Adaptations of the evidence-based Transitional Care Model in the U.S
| Autor: | Elizabeth C. Shaid, Mark Toles, Olga F. Jarrín, Karen B. Hirschman, Mark V. Pauly, Mary D. Naylor |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Health (social science) Evidence-based practice Psychological intervention Context (language use) 03 medical and health sciences 0302 clinical medicine History and Philosophy of Science Evidence based interventions medicine Humans Transitional care 030212 general & internal medicine Qualitative Research Aged Evidence-Based Medicine 030503 health policy & services Care continuity Transitional Care United States Clinical trial Health Care Surveys Models Organizational Family medicine Chronic Disease 0305 other medical science Psychology Healthcare system |
| Zdroj: | Social Science & Medicine. 213:28-36 |
| ISSN: | 0277-9536 |
| DOI: | 10.1016/j.socscimed.2018.07.023 |
| Popis: | Despite a growing body of evidence that adaptations of evidence-based interventions (EBI) are ubiquitous, few studies have examined the nature and rationale for modifications to the components of these interventions. The primary aim of this study was to describe and classify common local adaptations of the Transitional Care Model (TCM), an EBI comprised of 10 components that has been proven in multiple clinical trials to improve the care and outcomes of chronically ill older adults transitioning from hospitals to home. Guided by Stirman's System of Classifying Adaptations, 582 transitional care clinicians in health systems and community-based organizations throughout the U.S. completed a survey between September 2014 and January 2015; interviews were then conducted with a subset of survey respondents (N = 24) between April and December 2015. A total of 342 survey respondents (59%) reported implementation of the TCM in distinct organizations. Of this group, 96% reported a mean of 4.4 adaptations to the 10 TCM components (40%, one to three; 43%, four to six; and 17%, seven to nine). Nine of ten respondents (94%) reported contextual adaptations while content adaptations were less frequently reported (58%). The top three reported adaptations all related to context (i.e., delivering services from hospital to home, relying on advance practice nurses, and fostering care continuity); interviews clarified a diverse set of reasons for such modifications. Findings reinforce the need for investment in adaptation science and suggest hypotheses to guide rigorous examination of the association between adaptations of TCM components and desired outcomes. |
| Databáze: | OpenAIRE |
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