An implementation strategy postmortem method developed in the VA rural Transitions Nurse Program to inform spread and...

Area of Science:

• Implementation Science
• Healthcare Interventions
• Program Evaluation

Background:

• Evaluating implementation strategies is crucial but often lacks practical, retrospective methods.
• Prospective evaluations can be resource-intensive, necessitating alternative approaches.
• The Transitions Nurse Program (TNP), a national care coordination intervention, serves as the case study.

Purpose of the Study:

• To establish a retrospective implementation strategy postmortem method.
• To identify implementation strategies used, their timing, and perceived importance.
• To evaluate the implementation of the TNP intervention across 11 hospitals over three years.

Main Methods:

• A retrospective, mixed-method, phased postmortem approach was employed.
• Implementation teams and front-line staff reported on strategy use, timing, frequency, ease, and importance.
• Data analysis involved descriptive statistics for surveys and matrix content analysis for qualitative data, guided by ERIC, QERI, and Proctor's frameworks.

Main Results:

• The postmortem identified 45 of 73 Expert Recommendations for Implementing Change (ERIC) strategies.
• External facilitation, centralized technical assistance, and clinical supervision were most important and frequently used.
• Implementation strategies were most intensive initially and decreased over time.

Conclusions:

• The postmortem method successfully identified more strategies than anticipated and pinpointed critical ones.
• Findings highlight the importance of specific strategies from staff perspectives.
• Results can inform future implementation studies and the dissemination of the TNP intervention.