Abstract
BackgroundTransitions 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.MethodsA 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.ResultsTwenty-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.ConclusionsPriority 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.
Highlights
Transitions in care for older persons requiring long-term care are common and often problematic
Priority factors influencing the implementation of transitional care innovations (TCIs) were mostly at the organizational and process levels
Alternative strategies considering the interaction between the organizational context and the outer setting holds a potential for enhancing the implementation of TCIs
Summary
Transitions in care for older persons requiring long-term care are common and often problematic. The implementation of transitional care innovations (TCIs) aims to improve necessary or avert avoidable care transitions. Transitions in care are common among older persons and entail the movement between different settings and healthcare providers [1, 2]. Transitional care innovations (TCIs) are emerging evidence-based interventions (EBIs) designed to enhance the continuity and coordination of care for older persons when transferring between multiple care settings [4,5,6]. TCIs normally involve two or more care settings or organizations that can be at different levels of readiness for implementing new interventions. Transitions in care for older persons with dementia [14] differ from those who suffer from the consequences of a stroke [15], which in turn, adds to the complexity of implementing TCIs
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