DOCUMENT
Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
DOCUMENT
Living labs are complex multi-stakeholder collaborations that often employ a usercentred and design-driven methodology to foster innovation. Conventional management tools fall short in evaluating them. However, some methods and tools dedicated to living labs' special characteristics and goals have already been developed. Most of them are still in their testing phase. Those tools are not easily accessible and can only be found in extensive research reports, which are difficult to dissect. Therefore, this paper reviews seven evaluation methods and tools specially developed for living labs. Each section of this paper is structured in the following manner: tool’s introduction (1), who uses the tool (2), and how it should be used (3). While the first set of tools, namely “ENoLL 20 Indicators”, “SISCODE Self-assessment”, and “SCIROCCO Exchange Tool” assess a living lab as an organisation and are diving deeper into the organisational activities and the complex context, the second set of methods and tools, “FormIT” and “Living Lab Markers”, evaluate living labs’ methodologies: the process they use to come to innovations. The paper's final section presents “CheRRIes Monitoring and Evaluation Tool” and “TALIA Indicator for Benchmarking Service for Regions”, which assess the regional impact made by living labs. As every living lab is different regarding its maturity (as an organisation and in its methodology) and the scope of impact it wants to make, the most crucial decision when evaluating is to determine the focus of the assessment. This overview allows for a first orientation on worked-out methods and on possible indicators to use. It also concludes that the existing tools are quite managerial in their method and aesthetics and calls for designers and social scientists to develop more playful, engaging and (possibly) learning-oriented tools to evaluate living labs in the future. LinkedIn: https://www.linkedin.com/in/overdiek12345/ https://www.linkedin.com/in/mari-genova-17a727196/?originalSubdomain=nl
DOCUMENT