Realist evaluation of a pilot intervention implementing interprofessional and interinstitutional processes for transitional care

Figures & data

Table 1. Description of interprofessional and interinstitutional shared decision-making processes (IIPs)

	Multilateral iterative coordination processes (iterative IIPs)	Interprofessional and interinstitutional coordination meetings (meeting IIPs)
Persons involved	Nonprofessionals: at least the patients or their informal caregiver/representative Professionals: at least two persons from two different professional groups OR at least two persons from the same professional group but from two different institutions
Shared decision-making processes	Iterative: multilateral processes that can occur in real-time (i.e. physically, by phone or using other methods) or via e-mail and other asynchronous methods (i.e. fax)	Simultaneous: at least three people physically meet
Outcomes	The shared decision-making processes identify at least one shared goal
Indicators	Iterative IIPs occurred during the SSU stay: yes/no Actors involved Outcome present: yes/no	Meeting IIPs occurred: yes/no Occurred during the SSU stay: yes/no Occurred within 30 days of discharge from the SSU: yes/no Actors involved Outcome present: yes/no

Abbreviation: SSU: short-stay unit; Source: (Kaiser et al., 2019)

Table 2. Definitions of intervention, context, mechanisms, outcomes and demi-regularities

Intervention	Uses various types of resources to achieve its objective.
Context (C)	Refers to those elements, outside the resources provided by the intervention, that may have a causal influence on the production of effects by the intervention.
Mechanisms(M)	Are the responses of actors exposed to the resources provided by an intervention in a specific context; mechanisms can be disaggregated into resources (Res, components introduced in a context) and reasoning (Rea, “stakeholders’ volition” (Schmitz et al., 2020)): M(Res) + C→M (Rea) = O.
Outcomes(O)	Are produced by the actors exposed to the resources provided by the intervention, all in a specific context. Through ripple effect, outcomes may change the context over time.
Demi-regularities	Are semi-predictable patterns of CMO configurations, i.e. regular occurrences of an outcome following the implementation of an intervention that triggers one or more mechanisms in a particular context.

Sources: (Schmitz et al., 2020, p. 21; imad, 2020; Schusselé Filliettaz et al., 2021)

Figure 1. Iterative steps for our realist evaluation

Table 3. Wrapping middle-range theories into an initial intervention theory

Conditions under which the negative implications of the innovation (=IIPs) would be outweighed by its positive implications	Initial intervention theory
A change agent (=SSU care coordinator) takes over some of the negative implications (the negotiation and organization of IIPs).	A stay at the SSU, with inpatient professionals committed to facilitating IIPs, will reinforce the implementation of IIPs, especially for patients with CNs.
A change agent (=SSU care coordinator) with an appropriate, agile, professional & interpersonal approach gathers and emphasizes outpatient actors’ perspectives individually and collectively (=IIPs).
In an acute phase (=SSU stay) within a context of CNs, the desirability of (new) collaborative solutions (=IIPs) to (old) needs increases.
The assessment of needs is holistic enough (=SSU CNs assessment) to bring (new) solutions to professionals’ needs (e.g. improving care, improving recognition, improving communication & trust, reducing necessary energy & anxiety), as well as to patients’ needs (e.g. improving health, reducing anxiety).
Previous IIPs have had positive implications.
In a specific context (=SSU stay) where broader financial and interinstitutional barriers can be dealt with.

(Elements from the middle-range theories described in the text are in bold)

Figure 2. Realist intervention theory

Kaiser, N., Amann, F., Meier, N., Inderbitzi, L., Haering, B., Eicher, M., and Stanic, J, 2019). Berufsausübung: Potenziale für Interprofessionalität [Professional practice: Potentials for interprofessionality] (90 p. Retrieved 18 10 2019). Bern, Switzerland: Federal office of public health (FOPH). www.bag.admin.ch

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