Process evaluation of the implementation of an integrated care pathway in Short Term Residential Care (STRC) in the Netherlands

Background: Short Term Residential Care (STRC) is an intermediate care model in the Netherlands that provides temporary inpatient care for community-dwelling older adults who experience a sudden health or functionality decline. Since there were no guidelines or pathways available describing best practice in STRC, an integrated care pathway was developed. This pathway follows the patient journey from referral to discharge, based on evidence regarding best practice and recommendations from professionals. To assess whether or not the elements of the care pathway were implemented, a process evaluation was conducted.

 

Approach: This study design incorporated mixed methods. Following Saunders et al.’s (2004) framework, qualitative and quantitative data were collected between February 2025 and June 2025 to assess the implementation of the care pathway. Elements of the framework of Saunders that were used to assess implementation were fidelity, dose delivered, dose received and context. Data were collected using surveys, logbook records and semi-structured interviews with professionals and clients in STRC.

 

Results: Six healthcare organizations across the Netherlands implemented one or more of the elements of the pathway. Results from the surveys showed that the elements of the integrated care pathway were only in 45-70% implemented as planned. Interviews focusing on the experience of professionals and clients with the elements of the care pathway demonstrated a diversity of experiences, ranging from highly positive to critical reflections.

Key contextual factors influencing implementation included, among others, staff shortage, limited time, insufficient reimbursement and support from management. Definite results will be presented during the conference.

 

Implications: Insights from this process evaluation will contribute to adapting and wider implementation of the integrated care pathway in STRC in the Netherlands. Furthermore, the findings might offer generalizable lessons regarding the implementation of similar integrated care initiatives in other countries.