Elucidating the Program Theory of a Successful Interdisciplinary Team-Based Model of Rheumatology Care: An Implementation Science Exploratory Case Study
Notice bibliographique
Résumé
Objectives The increasing prevalence of RMDs has resulted in a demand for care that surpasses the supply of rheumatologists, necessitating innovative care models to provide accessible, effective treatment. Interdisciplinary team-based models of rheumatology care, involving rheumatologists working with interdisciplinary health professionals (IHPs), have shown promise in improving quality of RMD management and patient outcomes. An understanding of the key components of successful interdisciplinary team-based rheumatology care, and how they operate to achieve their effects, remains elusive and is crucial to facilitate spread and scale. Our objective was to elucidate the program theory underlying the Centre of Arthritis Excellence (CArE), Ontario’s only provincially funded community team-based model of rheumatology care. Methods We conducted an exploratory case study of CArE guided by the Medical Research Council Framework for Developing and Evaluating Complex Interventions. We focused on the interaction with context, the underpinning program theory (how and why it achieves its intended outcomes), and diverse strategic partner perspectives. We completed semi-structured interviews with CArE patients (n=9) and health professionals (rheumatologists n=3, IHPs n=6, and administrators n=1), naturalistic observations (n=3), and relevant document review (n=32). Framework analysis was informed by the Consolidated Framework for Implementation Research 2.0, Expert Recommendations for Implementing Change, and the Implementation Outcomes Framework. We triangulated learnings to construct a program theory following an implementation research logic model (IRLM). Results The CArE interdisciplinary model involved rheumatologists and IHPs (including physical therapists, occupational therapists, and pharmacists) working within the same physical space and patient medical record system, sharing responsibilities along the continuum of rheumatology care from initial referral and throughout follow-up. Actioning this model distributed responsibilities away from the rheumatologist and enabled greater capacity for timely patient visits and comprehensive, person-centered care. The provision of ongoing training and mentorship to the IHPs was critical for their skill development and functioning within the rheumatology environment, and in turn, led to greater IHP autonomy and satisfaction. IHPs’ delivery of disease education to patients supported patient disease knowledge and self-efficacy, enabling improved self-management. The ongoing evaluation, refinement and adaptations of the model supported changing care needs. We present an IRLM in Figure 1. Figure 1. Implementation Research Logic Model outlining the program theory of the Centre of Arthritis Excellence. Conclusion By elucidating the program theory of CArE, this study has provided insights into the critical components and contextual factors that contribute to successful delivery of interdisciplinary team-based rheumatology care. The findings will support the adoption, spread and scale of effective team-based models, aiming to improve the quality of care for individuals with RMDs.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,038 | 0,029 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,008 | 0,014 |
| Communication savante | 0,007 | 0,006 |
| Science ouverte | 0,003 | 0,007 |
| Intégrité de la recherche | 0,002 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».