Elucidating the Program Theory of a Successful Interdisciplinary Team-Based Model of Rheumatology Care: An Implementation Science Exploratory Case Study
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.038 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.008 | 0.014 |
| Scholarly communication | 0.007 | 0.006 |
| Open science | 0.003 | 0.007 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".