Harnessing Protocolized Adaptation in Dissemination: Successful Implementation and Sustainment of the Veterans Affairs Coordinated‐Transitional Care Program in a Non‐Veterans Affairs Hospital |
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| Authors: | Amy J. H. Kind MD PhD Maria Brenny‐Fitzpatrick MSN CNS Kris Leahy‐Gross MSN RN Jacquelyn Mirr BS Elizabeth Chapman MD Brooke Frey BBA Beth Houlahan MSN RN |
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| Affiliation: | 1. Geriatrics Division, Department of Medicine, School of Medicine and Public Health, William S Middleton Hospital Madison, Madison, Wisconsin;2. School of Nursing, William S Middleton Hospital Madison, Madison, Wisconsin;3. School of Pharmacy, William S Middleton Hospital Madison, Madison, Wisconsin;4. Department of Veterans Affairs, Geriatric Research Education and Clinical Center, William S Middleton Hospital Madison, Madison, Wisconsin;5. University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin |
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| Abstract: | The Department of Veterans Affairs (VA) Coordinated‐Transitional Care (C‐TraC) program is a low‐cost transitional care program that uses hospital‐based nurse case managers, inpatient team integration, and in‐depth posthospital telephone contacts to support high‐risk patients and their caregivers as they transition from hospital to community. The low‐cost, primarily telephone‐based C‐TraC program reduced 30‐day rehospitalizations by one‐third, leading to significant cost savings at one VA hospital. Non‐VA hospitals have expressed interest in launching C‐TraC, but non‐VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture, and resources. The objective of this project was to adapt C‐TraC to the specific context of one non‐VA setting using a modified Replicating Effective Programs (REP) implementation theory model and to test the feasibility of this protocolized implementation approach. The modified REP model uses a mentored phased‐based implementation with intensive preimplementation activities and harnesses key local stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C‐TraC protocol was created and launched at the non‐VA hospital in July 2013. In its first 16 months, C‐TraC successfully enrolled 1,247 individuals with 3.2 full‐time nurse case managers, achieving good fidelity for core protocol steps. C‐TraC participants experienced a 30‐day rehospitalization rate of 10.8%, compared with 16.6% for a contemporary comparison group of similar individuals for whom C‐TraC was not available (n = 1,307) (P < .001). The new C‐TraC program continues in operation. Use of a modified REP model to guide protocolized adaptation to local context resulted in a C‐TraC program that was feasible and sustained in a real‐world non‐VA setting. A modified REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities. |
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| Keywords: | transitional care rehospitalization implementation science dissemination nursing |
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