A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project

Abstract

Introduction: Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integrated care for frail older adults is successful in practice. In this study, we aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integrated care model in newly created information and advice centers for older adults in Canton Basel-Landschaft, Switzerland. Methods: We conducted a contextual analysis to determine factors which may influence the integrated care model and implementation strategies needed. A logic model depicting the overall program theory, including inputs, core components, outputs and outcomes, was designed using a deductive approach, and included stakeholders’ feedback and preliminary implementation strategies. Results: Contextual factors were identified (e.g., lack of integrated care regulations, existing community services, and a care pathway needed). Core components of the care model include screening, referral, assessment, care plan creation and coordination, and follow-up. Outcomes included person-centred coordinated care experiences, hospitalization rate and symptom burden, among others. Implementation strategies (e.g., nurse training and co-developing educational materials) were proposed to facilitate care model adoption. Conclusion: Contextual understanding and a clear logic model should enhance the potential for successful implementation of the integrated care model.

Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project

“…Its six components provide an overall, theorybased guidance for "how to do" contextual analyses in IS projects and raise questions in regard to contextual analysis that needs to be answered individually for each project. BANANA is not limited to the stem cell transplant population or any clinical settings, yet contextual analyses based on the principles of BANANA were already conducted in community-based care [133] and geriatric care [134]. Further application of BANANA for example in the community pharmacy setting is planned.…”

Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study

“…The present study is part of the larger INSPIRE (Imple-meNtation of a community-baSed care Program for home dwelling senIoR citizEns) parent study taking place in one canton, Basel-Landschaft (BL), an area in the Northwestern part of Switzerland. A cantonal care law enforced in 2018 ensued that older adults living at home will have access to a new information and advice center (IAC) for advice related to care and nursing in old age, as well as an assessment of needs, and either mediation of care or potential nursing home referral [37,38]. The INSPIRE project aims to develop, implement, and evaluate an integrated care model for these IACs [38].…”

“…A cantonal care law enforced in 2018 ensued that older adults living at home will have access to a new information and advice center (IAC) for advice related to care and nursing in old age, as well as an assessment of needs, and either mediation of care or potential nursing home referral [37,38]. The INSPIRE project aims to develop, implement, and evaluate an integrated care model for these IACs [38]. During the development phase, a contextual analysis was conducted which included a population survey [39] followed by interviews with older adults [40] to create an IAC care model which was suited to local health and social needs and preferences.…”

“…During the development phase, a contextual analysis was conducted which included a population survey [39] followed by interviews with older adults [40] to create an IAC care model which was suited to local health and social needs and preferences. More information on the parent study can be found elsewhere [38][39][40]. Using a quantitative approach, we investigated the type and frequency of formal health and social care as well as informal care and social support that frail older adults are currently using and their future preferences, and to what extent the older adults perceive their support in place meets their current needs.…”

Integrated care for older people and program evaluation

“…It contains the outcomes, indicators, assumptions, rationales, and linkages between the previous factors with a proper methodology described elsewhere ( 9 ). Examples of the use of ToC for evaluating public health interventions include the INSPIRE project, which used a ToC to provide a well-defined theory and design in a public healthcare program ( 10 ).…”