Table 4.

Matrix of key limiting and facilitating conditions, components of the diffusion of innovation model, and strategies

Components of Greenhalgh model	Key limiting and facilitating conditions	Strategies to be used to enhance implementation
Attributes of CM as an innovation	Intensity of CM and size of caseload	High intensity of CM Optimal caseload (50–60 patients per full-time case manager)
	Inclusion criteria	Use of patient-oriented approach rather than age/diagnosis-oriented strategy
Concerns of potential adopters	Negative attitudes of health care professionals, case managers, and patient-caregiver dyads toward CM	Information campaign about the value of CM targeting health care professionals involved in dementia health care
		Regular feedback to tailor the intervention to the needs of health care professionals and the context of the health care facility
		Regular contact with health care professionals to promote the role of case manager
Communication and influence	Communication between health care professionals, case managers, and patient-caregiver dyads	Clear delineation of the responsibilities of the health care professionals involved in CM (eg, interdisciplinary care protocol)
		Regular meetings of case managers with interdisciplinary team and PCPs Internet-based care management software system for care planning and coordination
		Web-based access to electronic health records
Organizational antecedents for innovation	Interorganizational communication	Clear system of communication (eg, referral system)
		Specific guidelines for referral to support services (eg, AlzheimerAssociation)
Organizational readiness for innovation	Time constraints	Definition of priorities in the provision of care (simple cases versus more complicated conditions)
		Sharing of tasks between PCPs and case managers
	Lack of CM integration into current health care system	Integration of CM in the primary health care facility
Implementation process	Turnover of case managers	Appointment of case managers with experience and good communication qualities
		Training in communication for case managers
		Individual and team training for staff members
	Absence of colocation between case manager and PCP	Location of the case manager in the same facility as PCPs
	Lack of training in geriatrics	Educational training (eg, facilitated sessions and decision-support software to improve diagnosis of dementia)
		Use of dementia treatment guidelines designed for PHC
	Duration of intervention	At least 12 months of intervention before evaluating the outcomes
Linkage	Lack of PCP involvement or reluctance of PCPs to be involved in care of patients with dementia Engagement period	Information campaign targeting PCPs about the value of CM (champion)
		Training (eg, facilitated sessions and decision-support software to improve diagnosis of dementia)
		At least 6 months of engagement to develop confidence in the intervention
Broader context	Financial factors	Capitation-based or mixed remuneration

Abbreviations: CM, case management; PCP, primary care physician; PHC, health care.