Overcoming barriers to implementation: mapping implementation strategies in four hospital in home programs within the Veterans Health Administration

ABSTRACT

The Hospital at Home model, called Hospital-in-Home (HIH) in the Department of Veterans Affairs, delivers coordinated, high-value care aligned with older adult and caregiver preferences. Documenting implementation barriers and corresponding strategies to overcome them can address challenges to widespread adoption. To evaluate HIH implementation barriers and identify strategies to address them, we conducted interviews with 8 HIH staff at 4 hospitals between 2010 and 2013. We utilized qualitative directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR) and mapped identified barriers to possible strategies using the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool. We identified 11 barriers spanning 5 CFIR domains. Three implementation strategies – identifying and preparing champions, conducting educational meetings, and capturing and sharing local knowledge – achieved high expert endorsement for each barrier. A mix of strategies targeting resources, organizational readiness and fit, and leadership engagement should be considered to support the sustainability and spread of HIH.

KEYWORDS:

• Hospital at home
• Veterans
• implementation science
• implementation strategies

Acknowledgments

We acknowledge the role the following colleagues had in initial data collection: Bert White, DMin, MBA, Whitney Rudin, MPH, MSW, and Melissa K Afable, MPH. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs. The information collected as part of the interviews for this non-research evaluation are not available to the public, however, access to the codebook is available upon request the and CFIR-ERIC Matching Tool is a publicly available resource.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the Boston University Institute for Health System Innovation and Policy; and the Transformation to the 21st Century Care funds from the Veterans Health Administration Office of Geriatrics and Extended Care 2010-2013 (Jennifer Sullivan, PI).