Figure 1
INSPIRE project overview mapped according to the Framework of the Medical Research Council.
Figure 2
The INSPIRE project approach to care model development.
Table 1
Data sources used for the contextual analysis.
| DATA SOURCE | PARTICIPANTS INVOLVED | N | MODE OF DATA COLLECTION | PURPOSE OF DATA COLLECTION |
|---|---|---|---|---|
| INSPIRE Project Cantonal stakeholder meetings | The project team invited various individuals to the first INSPIRE Project Cantonal stakeholder meeting from organizations who are relevant in supporting or caring for the older population. New members are continuously welcomed, and participation has now grown to up to 70 members | 5 cantonal stakeholder meetings organized by the INSPIRE research team between January 2018 and December 2019, with the number of participants ranging between 20-40 per individual meeting. Correspondence was sent via email from the INSPIRE account. | In-person meetings | To help the INSPIRE team stay informed on current happenings; identify relevant barriers and facilitators; inform stakeholders and discuss their input and concerns related to various project components (e.g., the care law “Altersbetreuungs- und Pflegegesetz”, the early prototype of the IAC care model, and the Basel-Landschaft Older Persons Survey). |
| Cross-sectional surveys and informal follow-up meetings to confirm interpretation of findings | A selection of representatives who participated in the first INSPIRE Project Cantonal stakeholder meeting | 12 completed surveys | Electronic survey with 11 open-ended questions | To identify organizational interest in INSPIRE, current practices related to the intervention, perceived gaps in the health care supply, views on the role of the nurse in the IAC, as well as potential barriers and facilitators in implementing the IAC. |
| INSPIRE Project local stakeholder meetings | Health and social care providers and political representatives from specific care regions within Canton BL | Meetings are organized by the care regions approximately monthly (approximately 11 to date), and INSPIRE has been invited as a participant | In-person meetings | To discuss planning and implementation of the care model in local practice with the working groups from specific care regions. |
| Context analysis meetings | A local General Practitioner’s office, Specialist Centers for Ageing Issues and home-care providers in selected care regions | 5 meetings were arranged by the INSPIRE research team | In-person meetings and semi-structured interviews | To get an overview of the daily processes and activities related to the care of older adults in each setting, and learn how to work together with current providers to support the IAC implementation. |
| Local, national and international papers and reports related to integrated care or caring for multi-morbid/frail older adults | n/a | n/a | Report/article review and data extraction | To increase research team’s awareness and understanding of the background, trends, and recent evidence, and inform the thinking about relevant factors to consider with respect to the integrated care model. |
| Basel-Landschaft Older Persons Survey | n = 8,786 valid questionnaires were completed by home-based adults aged 75 and older living in Canton BL | More details reported elsewhere [44] | Quantitative paper survey | To understand the living preferences of home-based older adults in Canton BL as well as the support and services they require and anticipating needing in future to make ageing in place possible. |
[i] BL = Basel-Landschaft; IAC = Information and Advice Center.
Figure 3
The logic model for the INSPIRE care model.
BL = Basel-Landschaft; CGA = Comprehensive Geriatric Assessment; ED = Emergency Department; HC = Health care; HCP = Health care providers; HR-QoL = Health-related Quality of Life; IAC = Information and Advice Center; SSP = Social service providers.
Table 2
Potential implementation strategies for INSPIRE presented using the Expert Recommendations for Implementing Change (ERIC) compilation [49].
| ERIC CLUSTER | ERIC IMPLEMENTATION STRATEGY | Description of the implementation strategy in the INSPIRE project |
|---|---|---|
| Use evaluative and iterative strategies | Assess for readiness and identify barriers and facilitators | To identify barrier and facilitators, a contextual analysis was conducted. Readiness has been assessed through communication with cantonal stakeholders and local care regions. |
| Audit and provide feedback | A form of auditing and feedback will be provided to the IAC nurse and social worker based on data collected in the feasibility study. | |
| Conduct local needs assessment | Local needs, gaps and current care processes were assessed through the contextual analysis. To gather a deeper understanding of older adults’ experiences of their health and social needs and care, a population survey was conducted with older adults in Canton BL and interviews are planned with frail older adults. | |
| Adapt and tailor to context | Tailor strategies | Potential implementation strategies have been and will continue to be selected based on the contextual analysis, stakeholder input, and strength of evidence. New strategies will be selected during the feasibility phase based on any emerging barriers and discussed with stakeholders. |
| Develop stakeholder interrelationships | Build a coalition | The INSPIRE team established a Cantonal stakeholder group that aims to meet quarterly to discuss matters related to the IAC, the care model, the INSPIRE project activities and the new care law. The INSPIRE team also collaborates on a local level with workgroups. Local GPs will be engaged separately as an important stakeholder. |
| Conduct local consensus discussions | ||
| Use advisory boards and workgroups | The INSPIRE team participates in any working groups (which include local politicians and frontline social service professionals) that focus on implementation of the IAC within a selection of care regions, where the care model components and study design are discussed. The social service professionals and the research team are co-developing the electronic patient file for the IAC, which is the tool that will be used for consultations with older adults. | |
| Train and educate stakeholders | Conduct ongoing training | A training curriculum has been co-developed for the IAC nurse(s) which includes input from the contextual analysis. In-person and online training modules are planned for the IAC nurse(s). If needed, training or education sessions will be planned for the IAC social workers. |
| Make training dynamic | ||
| Develop educational materials | Educational materials will be co-developed with care regions and distributed to inform health and social service providers about the new IAC services, how to screen and refer at-risk older adults to the IAC, and the goals and process of integrated care planning. Any changes to the IAC services would also be communicated to these local professionals. | |
| Distribute educational materials | ||
| Conduct educational meetings | An event with local GPs is being planned in collaboration with stakeholders which will include discussion of the IAC. Additionally, a marketing plan and educational session will be planned with stakeholders for community providers to learn about the IAC, including their roles as community professionals, and provide their feedback. | |
| Support clinicians | Remind clinicians | A mechanism could be suggested to remind GPs and home care nurses to screen older adults with a certain geriatric risk profile, and refer them to the IAC if appropriate. |
| Revise professional roles | Roles and responsibilities will need to be clear for the IAC staff, and emphasizing the goals of care continuity and coordination between professionals. The INSPIRE team co-developed a job description for an IAC nurse and emphasized the importance of the role of the social worker in continuously collaborating with the IAC nurse to effectively co-deliver integrated care services. An integrated care pathway will be created to clearly outline the different roles of the professionals. The electronic patient file for the IAC may also help to delineate the roles of each professional. | |
| Engage consumers | Use mass media | Advertising materials should be co-developed with care regions to inform older adults, their family, care professionals and community members about the new IAC services. Consistency in advertising will be important. |
[i] BL = Basel-Landschaft; IAC = Information and Advice Center; GP = General Practitioner.