Background: Many health care interventions encounter implementation challenges because of inadequate stakeholder engagement and identification barriers. The brainwriting premortem technique is the silent sharing written ideas about why an intervention failed. method can engage stakeholders identify barriers more efficiently than traditional brainstorming focus groups. Purpose: We evaluated during a transition in Veterans Health Administration (VA). Clinicians from 10 VA facilities...

Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) nurse-led, Veteran-centered intervention designed improve transitional for funded by VA national offices other sites serving predominantly Veteran population. Here, we describe our novel approach evaluation = TNP. This controlled before after study that assesses both outcomes....

Abstract Background When complex health services interventions are implemented in real-world settings, adaptations inevitable. Adaptations changes made to an intervention, implementation strategy, or context prior to, during, and after improve uptake fit. There is a growing interest systematically documenting understanding including what changed, why, when, by whom, with impact. The rural Transitions Nurse Program (TNP) program the Veterans Health Administration (VHA), designed safely...

Abstract Background Veterans are often transferred from rural areas to urban VA Medical Centers for care. The transition hospital home is vulnerable postdischarge adverse events. Objective To evaluate the effectiveness of Transitions Nurse Program (TNP). Design, Setting, and Participants National hybrid‐effectiveness‐implementation study, within site propensity‐matched cohort in 11 hospitals. 3001 were enrolled TNP April 2017 September 2019, 6002 matched controls. Intervention Outcomes...

Veterans are often transferred from "spoke" Administration (VA) clinics or hospitals to "hub" tertiary VA for advanced inpatient care, but they face significant barriers safe transitions home. The Transitions Nurse Program was developed as an intervention address the unique needs of this population. A difference-in-differences (DiD) analysis used compare outcomes between 303 veterans enrolled in program and same spoke sites a second, similar hub. had significantly increased rates follow-up...

The field of sleep medicine has been an avid adopter telehealth, particularly during the COVID-19 pandemic. goal this study was to assess patients' experiences receiving care by telehealth.From June 2019 May 2020, authors recruited a sample patients for semi-structured interviews, including who had 1 3 types telehealth encounters in medicine: in-clinic video, home-based and telephone. Two analysts coded transcripts using content analysis identified themes that cut across categories.The...

Abstract Objectives Adapting evidence-based practices to local settings is critical for successful implementation and dissemination. A pre-implementation assessment evaluates context inform implementation, but there little published guidance clinician-implementers. The rural Transitions Nurse Program (TNP) a care coordination intervention that facilitates transitions veterans. In year 1 of TNP, assessments were conducted by centralized project team through multi-day visits at five sites...

Background: High-quality transitional care at discharge is essential for improved patient outcomes. Registered nurses (RNs) play integral roles in transitions; however, few receive structured training. Purpose: We sought to create, implement, and evaluate an evidence-informed nursing coordination curriculum, the Transitions Nurse Training Program (TNTP). Methods: conceptualized curriculum using adult learning theory evaluated with New World Kirkpatrick Model. Self-reported engagement,...

Veterans are increasingly eligible for non-VA care through the Veteran Health Administration (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks Act while maintaining in VA. Continuity of is challenging when delivered across multiple systems resulting avoidable complications. The Community Hospital Transitions Program (CHTP) intervention was developed to address challenges veterans face post hospitalization. Propensity score-matched analysis used compare outcomes...

Abstract Purpose Rural Veterans who receive inpatient care at a Health Administration (VA) tertiary facility can face significant barriers to safe transition home. The VA rural Transitions Nurse Program (TNP) is national, intensive coordination quality improvement program for Veterans. To communicate the reach of TNP into communities, we developed geographic information system (GIS) maps. This study evaluated transitions nurse and site champion perceptions GIS as communication tool...

Background High-quality implementation evaluations report on intervention fidelity and adaptations made, but a practical process for evaluating strategies is needed. A retrospective method also required as prospective methods can be resource intensive. This study aimed to establish an strategy postmortem identify the used, when, their perceived importance. We used rural Transitions Nurse Program (TNP) case study, national care coordination implemented at 11 hospitals over three years....

