Staff Perspectives on Primary Care Teams as De Facto “Hubs” for Care Coordination in VA: a Qualitative Study

Olmos-Ochoa, Tanya T.; Bharath, Purnima; Ganz, David A.; Noël, Polly Hitchcock; Chawla, Neetu; Barnard, Jenny M.; Rose, Danielle E.; Stockdale, Susan; Simon, Alissa; Finley, Erin P.

doi:10.1007/s11606-019-04967-y

Cited by 21 publications

(12 citation statements)

References 20 publications

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“…Understanding what these stakeholders value can help inform evaluation design and program outcomes [ 22 ]. Further, understanding the role of key stakeholders may reduce perceptions of role duplication [ 23 ]. The TNP team conducted in-depth pre-implementation assessments [ 11 , 14 , 15 ] and identified concerns about role duplication early on.…”

Section: Discussionmentioning

confidence: 99%

Sustainment stories: a qualitative analysis of barriers to sustainment of the National Rural Transitions of Care Nurse Program

Nunnery

Gilmartin

McCarthy

et al. 2022

BMC Health Serv Res

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Background Understanding how to successfully sustain evidence-based care coordination interventions across diverse settings is critical to ensure that patients continue to receive high quality care even after grant funding ends. The Transitions Nurse Program (TNP) is a national intervention in the Veterans Administration (VA) that coordinates care for high risk veterans transitioning from acute care VA medical centers (VAMCs) to home. As part of TNP, a VA facility receives funding for a full-time nurse to implement TNP, however, this funding ends after implementation. In this qualitative study we describe which elements of TNP sites planned to sustain as funding concluded, as well as perceived barriers to sustainment. Methods TNP was implemented between 2016 and 2020 at eleven VA medical centers. Three years of funding was provided to each site to support hiring of staff, implementation and evaluation of the program. At the conclusion of funding, each site determined if they would sustain components or the entirety of the program. Prior to the end of funding at each site, we conducted midline and exit interviews with Transitions nurses and site champions to assess plans for sustainment and perceived barriers to sustainment. Interviews were analyzed using iterative, team-based inductive deductive content analysis to identify themes related to planned sustainment and perceived barriers to sustainment. Results None of the 11 sites planned to sustain TNP in its original format, though many of the medical centers anticipated offering components of the program, such as follow up calls after discharge to rural areas, documented warm hand off to PACT team, and designating a team member as responsible for patient rural discharge follow up. We identified three themes related to perceived sustainability. These included: 1) Program outcomes that address leadership priorities are necessary for sustainment.; 2) Local perceptions of the need for TNP or redundancy of TNP impacted perceived sustainability; and 3) Lack of leadership buy-in, changing leadership priorities, and leadership turnover are perceived barriers to sustainment. Conclusions Understanding perceived sustainability is critical to continuing high quality care coordination interventions after funding ends. Our findings suggest that sustainment of care coordination interventions requires an in-depth understanding of the facility needs and local leadership priorities, and that building adaptable programs that continually engage key stakeholders is essential.

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Section: Discussionmentioning

confidence: 99%

Sustainment stories: a qualitative analysis of barriers to sustainment of the National Rural Transitions of Care Nurse Program

Nunnery

Gilmartin

McCarthy

et al. 2022

BMC Health Serv Res

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“…INTERMED could enable this approach once its predictive validity and feasibility from PHC teams’ perspective is confirmed. In fact, RCTs and implementation efforts to successfully deliver such a care planning in PHC have recently been conducted(71–73) or are under development(74), including one RCT that used the INTERMED tool (35)…”

Section: Discussionmentioning

confidence: 99%

Health Complexity Assessment in Primary Care: a validity and feasibility study of the INTERMED tool

