Fostering the implementation of transitional care innovations for older persons: prioritizing the influencing key factors using a modified Delphi technique

Abstract

Background Transitions in care for older persons requiring long-term care are common and often problematic. Therefore, the implementation of transitional care innovations (TCIs) aims to improve necessary or avert avoidable care transitions. Various factors were recognized as influencers to the implementation of TCIs. This study aims to gain consensus on the relative importance level and the feasibility of addressing these factors with implementation strategies from the perspectives of experts. This work is within TRANS-SENIOR, an innovative research network focusing on care transitions. Methods A modified Delphi study was conducted with international scientific and practice-based experts, recruited using purposive and snowballing methods, from multiple disciplinary backgrounds, including implementation science, transitional care, long-term care, and healthcare innovations. This study was built on the findings of a previously conducted scoping review, whereby 25 factors (barriers, facilitators) influencing the implementation of TCIs were selected for the first Delphi round. Two sequential rounds of anonymous online surveys using an a priori consensus level of > 70% and a final expert consultation session were performed to determine the implementation factors’: i) direction of influence, ii) importance, and iii) feasibility to address with implementation strategies. The survey design was guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected using Qualtrics software and analyzed with descriptive statistics and thematic analysis. Results Twenty-nine experts from 10 countries participated in the study. Eleven factors were ranked as of the highest importance among those that reached consensus. Notably, organizational and process-related factors, including engagement of leadership and key stakeholders, availability of resources, sense of urgency, and relative priority, showed to be imperative for the implementation of TCIs. Nineteen factors reached consensus for feasibility of addressing them with implementation strategies; however, the majority were rated as difficult to address. Experts indicated that it was hard to rate the direction of influence for all factors. Conclusions Priority factors influencing the implementation of TCIs were mostly at the organizational and process levels. The feasibility to address these factors remains difficult. Alternative strategies considering the interaction between the organizational context and the outer setting holds a potential for enhancing the implementation of TCIs.

Implementing Four Transitional Care Interventions for Older Adults: A Retrospective Collective Case Study

“…Likewise, this resonates with recent evidence from Belgium indicating that its current federal government structure, health care financing system, and lack of digital system/data sharing among providers hinders the implementation of care integration in general ( Danhieux et al, 2021 ). One factor we missed in this study was leadership which was not pointed out explicitly as a crucial factor to the implementation, as frequently recognized in the literature ( Fakha et al, 2022 ). Perhaps this could be because the project coordinators and health care professionals saw themselves as the leaders and facilitators of the four TCIs, hence driving through the implementation accordingly.…”

Eliciting and prioritising determinants of improved care in multimorbidity: A modified online Delphi study

“…The Delphi technique is an established formal “group facilitation” 15 method to gather anonymous opinions from a panel of experts with the aim of achieving consensus 16 , 17 and is often used in research to determine priorities. 18 This method was chosen for its flexibility, allowing us to elicit and prioritise a broad range of views on wider determinants relevant to improved care in multimorbidity.…”

“…The study was informed by the research question, a literature review, public and patient involvement and input from the wider study team. 17 The study was piloted before being deployed. Each round included data collection of socio-demographic characteristics.…”

Eliciting and prioritising determinants of improved care in Multiple Long Term Health Conditions (MLTC): A modified online Delphi study

“…The Delphi technique is a well-established formal "group facilitation" [15, p.1008] method to gather anonymous opinions from a panel of experts with the aim of achieving consensus [16][17] and is often used in research to determine priorities [18]. This method was chosen for its flexibility, allowing us to elicit and prioritise a broad range of views on wider determinants relevant to improved care in MLTC.…”

“…The study was informed by the research question, literature review, public and patient involvement and input from the wider study team [17]. The study was piloted before being deployed.…”