Abstract
Introduction: In line with patient, governmental, and clinician demands, GerOnTe (an Horizon 2020 funded randomised controlled trial being implemented across 16 different sites in 3 countries) will design, implement, test, and prepare for EU wide deployment a novel technology-supported integrated care pathway for older adults with cancer and other morbidities. Integration of care and services requires individualised coordination often across multiple specialities, services, and sites. Information Technology can provide a practical way to share and coordinate health information and care across services and sites on a large, traceable, and sustainable scale. Designing, implementing, and evaluating integrated, complex, or technology-supported care, requires a comprehensive understanding of the intervention, its implementation, and how it works in different contexts.
GerOnTe has built on existing Implementation Science theory and practice and combined Realist research principle, the Consolidated Framework for Implementation Science (CFIR), and the Non-Adoption, Abandonment, Scale-up, Spread, Sustainability (NASSS), to implement and evaluate an integrated technology-supported care pathway.
GerOnTe structured and comprehensive approach to implementation and evaluation aims to provide a structured, replicable, and user-friendly way to frame and analyse the intervention and its implementation in the multiple different contexts in which GerOnTe is being tested.
Methods: GerOnTe’s implementation team, in collaboration with the EU project Partner, stakeholders, and end-users co-created a structured approach to implementation evaluation for integrated and technology-supported interventions.
This new structured approach combines Realist Research principle, the CFIR, and the NASSS framework. Realist research principle frame data collection, anlsyse and systnesis to identify and describe ‘what works for who, in what ways and context’ (intervention’s mechanism of action with a given context). The CFIR and NASSS provide practical framework of the ‘implementation context’ and factors that impact implementation of technology.
This approach was co-created following analysis of the project’s implementation evaluation aims, outputs, and timelines, analysis of a review of the Implementation Science literature, using Expert Panel and Stakeholder working group to design and apply the new approach to the GerOnTe project.
Results: This new structured approach provides a structured evidence-based replicable way to research the implementation evaluation of a complex (integrated care pathway) intervention. The framework has been developed and continued to be tested, applied, and refined, across the project and sites to determine its ability to provide information to support implementation and adoption. Stakeholder feedback as well as measures of the approach’s ability and effectives between and across the 16 trial sites will be used to determine and report on the approach ability to support implementation and adoption.
Conclusion: This approach will provide a practical user-friendly framework to support the implementation of integrated or technology-supported care pathways.