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Direct Admission Program Implementation: A Qualitative Analysis of Variation Across Health Systems
Jordan A Taylor1, Corrie E McDaniel2,3, Cathryn A Stevens4
1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Pediatrics
|March 27, 2024
Summary
Direct admission (DA) programs show variable adoption across health systems. Implementation challenges and clinician trust impact program success, offering insights for improving hospital transitions.
Area of Science:
- Healthcare Management
- Implementation Science
- Patient Experience
Background:
- Direct admission (DA) bypasses the emergency department, potentially improving patient satisfaction and care timeliness.
- Understanding variations in DA program implementation is crucial for optimizing healthcare delivery.
Purpose of the Study:
- To characterize the reach, effectiveness, adoption, and implementation of a DA program across health systems.
- To explore parent and clinician perspectives on the DA program using the RE-AIM framework.
Main Methods:
- A stepped-wedge cluster randomized trial evaluated DA effectiveness.
- Semi-structured interviews with 137 parents and clinicians were analyzed using thematic and axial coding.
Main Results:
- DA rates varied 10-fold (0.9%–9.3%) across health systems, with 6.6% of 2599 hospitalizations via DA.
- Similarities in perceived effectiveness and engagement were noted, but implementation and adoption varied.
- Differences in transfer center efficiency, clinician trust, and organizational culture impacted adoption.
Conclusions:
- DA program adoption is inconsistent, presenting unique implementation challenges and opportunities.
- Findings can guide quality improvement initiatives for smoother hospital transitions.
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