Oliveira

Weber

Santos

et al. 2020

Preprint

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Background: While considerable attention has been devoted to patients health complexity epidemiology, comparatively less attention has been paid to tools to identify and describe, in a personalized and comprehensive way, complex patients in primary health care (PHC). Objective: To evaluate INTERMED tools validity and feasibility to assess health complexity in PHC. Design: Cross-sectional psychometric study. Setting: Three Brazilian PHC Units. Participants: 230 patients above 18 years of both sexes. Measurements: Spearmans rho assessed concurrent validity between the whole INTERMED and their four domains (biological, psychological, social, health system) with other well-validated instruments. Pearsons X2 measured associations of the sum of INTERMED current state items with use of PHC, other health services and medications. Cronbach Alpha assessed internal consistency. INTERMED acceptability was measured through patients views on questions and answers, understanding and application length as well as objective application length. Applicability was measured through patients views on its relevance to describe health aspects essential to care and INTERMEDs items-related information already existing in patients health records. Results: 18.3% of the patients were complex (INTERMED 20/21 cut-off). Spearman correlations located between 0.44 - 0.65. Pearson coefficients found were X2 = 26.812 and X2 = 26.883 (both p = 0.020) and X2 = 28.270 (p = 0.013). Cronbach Alpha was 0.802. All patients views were very favorable. Median application time was 7 minutes and 90% of the INTERMED interviews took up to 14 minutes. Only the biological domain had all its items described in more than 50% of the health records. Limitations: We utilized the cutoff point used in all previous studies, found in research performed in specialized health services. Conclusion: We found good feasibility (acceptability and applicability), and validity measures comparable to those found from specialized health services. Further investigations of INTERMED predictive validity and suitability for routine PHC use are worthwhile.

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“…The CTAC project is a QI initiative funded by the Veterans Health Administration (VA) to improve patients’ experience of care coordination between outpatient settings within and outside the VA [ 23 ], at sites confronting a variety of care coordination barriers [ 24 ]. Using a cluster-randomized design, matched pairs of VA clinics were recruited over time and randomized to either a passive strategy (access to an online toolkit) or an active strategy (distance-based facilitation plus online toolkit access) [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Sustaining implementation facilitation: a model for facilitator resilience

Olmos-Ochoa

Ganz

Barnard

et al. 2021

Implement Sci Commun

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Background Implementation facilitators enable healthcare staff to effectively implement change, yet little is known about their affective (e.g., emotional, mental, physical) experiences of facilitation. We propose an expansion to the Integrated Promoting Action on Research in Health Services (i-PARIHS) framework that introduces facilitation intensity and facilitator resilience to better assess facilitators’ affective experiences. Methods We used an instrumental case study and facilitator data (logged reflections and debrief session notes) from the Coordination Toolkit and Coaching initiative to conceptualize facilitation intensity and facilitator resilience and to better understand the psychological impact of the facilitation process on facilitator effectiveness and implementation success. Results We define facilitation intensity as both the quantitative and/or qualitative measure of the volume of tasks and activities needed to engage and motivate recipients in implementation, and the psychological impact on the facilitator of conducting facilitation tasks and activities. We define facilitator resilience as the ability to cope with and adapt to the complexities of facilitation in order to effectively engage and motivate staff, while nurturing and sustaining hope, self-efficacy, and adaptive coping behaviors in oneself. Conclusions Facilitators’ affective experience may help to identify potential relationships between the facilitation factors we propose (facilitation intensity and facilitator resilience). Future studies should test ways of reliably measuring facilitation intensity and facilitator resilience and specify their relationships in greater detail. By supporting facilitator resilience, healthcare delivery systems may help sustain the skilled facilitator workforce necessary for continued practice improvement. Trial registration The project was registered with ClinicalTrials.gov (NCT03063294) on February 24, 2017.

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Staff Perspectives on Primary Care Teams as De Facto “Hubs” for Care Coordination in VA: a Qualitative Study

Cited by 21 publications

References 20 publications

Sustainment stories: a qualitative analysis of barriers to sustainment of the National Rural Transitions of Care Nurse Program

Sustainment stories: a qualitative analysis of barriers to sustainment of the National Rural Transitions of Care Nurse Program

Health Complexity Assessment in Primary Care: a validity and feasibility study of the INTERMED tool

Sustaining implementation facilitation: a model for facilitator resilience

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