What is the impact of large-scale implementation of stroke Early Supported Discharge? A mixed methods realist evaluation study protocol

Table 1 Programme theory CMO framework

Context	Mechanisms (resources + responses)		Outcomes
Rurality of ESD service location	Eligibility criteria		Accelerated transfer of care from hospital to home
Rurality of ESD service location	Team composition		Accelerated transfer of care from hospital to home
Commissioning and financial arrangements	Whole time equivalent staff/patient ratio	Staff perspectives/behaviour	Rehabilitation delivery—responsiveness
ESD provider organisation	Stroke specialism and staff training	Patient perspectives/behaviour	Rehabilitation delivery—intensity of rehabilitation
Referring services characteristics and locations	Multidisciplinary team co-ordination (e.g. meetings)		Patient outcomes—recovery

Example of a facilitatory CMO with intended consequences
‘If members of an ESD service have to cover long travelling distances in a rural setting, then the team may respond by making effective use of communication at team meetings and increased coordination (timetabling), resulting in patient centred goal setting and increased intensity of rehabilitation provided’
Example of a countervailing CMO with unintended consequences
‘If members of an ESD service have to cover long travelling distances in a rural setting, this may place a burden of the team’s communication and coordination and result in patients receiving less therapy than patients in urban settings’

ISSN: 1748-5908