Pre-Implementation of Clinical Indicators of Frailty and Complexity in Homecare: An Analysis Based on the Implementation Research Logic Model
Introduction: Clinical indicators of frailty and complexity of home care situations are derived from the interRAI HC, but their implementation in practice requires a precise and prior analysis of the care context in which they could be used. The Implementation Research Logic Model (IRLM) is a reference framework that can be used for the whole implementation process including for the pre-implementation, an essential but often neglected step. Objective: This paper aims to present a procedure to applying the IRLM model that specifies the key elements (determinants, strategies, mechanisms and outcomes) of the pre-implementation stage. Procedure: Implementation takes place at the Geneva Institution for Home Care and Assistance (institution genevoise de maintien à domicile or imad) in Switzerland. The data collected (e.g., characteristics of the institution, nurse questionnaire) are entered into the IRLM by a working group. Evaluation: The analysis of pre-implementation elements points to contextual determinants that may promote implementation (e.g., availability of clinical indicators and care protocols) or hinder it (e.g., information overload). In addition, strategies put in place and the outcomes obtained at this stage (e.g., integration of indicators in the patient record, little resistance to change) are described. Discussion and conclusion: The anticipation and analysis of the conditions in which implementation takes place from the pre-implementation phase provides essential information on recommendations for adapting actions to specific contexts and concrete realities. The implementation of step-by-step strategies should help to meet the challenge of transferring new knowledge to contextualized clinical practice.