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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3120 — Stakeholders’ Reported Barriers and Facilitators to Implementing the 2010 Veteran’s Administration (VA) CHF-QUERI Hospital-to-Home (H2H) Initiative

Oliva NLSahay A, and Gholami P, VA Palo Alto Healthcare System; Heidenreich P, VA Palo Alto Healthcare System/Stanford University School of Medicine;

Objectives:
The aim of the VA H2H survey was to determine the impact of H2H initiative implementation within a randomized controlled trial (RCT) design of 61 intervention and 61 control sites, including identifying barriers and facilitators of projects to improve the care transitions of heart failure (HF) patients.

Methods:
We surveyed 122 VA facilities through emails to designated clinician/administrative staff (N = 598) three times in 2010 with a fourth, final survey in April, 2011. In each survey we utilized identical multiple- choice and fill-in-the blank questions, and one narrative comments item. Surveys were distributed by email within 4 to 16 months following the VA H2H launch. Identified stakeholders at each facility were asked to detail barriers and facilitators to implementing the H2H initiative and projects.

Results:
In the first two 2010 survey waves, 95 respondents from 91 facilities identified 101 barriers and 60 facilitators to the uptake of the H2H initiative. Funding, tangible resources, adequate staffing, clinic space, sufficient evaluation data, and lack of top leadership support were all cited as major barriers. Facilitators included strong senior leadership and internal H2H champions, engaged nursing and physician stakeholders, and effective interdisciplinary collaboration and team functioning. In the latter two survey waves, 128 respondents from 110 facilities identified 160 barriers and 75 facilitators to H2H uptake. Similar to the earlier 2010 results, respondents identified resource constraints, communication and collaboration deficits in the context of organizational culture disconnects, and insufficient administrative and clinical leadership support as barriers. In the last survey (April 2011) completed after H2H implementation, the influence on H2H implementation success of nursing, physician and other HF Team member champions and leaders, and facility administration, dominated responses.

Implications:
Barriers reported are predominantly organization- level staffing and system resource gaps and leadership deficits. Facilitators reported are H2H initiative championing by organizations’ leadership and clinician stakeholders, along with targeted H2H funding. These findings are consistent with implementation science models such as Promoting Action on Research Implementation in Health Services (PARiHS).

Impacts:
Organizational leadership and clinician stakeholder support, expressed through targeted resources and effective champions, were/are essential to successful H2H implementation.


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