GRECC Connect, a national program with interprofessional teams at urban-based VA medical facilities, partner community-based outpatient clinics (CBOCs) to provide geriatric specialty care via telemedicine rural, older Veterans. Our QI project explored factors affecting uptake. February-May 2020 we conducted 50 interviews CBOC staff across the US; 60–80% of patients were rural/highly rural described social determinants health negatively impacting access. Patients on edge digital divide risk...

Abstract The Veterans Health Administration, like other health systems, faces the challenge of meeting older rural Veterans’ needs. VA leaders must balance these complex needs with local priorities, and, at same time, a large number national directives. Little is known about what influences process setting priorities and making decisions from standpoint healthcare leaders. We aimed to better understand how weigh system their processes in turn impact prioritization services. interviewed 11...

Abstract The need to expand rural geriatric services has received increasing attention within and outside the VHA, yet medical center leaders are often challenged prioritize expanding these among myriad competing needs. To better understand potential levers move geriatrics up priority ladder, we conducted semi-structured interviews with 11 former in Veterans Health Administration. We explored perspectives on how health system priorities can be aligned improve quality reach of care solicited...

Abstract Veterans in rural areas often lack access to specialized geriatric care and may struggle reach distant VA facilities for treatment. To better understand the regional needs of aging Veterans, this project aims identify resources geriatrics services guide future expansion efforts. We describe efforts map Veterans’ utilization three states with large populations (Wisconsin, Montana, Hawaii) help improve targeting these resources. By examining data states, we try pinpoint local where...

Abstract The Veterans Administration (VA) established pathways to provide VA-issued tablets and increased access internet for without these resources. aged above 65, experience barriers with telemedicine such as usability. We sought improve the usability of rural, older receiving a tablet by modifying materials qualitatively evaluating their set-up preparing first appointment, guided user-centered design. conducted rapid exploratory evaluation, understand Veteran care partner experiences...

Abstract Innovative care models for older adults such as non-institutional and home-based have the potential to improve quality efficiency of healthcare, but adoption these requires resources from health systems. Health systems leaders can influence relative priority geriatric associated resource allocation. This is especially important areas with limited in rural areas. We interviewed recently retired system about their experience how priorities be aligned reach care. conducted qualitative...

Understanding how to successfully sustain evidence-based care coordination interventions across diverse settings is critical ensure that patients continue receive high quality even after grant funding ends. The Transitions Nurse Program (TNP) a national intervention in the Veterans Administration (VA) coordinates for risk veterans transitioning from acute VA medical centers (VAMCs) home. As part of TNP, facility receives full-time nurse implement however, this ends implementation. In...

Rationale: The field of sleep medicine has been an avid adopter telehealth, particularly during the COVID-19 pandemic. While numerous randomized trials support efficacy telehealth to treat conditions such as obstructive apnea (OSA) and insomnia, relatively little is known about patients' experiences perceptions in typical practice. Methods: We recruited a purposive sample patients who had provider encounters via one three modalities: in-clinic video, home-based telephone. conducted...

RationaleThe COVID-19 pandemic has shifted care away from face to encounters towards telephone and video telehealth. To accommodate this, the VA prioritized use of Video Connect (VVC) a software platform that connects providers with patients on their personal devices. As there may be factors particular pulmonary or other specialty clinics are barriers facilitators VVC use, we wished describe uptake in relative comparable (cardiology) primary care. We also sought evaluate whether appropriate...

Research Objective The Veterans Health Administration (VA) offers virtual care options including telephone and video‐based to supplement face‐to‐face visits, with the goal of expanding access for Veterans. Across Rocky Mountain Regional (RMR) VA Care System, had been used selectively prior COVID‐19 pandemic, but since March 2020, it has systematically expanded. Perceptions this rapid implementation from patients, providers primary clinic staff, are largely unknown. objective evaluation is...