1103 — Factors Affecting Implementation of a Patient-Centered Non-Institutional Long-Term Care Grant Program in the Veterans Health Administration

Sullivan JL, CHOIR-Bedford/Boston, MA; Engle RL, CHOIR-Bedford/Boston, MA; Adjognon O, CHOIR-Bedford/Boston, MA; Shin M, CHOIR-Bedford/Boston, MA; Afable M, CHOIR-Bedford/Boston, MA; White RA, CHOIR-Bedford/Boston, MA; VanDeusen Lukas C, CHOIR-Bedford/Boston, MA;

Objectives:
From 2010-2013, the Department of Veterans Health Administration (VA) funded a large pilot initiative to integrate innovative patient-centered non-institutional LTC programs (NILTC) into its medical centers. Of the 59 programs initially funded, 48 remained active until 2013 and were successful in meeting their grant goals. Our qualitative study examines the barriers to program implementation and their trends over time.

Methods:
Key informant semi-structured interviews began in 2011 and were repeated at 6-month intervals, resulting in 311 interviews. Content analysis was used to identify emergent themes, documented in a single site summary for each site. Data from all 48 sites were then compiled in a cross site summary matrix. The study team met regularly to define each factor, review all codes, and discuss discrepancies. Inter-rater reliability reached 90%. For each follow-up interview with the sites, the list of established factors was used as a priori themes. Emergent data were also coded.

Results:
The major factors affecting implementation in all sites included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Although over time, there was a decrease in the number of reported program challenges, the ranking of reported challenges remained consistent. For each factor, we identified specific strategies the sites used to address these challenges.

Implications:
The VA initiative was successful in implementing these pilot programs. When undertaking a large initiative such as NILTC, it is necessary to support sites with not only the resources to administer the program but also the flexibility to address issues that emerge over the course of implementation.

Impacts:
Better understanding key barriers to implementation of NILTC programs will facilitate nationwide spread of such innovative approaches, and keep more Veterans healthy longer in their regular environments.