Implementation and Adaptation Guide
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What's Adaptable?
Programs and implementation strategies often have well-defined key functions that have to be done to produce success. These are the basic reasons why a given activity is undertaken. When adapting programs and implementation strategies, keep in mind what the key functions are. Changes to the key functions of the program will almost always produce poorer outcomes. Forms, however, can change and can take various shapes.
We present here an example from one of our previous projects, Community Hospital Transitions Program (CHTP). The table below provides a description of the various components of the CHTP program, the description of their key functions, and examples of forms that might be suitable for each component.
The key to maintain the effectiveness of a program is to show fidelity to its key functions. How these functions are operationalized or made alive in the context of your settings can be different.
Changes to these components need to be made cautiously so that key functions of these components remain and only HOW they are delivered change.
In the CHTP program a key function is to perform warm hand off of the patient to a primary care provider (PCP) to allow for continuity of care. How this warm hand off happens can vary (i.e., it can take different forms) depending on the setting. In our study of CHTP we found that some sites performed the warm hand off via phone, email, direct messaging platform or co-signing providers to notes in electronic record management system.
| Component | Function | Forms |
|---|---|---|
| Notification of Community Hospitalization | CHTP clinical staff is notified of a Veteran hospitalization at a community hospital | Community hospital notifies CHTP staff via voicemail or fax. CHTP staff reviews VA ECHCS Bed Management Solution website for non-VA admissions. CHTP staff receives referrals from other programs/services. |
| Discharge Summary/Information Transfer | Clinically relevant information is sent to CHTP staff (discharge summary, face sheet, etc.) | Discharge summary are sent via a secure electronic fax line. CHTP staff uploads discharge instructions and relevant notes to electronic record management system. CHTP staff create a summary note in electronic record management system organizing aspects of care and follow up needs. |
| Handoff to VA Provider | CHTP Staff notifies VA provider of a Veteran hospitalization in a community and the necessary follow up care | CHTP staff communicates with Patient-Aligned Care Team (PACT) staff about Veteran hospitalization via phone, email, direct messaging platform and/or co-signing providers to notes in electronic record management system. |
| Follow-up Coordination | CHTP contacts Veteran and assists with follow up care needs as needed | CHTP staff contacts Veteran over the phone (Post discharge call can be as early as the following day or up to 2 weeks after discharge). Assists with follow up care as needed (medication check, follow up appointment with provider, etc.). |
Abbreviations:
CHTP: Community Hospital Transitions Program
PACT: Patient-Aligned Care Team
VA ECHCS: VA Eastern Colorado Health Care System
This concludes the Pre-Implementation phase. The next section will be the Implementation Phase followed by the Sustainment Phase.
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