Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
Gerontologist. 2023 Mar 21;63(3):451-466. doi: 10.1093/geront/gnac128.
Four interventions to improve care transitions between hospital and home or community settings for older adults were implemented in Leuven, Belgium over the past 4 years. These complex interventions consist of multiple components that challenge their implementation in practice. This study examines the influencing factors, strategies used to address challenges in implementing these interventions, and implementation outcomes from the perspectives of health care professionals involved.
This was a qualitative, collective case study that was part of the TRANS-SENIOR research network. Authors conducted semistructured interviews with health care professionals about their perceptions regarding the implementation. Thematic analysis was used, and the Consolidated Framework for Implementation Research guided the final data interpretation.
Thirteen participants were interviewed. Participants reported major implementation bottlenecks at the organizational level (resources, structure, and information continuity), while facilitators were at the individual level (personal attributes and champions). They identified engagement as the primary strategy used, and suggested other important strategies for the future sustainability of the interventions (building strategic partnerships and lobbying for policies to support transitional care). They perceived the overall implementation favorably, with high uptake as a key outcome.
This study highlights the strong role of health care providers, being motivated and self-driven, to foster the implementation of interventions in transitional care in a bottom-up way. It is important to use implementation strategies targeting both the individual-level factors as well as the organizational barriers for transitional care interventions in the future.
过去 4 年中，比利时鲁汶市实施了四项旨在改善老年人从医院到家庭或社区环境过渡期间的护理的干预措施。这些复杂的干预措施包含多个相互关联的部分，这给其实践带来了挑战。本研究从参与其中的医护人员的角度出发，考察了影响因素、实施这些干预措施时所采用的应对挑战的策略以及实施结果。
这是一项定性的、集体案例研究，是 TRANS-SENIOR 研究网络的一部分。作者对半结构化访谈进行了分析，了解医护人员对实施情况的看法。使用主题分析方法，整合实施研究框架指导最终数据解释。
共采访了 13 名参与者。参与者报告了组织层面（资源、结构和信息连续性）的主要实施瓶颈，而促进因素则在个人层面（个人特质和拥护者）。他们确定了参与作为主要采用的策略，并提出了未来干预措施可持续性的其他重要策略（建立战略伙伴关系和游说政策支持过渡性护理）。他们认为整体实施效果良好，关键结果是高接受度。
本研究强调了医护人员的积极作用，他们有动力和自我驱动力，以自下而上的方式促进过渡性护理干预措施的实施。未来针对个人层面因素和过渡性护理干预措施的组织障碍，使用实施策略非常重要。
