Implementation of the Community Assets Supporting Transitions (CAST) transitional care intervention for older adults with multimorbidity and depressive symptoms: A qualitative descriptive study

Abstract

Background Older adults with multimorbidity experience frequent care transitions, particularly from hospital to home, which are often poorly coordinated and fragmented. We conducted a pragmatic randomized controlled trial to test the implementation and effectiveness of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led intervention to support older adults with multimorbidity and depressive symptoms with the aim of improving health outcomes and enhancing transitions from hospital to home. This trial was conducted in three sites, representing suburban/rural and urban communities, within two health regions in Ontario, Canada. Purpose This paper reports on facilitators and barriers to implementing CAST. Methods Data collection and analysis were guided by the Consolidated Framework for Implementation Research framework. Data were collected through study documents and individual and group interviews conducted with Care Transition Coordinators and members from local Community Advisory Boards. Study documents included minutes of meetings with research team members, study partners, Community Advisory Boards, and Care Transition Coordinators. Data were analyzed using content analysis. Findings Intervention implementation was facilitated by: (a) engaging the community to gain buy-in and adapt CAST to the local community contest; (b) planning, training, and research meetings; (c) facilitating engagement, building relationships, and collaborating with local partners; (d) ensuring availability of support and resources for Care Transition Coordinators; and (e) tailoring of the intervention to individual client (i.e., older adult) needs and preferences. Implementation barriers included: (a) difficulties recruiting and retaining intervention staff; (b) difficulties engaging older adults in the intervention; (c) balancing tailoring the intervention with delivering the core intervention components; and (c) Care Transition Coordinators’ challenges in engaging providers within clients’ circles of care. Conclusion This research enhances our understanding of the importance of considering intervention characteristics, the context within which the intervention is being implemented, and the processes required for implementing transitional care intervention for complex older adults.

Effects of a transitional care intervention on readmission among older medical inpatients: a quasi-experimental study

“…Some studies have reported positive impacts, while others have reported no or negative impacts [ 17 , 18 , 33 – 37 ]. Other studies found major implementation bottlenecks due to lack of resources, and information and organisational problems [ 38 , 39 ]. This is in line with our experience with the TCI implementation.…”

Transitional Care from Hospital to Cardiac Rehabilitation During COVID-19: The Perspectives of Older Adults and Their Healthcare Providers

“…5 Care transitions can be very challenging because they encompass the integration and coordination of care across different health care sectors and providers that are involved in the patient's circle of care. 6 Given that the complexity of transitional care may increase for older adults as they navigate the healthcare system, 7 and since their participation in decision-making during transitional care is sometimes missing, 8,9 the present study aimed to explore the perspectives of older adults and their healthcare providers on transitional care from hospital to cardiac rehabilitation during the COVID-19 pandemic, with a special focus on the patient decision-making.…”

“…5 Care transitions can be very challenging because they encompass the integration and coordination of care across different health care sectors and providers that are involved in the patient's circle of care. 6…”