A myriad of factors influencing the implementation of transitional care innovations: a scoping review

Abstract

Background Care transitions of older persons between multiple care settings are frequently hampered by various issues such as discontinuous care delivery or poor information transfer among healthcare providers. Therefore, several innovations have been developed to optimize transitional care (TC). This review aims to identify which factors influence the implementation of TC innovations. Methods As part of TRANS-SENIOR, an international innovative training and research network focusing on enhancing or avoiding care transitions, a scoping review was conducted. The five stages of the Arksey and O’Malley framework were followed. PubMed/MEDLINE, EMBASE, and CINAHL were searched, and eligible studies published between years 2000 and 2020 were retrieved. Data were extracted from the included studies and mapped to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and Care Transitions Framework (CTF). Results Of 1537 studies identified, 21 were included. Twenty different TC innovations were covered and aimed at improving or preventing transitions between multiple care settings, the majority focused on transitions from hospital to home. Key components of the innovations encompassed transition nurses, teach-back methods, follow-up home visits, partnerships with community services, and transfer units. Twenty-five prominent implementation factors (seven barriers, seven facilitators, and eleven factors with equivalent hindering/facilitating influence) were shown to affect the implementation of TC innovations. Low organizational readiness for implementation and the overall implementation climate were topmost hindering factors. Similarly, failing to target the right population group was commonly reported as a major barrier. Moreover, the presence of skilled users but with restricted knowledge and mixed attitudes about the innovation impeded its implementation. Among the eminent enabling factors, a high-perceived advantage of the innovation by staff, along with encouraging transition roles, and a continuous monitoring process facilitated the implementation of several innovations. Other important factors were a high degree of organizational networks, engaging activities, and culture; these factors had an almost equivalent hindering/facilitating influence. Conclusions Addressing the right target population and instituting transition roles in care settings appear to be specific factors to consider during the implementation of TC innovations. Long-term care settings should simultaneously emphasize their organizational readiness for implementation and change, in order to improve transitional care through innovations.

Identification of Children of Mentally Ill Patients and Provision of Support According to the Norwegian Health Legislation: A 11-Year Review

“…This is also true for changing health personnel's practice related to patient's minor children (11,17). Implementation science focuses on studying methods for promoting the uptake of consolidated research findings into routine healthcare practice and health policy, and many researchers have studied which factors have an impact on the implementation of new practices (16,18,19). A recent scoping review conducted by Fakha et al (18), identified an interplay of 25 main factors that acted as barriers and facilitators during the implementation of diverse health care innovations (18).…”

“…Implementation science focuses on studying methods for promoting the uptake of consolidated research findings into routine healthcare practice and health policy, and many researchers have studied which factors have an impact on the implementation of new practices (16,18,19). A recent scoping review conducted by Fakha et al (18), identified an interplay of 25 main factors that acted as barriers and facilitators during the implementation of diverse health care innovations (18). There is a wide range of interrelated factors existing at multiple levels that determine the success of the implementation of innovations (18), which explains why changing clinical practice is challenging, time consuming and needs to be monitored over time.…”

“…A recent scoping review conducted by Fakha et al (18), identified an interplay of 25 main factors that acted as barriers and facilitators during the implementation of diverse health care innovations (18). There is a wide range of interrelated factors existing at multiple levels that determine the success of the implementation of innovations (18), which explains why changing clinical practice is challenging, time consuming and needs to be monitored over time.…”

Implementation Experience with a 30-Day Hospital Readmission Risk Score in a Large, Integrated Health System: A Retrospective Study

“…Even with appropriate program offering to patients and available reimbursement with recent increased national trends of utilization, 27 the acceptance of transitional care programs may vary 24 , 28 , 29 and addressing both medical and social needs 30 after discharge will be required to have impact on longer-term outcomes. Future work will require focus not only on utilizing the risk score to inform resource allocation for post-discharge initiatives and subsequent assessment of clinical outcomes but on implementation strategies to improve uptake of the programs offered.…”

Nursing home performance in a trial to reduce hospitalizations: Implications for future trials

“…Participating NHs did commonly mentioned leadership support as an important factor for facilitating implementation. Several studies have identified leadership support and organizational culture as important factors in improving NH care 27–35 . Measures of leadership support in future studies could include providing dedicated time for champions, leadership turnover, execution of a participation agreement at the beginning of the project by facility and corporate leaders, and utilizing regional nurses for monitoring intervention implementation.…”