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Implementing the MIRROR-TCM Randomised Control Trial During the COVID-19 Pandemic: A Mixed-Methods Evaluation
Molly McHugh1, Karen B Hirschman1, Mark P Toles2
1NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
Journal of Advanced Nursing
|November 25, 2024
Summary
The COVID-19 pandemic challenged the implementation of the Transitional Care Model (TCM), an advanced practice registered nurse-led intervention. Findings highlight the need for robust support during hospital-to-home transitions.
Area of Science:
- Healthcare delivery and patient outcomes.
- Nursing interventions and patient care.
- Evidence-based healthcare solutions.
Background:
- The COVID-19 pandemic presented unprecedented challenges to healthcare systems globally.
- The Transitional Care Model (TCM) is an evidence-based intervention designed to improve patient transitions from hospital to home.
- Evaluating the implementation of advanced practice registered nurse-led interventions during a public health crisis is crucial.
Purpose of the Study:
- To assess the implementation fidelity of the Transitional Care Model (TCM) during the initial year of the COVID-19 pandemic.
- To identify challenges and develop strategies for implementing evidence-based nursing interventions amidst a global health crisis.
- To understand the impact of the pandemic on the delivery of a multi-component advanced practice registered nurse-led intervention.
Main Methods:
- A parallel convergent mixed-methods approach was employed.
- Data were collected from June 2020 to February 2021, involving 78 patients receiving the TCM and 68 meetings with system leaders and clinical teams.
- Descriptive statistics, directed content analysis, and joint display were used for data analysis.
Main Results:
- Fidelity to TCM components varied significantly, with Hospital-to-Home visits ranging from 14.3% to 100% and Maintaining Relationships elements showing high fidelity (97.3%-98.6%).
- Twenty-seven implementation challenges and fifteen strategies for maintaining TCM fidelity during the pandemic were identified.
- The pandemic broadly impacted TCM delivery across all participating sites.
Conclusions:
- The COVID-19 pandemic significantly affected the implementation of the Transitional Care Model (TCM).
- The study underscores the critical need for enhanced services and support systems for patients and caregivers during hospital-to-home transitions.
- Findings will inform the implementation and scaling of transitional care and other evidence-based interventions in diverse healthcare settings.
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