Influencing Factors Associated with Implementation of INTERACT (Interventions to Reduce Acute Care Transfers) in VA Community Living Centers (CLCs) Using the Consolidated Framework

ABSTRACT

Our objective was to identify the influencing factors associated with the implementation of the INTERACT (Interventions to Reduce Acute Care Transfers) Quality Improvement program within a national healthcare system. INTERACT focuses on early identification and management of changes in residents’ condition leading to a reduction in potentially preventable hospital transfers. The Consolidated Framework was used to evaluate implementation data from eight VA Community Living Centers. Qualitative implementation data suggest two influencing Consolidated Framework domains had a strong influence: 1) key attributes of the intervention (e.g., adaptability or complexity) and 2) internal organizational factors (e.g., culture or compatibility). Using the Consolidated Framework can assist future adaptations to this and other complex quality improvement initiatives.

KEYWORDS:

• Quality improvement
• implementation
• preventable hospitalizations
• intervention
• education

Key points

• Consolidated Framework identifies factors that facilitate a complex intervention.

• Level of staff commitment is common inconsistency in the implementation of intervention.

• Organizational culture predisposes to the success or failure of health-care intervention.

Acknowledgments

We acknowledge Nancy Henry, GNP, for her immense contributions to our work prior to her passing in December 2017. Nancy was crucial to the implementation of INTERACT, responsible for training intervention staff and monitoring the implementation process from the beginning through its completion. Without her expertise, skills and support throughout, this work would not be possible.

Disclosure statement

J.O. serves as a paid adviser to Pathway Health, Think Research, and Curavi. Work on funded INTERACT research is subject to the terms of Conflict of Interest Management plans approved by the FAU Financial Conflict of Interest Committee.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by Merit Review Award # CRE-12-025 from the United States (U.S.) Department of Veterans Affairs Health Services Research and Development Service. Additionally, this was work was supported by the Center of Innovation in Long Term Services and Supports (COIN-LTSS) (CIN 13-419), employees of VAMC, and resources of the Providence VAMC, Providence, RI. Without the support and resources provided, this work could not have been completed. The content does not represent the views of the U.S. Department of Veterans Affairs or the United States Government.