The Cardiac Care Bridge Transitional Care Program; A Mixed Method Process Evaluation

Abstract

Background. The Cardiac Care Bridge (CCB) intervention was designed to reduce unplanned readmission and mortality within six months after hospital admission, for frail cardiac patients of ≥70 years. The Medical Research Council Process Evaluation framework (MRCPE) provides guidance to assess contextual factors, implementation success and mechanisms of impact. Aims. The first aim was to assess the level of treatment delivery, by fidelity, dose, and reach. The second aim was to gain insights in the caregivers’ experience with the delivery of the CCB intervention. By gaining insight in the contextual factors, implementation success and mechanisms of impact from the MRCPE. Methods. A mixed-method concurrent qualitative dominant design was conducted, with a retrospective descriptive design for the quantitative part, using self-reported logbooks. An interpretive descriptive design, using semi-structured interviews with the caregivers (nurses and physiotherapists) for the qualitative part. Results. Delivery rates ranged from 13.7% to 91.9% per key-element. One patient received all key-elements. Caregivers expressed strong beliefs in the effectiveness of the CCB intervention but experience some barriers in providing the key-elements. Expressed barriers were related to lack of insights in the added value of key-elements, time limitations and planning issues. The motivation of the patients had a large influence on providing care during home-visits. Conclusion. The CCB intervention is currently not completely provided as intended, but caregivers strongly believe in the intervention. They are confident that this intervention can contribute to the patients’ wellbeing and prevents adverse events like readmissions. Recommendations. The research-team should apply targeted implementation strategies during the study period to increase the level of adherence to the protocol by the caregivers. A secondary qualitative analysis guided by the Normalization Process Theory could contribute to a better understanding of the normalization level of the CCB intervention.