Table 2 Synthesis of each Intervention-Context-Mechanism-Outcome (ICMO) configuration
INTERVENTION COMPONENTS (I) | CONTEXTS (C) | MECHANISMS (M) | OUTCOMES (O) |
|---|---|---|---|
ICMO-1: Two-way communication between healthcare providers and patients/caregivers | |||
Provide patients and families with individually tailored, complete and repeated information [34] Regarding: health conditions, symptoms, how they evolve and how to manage them [9, 34] healthcare planning [9, 35,36,37,38] information seeking [9] Using: verbal and written communication [34] (adapted to each patient) [39] simple language [40] Involve patients and families in healthcare and discharge planning [9, 35, 36, 38, 41] Improve knowledge and understanding of families’ concerns, barriers and expectations to recovery [34, 41, 42] | When Throughout the discharge planning process - from admission [37, 43] to post-discharge (home) [37] - frequently [35] Communication on recovery time and risk management For whom Some intrinsic characteristics may compromise communication [38, 44] - high degree of frailty [38, 44] - living alone [38] | For patients ↑ understanding of how to balance risks safely [38] For patients and families ↑ knowledge of the illness/ injury [36] and how to manage it [9] ↑ adjustment of expectations regarding recovery [41] ↑ self-confidence, sense of control [38] and feeling of being prepared [37] ↓ stress and frustration [9, 34,35,36] ↓ confusion and tension between family members [37] For healthcare providers ↑ ability to address questions that patients do not know how to ask [41, 45] | |
ICMO-2: Interprofessional communication within and across healthcare settings | |||
Interprofessional communication and information sharing accurate and effective [9, 36, 38,39,40, 45, 46] By using/doing: standardized routine for information exchange [9, 47] verbal and timely non formal communication [9] regular multidisciplinary meetings [9, 43, 47] complete handovers documenting fall risk [36, 46, 47] Web-based information system [9, 35, 39] (interoperable across care settings and available to all healthcare providers throughout the continuum of care) [39] clear boundaries for care (tasks and responsibilities) between all healthcare providers [35, 40] | When Throughout the healthcare continuum [9, 39] Between different healthcare settings [39] Where In a supportive organizational and management context (local and national levels) [44, 47] | ↑ knowledge and understanding of healthcare providers regarding patients’ situations, and their own respective roles, tasks and responsibilities [9, 34, 46] ↓ redundancies, overlap, delays, inaccuracies, incompleteness, uncertainties regarding what has been done [34] ↓ losses of information across care settings [39] ↓ anxiety and frustration experienced by healthcare providers [39] ↓ time spent gathering information on patients [9] | ↓ hospital readmissions [9, 35] ↑ identification of patients at risk of falls [47] |
ICMO-3: Patient/caregiver individually tailored education on fall prevention | |||
Patients’ and caregivers’ education and training should: Target real needs of patients at home [37, 48, 49] Teach possible prevention strategies and exercises to foster recovery [37, 38, 48, 49] Encourage and motivate patients to use these strategies and do the exercises [42, 48] Provide families with written educational material [48] Caregivers’ education and training should also: Cover patients’ medical condition, signs of complications, physical care requirements, medication, etc. (be prepared for “afterwards”) [37, 38] | When Reinforced education by follow up phone call post discharge [49] For whom Optimal in cognitively healthy patients [42, 48, 49] If patients cognitively impaired: caregivers’ education is essential [48] | For patients and caregivers ↑ awareness of fall prevention [37] ↑ recognition of near-falls [49] For patients ↑ knowledge of prevention strategies [42, 48] ↑ confidence and motivation to use them [42, 48] For caregivers ↑ knowledge of the illness/ injury makes them more resilient when providing care (↑ flexibility and abilities) [37, 38] | ↓ negative psychological impacts on caregivers (burden) [37] ↑ safety in the care provided by caregivers at home [36] ↑ continuity for patients in transition from hospital to home [37] |
ICMO-4: Discharge planning coordination | |||
Designation of 1 pivotal healthcare provider (coordinator) to manage discharge planning [35, 38, 39, 50]: Acting as the single regular contact point for patients [35] Coordinating a comprehensive intervention adapted to patients [50] Tools to facilitate coordination: Interdisciplinary worksheet to record all the barriers to a safe return home identified by all the healthcare providers [51] Web-based information system to integrate information from different providers and care settings [35, 50, 52] | When Throughout the discharge planning process - from admission to discharge [35, 36, 40, 51] - post-discharge (home) [36] For whom Older patients’ multiple comorbidities and medical complexities require extensive coordination as many healthcare providers are involved [35, 36, 41, 50, 53] | ↑ stability and consistency through coordinator’s regular contacts with patients, families and professionals [34, 39] ↑ trust [39] ↑ identification, anticipation and alleviation of barriers experienced by patients [34, 35] ↑ communication and information sharing among healthcare providers and settings [53] ↑ identification and prioritization of patients’ needs [48] ↑ personal engagement from each healthcare provider and families over care [34] | ↑ quality (continuity) of care [34, 39, 48, 53] ↑ patients’ quality of life (physical, psychological and social needs met) [48] ↑ patients’ satisfaction [52] |