Introducing a Computerized Care-Pathways System for Older Adults in Home-Care Settings

Abstract

Introducing computerized care pathways for older adults living at home may be a promising way to improve the clinical dimension of integrated care. Evidence on how to implement them in various home-care contexts is, however, sparse. A prospective, comparative multiple case study with nested analysis units was conducted across three home-care settings. Participants included managers, healthcare professionals, and home-care clients. We used a variety of frameworks and both qualitative and quantitative methods to understand the implementation process. The implementation research logic model (IRLM) presents links among determinants, strategies, mechanisms, and outcomes. Twelve barriers and 35 facilitators were similarly perceived, and 40 strategies were commonly adopted during implementation. After 12 months, OCCI implementation was feasible, appropriate, and acceptable at moderate-to-high levels. They were delivered with a moderate level of fidelity, but the level of penetration after 24 months was high. Participants perceived the OCCIs as supporting a holistic approach, good relationships, clinical decision-making, information sharing, and interprofessional coordination, but not as much productivity and efficiency. Home-care clients had a high level of satisfaction with health care and services. They were satisfied about their involvement in decision-making and with computer use by professionals. We identified four causal pathways: engaging interest holders in a partnership model throughout the study; providing an information system that supports clinical processes; building a conducive environment with deliberate efforts to increase buy-in and engagement; facilitating capacity and relationship building to increase adoption; and embedding the OCCIs in usual practice. The results illustrate how a real understanding of contexts was important to elucidate the mechanisms at work during this study. Adapting the innovation to achieve a better fit between it and the clinical contexts was fundamental. Positive outcomes relied on time, appropriated resources, and a continual, iterative process corresponding to “Make It Happen.”