Journal of Gerontological Social Work · 2018 · 26 citations · 19 references
Health ProfessionsHealth Services AdministrationSocial WorkHospital AdministrationImplementation ScienceTransitional CareCare Transition PlanningEvidence-based Practice ImplementationHealth Care Change ManagementHealth Systems ManagementImplementation FacilitatorsTransitions Of CareCommunity-based OrganizationsEvidence-based Practice CultureHealth Care Payment ModelsHealthcare Provider CollaborationHospital Readmissions ReductionImplementation ChampionsSemi-structured InterviewsTransitional Care Models
This qualitative study analyzed the experience of community-based organizations (CBOs) implementing and sustaining the Bridge Model of Transitional Care, a social work-based health service intervention for reducing hospital readmissions. We conducted semi-structured interviews with clinical supervisors from 13 CBOs that received Bridge Model training between 2012 and 2015. CBOs faced significant challenges implementing and sustaining transitional care programs, particularly related to building effective and sustainable partnerships with hospitals. Additional barriers to program implementation and sustainability included financial barriers and staff turnover. Facilitators to implementation and sustainability included organizational champions, organizational culture, and value of evidence. Recommendations for CBOs to implement health service interventions include gaining early buy-in from hospital partners, creating a contractual arrangement with the hospital partner, understanding changes in health-care payment models, diversifying funding sources, developing an evaluation plan, and nurturing organizational champions.
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The Care Transitions Intervention
Eric A. Coleman, Carla Parry, Sandra Chalmers et al. · Archives of Internal Medicine · 2006 · 1.9K citations
Jo Rycroft‐Malone, Gill Harvey, Brendan McCormack et al. · Implementation Science · 2008 · 1.3K citations · Full text