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Implementation Fidelity of the Transitional Care Model: A Mixed Methods Study
Karen B Hirschman1, Mark Toles2, Christina R Whitehouse3
1NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, USA.
Global Implementation Research and Applications
|July 28, 2026
Summary
The Transitional Care Model (TCM) achieved high implementation fidelity (90%) across healthcare systems, demonstrating successful protocol delivery despite challenges. Strategies were developed to address barriers, with some systems integrating the model into routine practice.
Area of Science:
- Implementation Science
- Healthcare Management
- Clinical Trials
Background:
- The Transitional Care Model (TCM) aims to improve patient outcomes during care transitions.
- Multisite studies are crucial for evaluating the generalizability of healthcare interventions.
Purpose of the Study:
- To evaluate the implementation of the TCM protocol delivery and its associated randomized clinical trial.
- To identify challenges and strategies for implementing the TCM in diverse healthcare settings.
Main Methods:
- A concurrent mixed-methods design guided by the Practical, Robust, Implementation, and Sustainability Model.
- Utilized the Reach, Adoption, Implementation, and Maintenance (RAIM) framework to assess implementation.
- Measured fidelity through a standardized count of protocol components and qualitative content analysis of meetings.
Main Results:
- High mean fidelity score (34/38, ~90%) to the TCM protocol, with improvement over three years.
- Identified 24 challenges (e.g., patient engagement, nurse availability) and 15 strategies (e.g., care network building, patient engagement).
- COVID-19 impacted enrollment and caused staffing delays, but one system integrated TCM into routine practice.
Conclusions:
- Systematic assessment of intervention delivery and trial implementation is vital for interpreting outcomes.
- The TCM demonstrates feasibility and potential for sustainability with appropriate strategies.
- Adaptability and proactive problem-solving are key to successful healthcare model implementation.
