A transmural allied healthcare pathway (TULIP): a multi-methods process evaluation

The transmural allied healthcare pathway (TULIP) was developed to improve interprofessional collaboration and continuity of care during hospital-to-home transitions for patients with complex care needs. This process evaluation aimed to examine the implementation and integration of TULIP into routine care.

This study was a multi-methods process evaluation guided by the RE-AIM framework, assessing the reach, effectiveness, adoption, implementation, and maintenance of TULIP. Data were collected through interviews, focus groups, and surveys with professionals, patients, and managers across hospital, geriatric rehabilitation centers, and primary care settings.

Reach included 84 healthcare professionals across hospital, geriatric rehabilitation, and primary care settings; patient enrollment was limited due to a small eligible population. Effectiveness showed a slight improvement in the consistency of care delivery among active users, with no significant changes in perceived collaboration or work performance, although limited intervention uptake may have constrained the assessment of potential effects. Adoption varied across professionals and settings and relied heavily on the implementation researcher, indicating limited organizational ownership. Implementation was hindered by intervention complexity, differing task perceptions among professionals, and challenges in cross-setting coordination and patient eligibility. Maintenance was considered unlikely without structural organizational support, integration into existing workflows, and a clearly perceived need among professionals.

The sustainable implementation of TULIP requires stronger organizational commitment, clearer roles and responsibilities, and integration into routine workflows to support the continuity of care during hospital-to-home transitions.