Hospital In Home: Evaluating Need and Readiness for Implementation (HENRI) in the Department of Veterans Affairs: protocol for a mixed-methods evaluation and participatory implementation planning study

Jennifer L Sullivan; Reza Yousefi-Nooraie; Derek D'Arcy; Adele Levine; Lindsey Zimmerman; Marlena H Shin; Emily Franzosa; William Hung; Orna Intrator

doi:10.1186/s43058-022-00338-7

Hospital In Home: Evaluating Need and Readiness for Implementation (HENRI) in the Department of Veterans Affairs: protocol for a mixed-methods evaluation and participatory implementation planning study

Implement Sci Commun. 2022 Aug 29;3(1):93. doi: 10.1186/s43058-022-00338-7.

Authors

Jennifer L Sullivan^{1

2}, Reza Yousefi-Nooraie³, Derek D'Arcy⁴, Adele Levine⁵, Lindsey Zimmerman^{6

7

8}, Marlena H Shin⁹, Emily Franzosa¹⁰, William Hung¹⁰, Orna Intrator^{3

4}

Affiliations

¹ Center for Innovation in Long Term Service and Supports, Providence VA Healthcare System, Providence, USA. Jennifer.sullivan@va.gov.
² Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, 02916, USA. Jennifer.sullivan@va.gov.
³ Department of Public Health Science, University of Rochester, Rochester, NY, USA.
⁴ VA Finger Lakes Healthcare System, Canandaigua, NY, USA.
⁵ Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA.
⁶ Office of Mental Health and Suicide Prevention, National Center for PTSD, Rockville, USA.
⁷ Stanford Department of Psychiatry and Behavioral Health, San Francisco, USA.
⁸ University of Washington Department of Psychiatry and Behavioral Health, Seattle, USA.
⁹ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
¹⁰ Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.

Abstract

Background and objectives: The Department of Veterans Affairs (VA) Hospital-In-Home (HIH) program delivers patient-centered, acute-level hospital care at home. Compared to inpatient care, HIH has demonstrated improved patient safety, effectiveness, and patient and caregiver satisfaction. The VA Office of Geriatrics & Extended Care (GEC) has supported the development of 12 HIH program sites nationally, yet adoption in VA remains modest, and questions remain regarding optimal implementation practices to extend reach and adaptability of this innovation. Guided by theoretical and procedural implementation science frameworks, this study aims to systematically gather evidence from the 12 HIH programs and to develop a participatory approach to engage stakeholders, assess readiness, and develop/adapt implementation strategies and evaluation metrics.

Research design and methods: We propose a multi-phase concurrent triangulation design comprising of (1) qualitative interviews with key informants and document review, (2) quantitative evaluation of effectiveness outcomes, and (3) mixed-methods synthesis and adaptation of a Reach Effectiveness Adoption Implementation Maintenance (RE-AIM)-guided conceptual framework.

Results: The prospective phase will involve a participatory process of identifying stakeholders (leadership, HIH staff, veterans, and caregivers), engaging in planning meetings informed by implementation mapping, and developing implementation logic models and blueprints. The process will be assessed using a mixed-methods approach through participant observation and document review.

Discussion and implication: This study will support the continued spread of HIH programs, generate a catalog of HIH implementation evidence, and create implementation tools and infrastructure for future HIH development. The multi-phase nature of informing prospective planning with retrospective analysis is consistent with the Learning Health System framework.

Keywords: Home care; Hospital at Home; Innovation; Older adults; Veterans.

Abstract

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