Implementation of Complex Interventions

Abstract

Background: Despite the well-documented risks to patient safety associated with transitions from one care setting to another, health care organizations struggle to identify which interventions to implement. Multiple strategies are often needed, and studying the effectiveness of these complex interventions is challenging. Objective: The objective of this study was to present lessons learned in implementing and evaluating complex transitional care interventions in routine clinical care. Research Design: Nine transitional care study teams share important common lessons in designing complex interventions with stakeholder engagement, implementation, and evaluation under pragmatic conditions (ie, using only existing resources), and disseminating findings in outlets that reach policy makers and the people who could ultimately benefit from the research. Results: Lessons learned serve as a guide for future studies in 3 areas: (1) Delineating the function (intended purpose) versus form (prespecified modes of delivery of the intervention); (2) Evaluating both the processes supporting implementation and the impact of adaptations; and (3) Engaging stakeholders in the design and delivery of the intervention and dissemination of study results. Conclusion: These lessons can help guide future pragmatic studies of care transitions.

Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals

“…Transitional care encompasses the transfer of patients within or across care settings, that is, vertically or horizontally, in a seamless and safe way [2]. The safety of older persons might be threatened during care transitions from specialist to primary care, or within levels, and research supports that these transitions have the potential for improvement [3]. Increasingly specialised healthcare service, in combination with a trend of decentralisation of tasks from specialist care to the municipalities, means that persons are discharged from hospitals earlier than before [4].…”

Pragmatic Clinical Trial to Improve Patient Experience Among Adults During Transitions from Hospital to Home: the PArTNER study

“…It is possible the Navigator intervention was insufficient in addressing some barriers in a meaningful way (e.g., employment/income insecurity), or the barriers acted as competing responsibilities for patients who may have prioritized providing for their basic needs over healthcare. These findings could inform the design of future studies, 33 which may benefit from addressing core social issues more broadly, collecting data about participant interest in and engagement with referral to social services, real-time audit-and-feedback mechanisms to promote intervention fidelity, and piloting the bundle of interventions in the actual study context, even if elements of the intervention have been previously used successfully. 12,13 Our study has several limitations.…”

Patient-Centered Approaches to Transitional Care Research and Implementation

“…46 The second paper by Gesell and colleagues invites us to understand lessons learned in the implementation of the PCORI transitional care studies. 47 Using case studies, this paper grapples with the tensions inherent in conducting complex interventions in real-world settings and offers guidance in navigating those tensions. A third paper addresses methodological and analytical considerations associated with the deployment of a pragmatic care transitions trial.…”

“…Reeves and colleagues discuss the opportunities and challenges of integrating patient-centered outcomes into transitional care research and call for the harmonization and standardization of patient-centered outcomes measures that are valid and reliable 46. The second paper by Gesell and colleagues invites us to understand lessons learned in the implementation of the PCORI transitional care studies 47. Using case studies, this paper grapples with the tensions inherent in conducting complex interventions in real-world settings and offers guidance in navigating those tensions.…”