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Table 1 Programme theory CMO framework

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

Context Mechanisms (resources + responses) Outcomes
Rurality of ESD service location Eligibility criteria   Accelerated transfer of care from hospital to home
Team composition
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
  1. Example of a facilitatory CMO with intended consequences
  2. ‘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’
  3. Example of a countervailing CMO with unintended consequences
  4. ‘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’