Determinants of inter-organizational implementation success: A mixed-methods evaluation of Veteran Directed Care

Nina R Sperber; Edward J Miech; Alecia Slade Clary; Kathleen Perry; Merle Edwards-Orr; James L Rudolph; Courtney Harold Van Houtven; Kali S Thomas

doi:10.1016/j.hjdsi.2022.100653

Determinants of inter-organizational implementation success: A mixed-methods evaluation of Veteran Directed Care

Healthc (Amst). 2022 Dec;10(4):100653. doi: 10.1016/j.hjdsi.2022.100653. Epub 2022 Sep 12.

Authors

Nina R Sperber¹, Edward J Miech², Alecia Slade Clary³, Kathleen Perry⁴, Merle Edwards-Orr⁵, James L Rudolph⁶, Courtney Harold Van Houtven⁷, Kali S Thomas⁶

Affiliations

¹ Center to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, USA; Department of Population Health Sciences, Duke University, USA; Duke-Margolis Center for Health Policy, USA. Electronic address: nina.sperber@va.gov.
² VA EXTEND QUERI, VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA.
³ Reagan-Udall Foundation for the FDA, USA.
⁴ Vagelos College of Physicians & Surgeons, Columbia University, USA.
⁵ Applied Self-Direction, USA.
⁶ Brown University School of Public Health, USA; Providence VA Medical Center, USA.
⁷ Center to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, USA; Department of Population Health Sciences, Duke University, USA; Duke-Margolis Center for Health Policy, USA.

Abstract

Background: Veteran Directed Care (VDC) aims to keep Veterans at risk for nursing home placement in their communities. VA medical centers (VAMCs) purchase VDC from third-party organizational providers who then partner with them during implementation. Experiences with VDC implementation have varied.

Objectives: We sought to identify conditions differentiating partnerships with higher enrollment (implementation success).

Methods: We conducted a case-based study with: qualitative data on implementation determinants two and eight months after program start, directed content analysis to assign numerical scores (-2 strong barrier to +2 strong facilitator), and mathematical modeling using Coincidence Analysis (CNA) to identify key determinants of implementation success. Cases consisted of VAMCs and partnering non-VAMC organizations who started VDC during 2017 or 2018. The Consolidated Framework for Implementation Research (CFIR) guided analysis.

Results: Eleven individual organizations within five partnerships constituted our sample. Two CFIR determinants- Networks & Communication and External Change Agent-uniquely and consistently identified implementation success. At an inter-organizational partnership level, Networks & Communications and External Change Agent +2 (i.e., present as strong facilitators) were both necessary and sufficient. At a within-organization level, Networks & Communication +2 was necessary but not sufficient for the non-VAMC providers, whereas External Change Agent +2 was necessary and sufficient for VAMCs.

Conclusion: Networks & Communication and External Change Agent played difference-making roles in inter-organizational implementation success, which differ by type of organization and level of analysis.

Implications: This multi-level approach identified crucial difference-making conditions for inter-organizational implementation success when putting a program into practice requires partnerships across multiple organizations.

Keywords: Aging; Configurational analysis; Implementation science; Long-term care; Long-term services and supports; Mixed-methods; Self-directed care.

Published by Elsevier Inc.

MeSH terms

Communication
Humans
Organizations
Veterans*

Abstract

MeSH terms

Grants and funding