Operationalizing an Implementation Framework to Disseminate a Care Coordination Program for Rural Veterans

Area of Science:

• Implementation Science
• Healthcare Management
• Veterans Health Administration (VHA)

Background:

• Effective care coordination is crucial for disseminating best practices across diverse healthcare settings.
• The Veterans Health Administration (VHA) sought to implement the rural Transitions Nurse Program (TNP) to enhance care for rural Veterans.
• Pre-implementation assessment of local context is vital for successful program rollout.

Purpose of the Study:

• To operationalize the Practical Robust Implementation and Sustainability Model (PRISM) for pre-implementation assessment of the TNP.
• To identify facilitators and barriers to implementing a care coordination program in diverse VHA facilities.
• To adapt implementation strategies based on site-specific contextual factors.

Main Methods:

• Utilized PRISM to guide qualitative data collection, including interview guides, semi-structured observations, and group brainwriting premortems.
• Assessed local context, current care coordination, and perceptions of the TNP prior to implementation at five VHA facilities.
• Employed deductive-inductive framework analysis to identify PRISM-related themes and adapted implementation strategies accordingly.

Main Results:

• Identified actionable themes within PRISM domains, particularly 'organizational characteristics' and 'implementation and sustainability infrastructure'.
• Common themes included disconnects between primary care and inpatient teams, concerns about work duplication, and nurse capacity.
• These findings directly informed the adaptation of TNP implementation strategies at each site.

Conclusions:

• PRISM pre-implementation assessments provided critical insights that guided TNP implementation adaptations.
• Identified barriers and facilitators may be common across various care coordination interventions.
• Establishing a common language for barriers and facilitators can enhance generalizability and best practice dissemination in care coordination.