most effective and in what context. METHODS: A realist evaluation approach composed of two interlinking work packages will be adopted to investigate how and why ESD works, for whom and in what circumstances. Work package 1 (WP1) will begin with a rapid evidence synthesis to formulate preliminary realist hypotheses. Quantitative analyses of historical prospective Sentinel Stroke National Audit Programme (SSNAP) data will be performed to evaluate service outcomes based on the degree to which evidence-based ESD has been implemented. Work package 2 (WP2) will involve the qualitative investigation of purposively selected case study sites featuring in WP1 and covering different regions in England. The perspectives of clinicians, managers, commissioners, and service users will be explored qualitatively. Cost implications of ESD models will be examined using a cost-consequence analysis. Cross-case comparisons and triangulation of the data sources from both work packages will be performed to test, revise, and refine initial programme theories and address research aims. DISCUSSION: This study will investigate whether and how current large-scale implementation of ESD is achieving the outcomes suggested by the evidence base. The theory-driven evaluation approach will highlight key mechanisms and contextual conditions necessary to optimise outcomes and allow us to draw transferable lessons to inform the effective implementation and sustainability of ESD in clinical practice. In addition, the methodological framework will progress the theoretical understanding of implementation and evaluation of complex rehabilitation interventions in stroke care. TRIAL REGISTRATION: ISRCTN: 15568163, registration date: 26 October 2018. BioMed Central 2019-06-13 /pmc/articles/PMC6567399/ /pubmed/31196123 http://dx.doi.org/10.1186/s13012-019-0908-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Study Protocol
Fisher, Rebecca
Chouliara, Niki
Byrne, Adrian
Lewis, Sarah
Langhorne, Peter
Robinson, Thompson
Waring, Justin
Geue, Claudia
Hoffman, Alex
Paley, Lizz
Rudd, Anthony
Walker, Marion
What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol
title What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol
title_full What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol
title_fullStr What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol
title_full_unstemmed What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol
title_short What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol
title_sort what is the impact of large-scale implementation of stroke early supported discharge? a mixed methods realist evaluation study protocol
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567399/
https://www.ncbi.nlm.nih.gov/pubmed/31196123
http://dx.doi.org/10.1186/s13012-019-0908-0
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