How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)

Table 1 Programme theory framework

Contex	Mechanisms		Outcomes
	Resources ^a	Responses
Service capacity Geographical location Commissioning and financial arrangements ESD Provider organisation Referring services characteristics & locations	Eligibility criteria Team composition Whole time equivalent Staff/patient ratio Stroke specialism & staff training Multidisciplinary team co-ordination (e.g. meetings)	Staff perspectives/ behaviour Patient perspectives/ behaviour	Rehabilitation delivery – responsiveness Rehabilitation delivery – intensity of rehabilitation

Example of a CMO configuration with intended outcomes: “If services covering rural areas have telerehabilitation technologies in place, then MDT members may use flexible working arrangements effectively, helping to maximise resources and optimise service responsiveness and intensity.”
Example of a CMO configuration with unintended outcomes: “If ESD services covering rural geographical areas offer on-site rehabilitation groups to augment intensity, but support with transport is not available, patients living remotely might refuse attendance and receive less therapy that patients living closer to the service.”
^aCore components of evidence-based ESD services

ISSN: 1472-6963