Abstract
Introduction: In 2020, North York Community Access to Resources Enabling Support (NYCARES) was launched as a new hospital-to-home integrated care program for older adults requiring an alternate level of care. This process evaluation described and assessed NYCARES by its contexts, implementation conditions, and mechanisms of impact.
Methods: Data were program documentation, field notes, implementation metrics, and stakeholder interviews. Quantitative and qualitative data were analyzed descriptively and thematically, then interpretively synthesized. Logic models were developed to describe the program theory of change and tested to assess implementation.
Results: Coordinated, wraparound care by an intersectoral team was an expected mechanism. An unexpected mechanism was the care navigator who facilitated multiple program processes. Implementation challenges involved decision-making relationships among teams and timely operationalization of program decisions.
Discussion: Logic modelling demonstrated the program’s evolution from design through real-world implementation. Unexpected mechanisms may arise due to implementation issues like a lack of clarity on target populations and program processes. Process evaluation findings can be incorporated into a refined theory of change for evaluation of program effectiveness.
Conclusion: Alignment among program teams is critical when delivering new integrated care programs. Such programs require optimization of specific and unexpected contextual and operational factors as the design evolves.