title: Harnessing Protocolized Adaptation in Dissemination: Successful Implementation and Sustainment of the Veterans Affairs Coordinated-Transitional Care Program in a Non-Veterans Affairs Hospital.
abstract: The Department of Veterans Affairs (VA) Coordinated-Transitional Care (C-TraC) program is a low-cost transitional care program that uses hospital-based nurse case managers, inpatient team integration, and in-depth posthospital telephone contacts to support high-risk patients and their caregivers as they transition from hospital to community. The low-cost, primarily telephone-based C-TraC program reduced 30-day rehospitalizations by one-third, leading to significant cost savings at one VA hospital. Non-VA hospitals have expressed interest in launching C-TraC, but non-VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture, and resources. The objective of this project was to adapt C-TraC to the specific context of one non-VA setting using a modified Replicating Effective Programs (REP) implementation theory model and to test the feasibility of this protocolized implementation approach. The modified REP model uses a mentored phased-based implementation with intensive preimplementation activities and harnesses key local stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C-TraC protocol was created and launched at the non-VA hospital in July 2013. In its first 16 months, C-TraC successfully enrolled 1,247 individuals with 3.2 full-time nurse case managers, achieving good fidelity for core protocol steps. C-TraC participants experienced a 30-day rehospitalization rate of 10.8%, compared with 16.6% for a contemporary comparison group of similar individuals for whom C-TraC was not available (n = 1,307) (P < .001). The new C-TraC program continues in operation. Use of a modified REP model to guide protocolized adaptation to local context resulted in a C-TraC program that was feasible and sustained in a real-world non-VA setting. A modified REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities.
authors.affiliation: Geriatrics Division, Department of Medicine, School of Medicine and Public Health, William S Middleton Hospital Madison, Madison, Wisconsin.|School of Nursing, William S Middleton Hospital Madison, Madison, Wisconsin.|School of Pharmacy, William S Middleton Hospital Madison, Madison, Wisconsin.|Department of Veterans Affairs, Geriatric Research Education and Clinical Center, William S Middleton Hospital Madison, Madison, Wisconsin.
authors.forename: Amy J H
authors.initials: AJ
authors.lastname: Kind
authors.affiliation: University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin.
authors.forename: Maria
authors.initials: M
authors.lastname: Brenny-Fitzpatrick
authors.affiliation: University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin.
authors.forename: Kris
authors.initials: K
authors.lastname: Leahy-Gross
authors.affiliation: Geriatrics Division, Department of Medicine, School of Medicine and Public Health, William S Middleton Hospital Madison, Madison, Wisconsin.|Department of Veterans Affairs, Geriatric Research Education and Clinical Center, William S Middleton Hospital Madison, Madison, Wisconsin.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Mirr
authors.affiliation: Geriatrics Division, Department of Medicine, School of Medicine and Public Health, William S Middleton Hospital Madison, Madison, Wisconsin.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chapman
authors.affiliation: University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin.
authors.forename: Brooke
authors.initials: B
authors.lastname: Frey
authors.affiliation: University of Wisconsin Hospitals and Clinics, William S Middleton Hospital Madison, Madison, Wisconsin.
authors.forename: Beth
authors.initials: B
authors.lastname: Houlahan
mesh_terms: D000368:Aged; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010359:Patient Readmission / Q000706:statistics & numerical data; D013689:Telephone; D000069341:Transitional Care / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: dissemination; implementation science; nursing; rehospitalization; transitional care