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Methods for measuring implementation fidelity to the transitional care model
Monica L Ahrens1, Alexandra L Hanlon2, Karen B Hirschman3
1Department of Statistics, Center for Biostatistics and Health Data Science, College of Science, Virginia Tech, Four Riverside Circle, Roanoke, VA, 24016A, USA.
Trials
|May 15, 2026
Summary
This study operationalized a flexible fidelity scoring method for the Transitional Care Model (TCM) intervention. This approach accounts for real-world implementation variability and aids in evaluating intervention effectiveness.
Area of Science:
- Healthcare Implementation Science
- Clinical Intervention Evaluation
Background:
- Intervention fidelity is crucial for valid outcome assessment, preventing confounding implementation variability with efficacy.
- The MIRROR-TCM study evaluated the Transitional Care Model (TCM), a 10-component intervention supporting older adults post-hospitalization.
- A key objective was operationalizing a fidelity measure for the TCM intervention.
Purpose of the Study:
- To describe the development and operationalization of a novel fidelity measure for the Transitional Care Model (TCM) intervention.
- To establish a method for assessing fidelity at element, component, and overall intervention levels.
- To create a flexible scoring system accommodating real-world implementation variations.
Main Methods:
- Fidelity was operationalized across 38 elements organized into 8 TCM components.
- Element-level fidelity scores (0/1) were defined by clinicians and statisticians, refined with provider feedback.
- Component and overall fidelity scores were calculated as proportions of completed elements, incorporating rule-based exemptions.
Main Results:
- A comprehensive TCM fidelity score was developed, integrating 38 elements and 8 components.
- A novel methodology for flexible fidelity scoring in multicomponent interventions was established.
- The fidelity measure allowed for rule-based exemptions, accommodating participant-specific needs and implementation variability.
Conclusions:
- Accurate fidelity evaluation is essential for assessing intervention implementation.
- The developed fidelity measure offers a flexible approach for complex, multicomponent interventions.
- Future work includes validating the metric by linking fidelity to clinical outcomes in the MIRROR-TCM study.
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