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• W4234084877 abstract "Abstract Background Quality Improvement Networks Quality Improvement Organizations (QIN-QIOs) developed community coalitions to align care coordination efforts for Medicare beneficiaries in order to reduce readmission rates within geographically defined communities. This CMS (Centers for Medicare & Medicaid Services) funded national quality improvement program worked with 380 coalitions from 2014-2019, facilitating a variety of interventions within each community. Baseline readmission rates among communities, calculated from claims data, varied from 17.7 to 112 readmissions/1000 beneficiaries. Program results ranged from +40.7% (high performance) to -35.8% (low performance) relative improvement.We applied an implementation framework (CFIR) to the QIN-QIO efforts to define common characteristics of interventions, implementation strategies, and contexts in which improvement efforts took place. We identify features associated with successful and unsuccessful intervention implementation, and with changes in readmission rates. Methods We selected 22 communities representing a range of relative improvement, geographic characteristics and baseline readmissions rates. We measured the QIN-QIO’s perception of influence of individual CFIR constructs on community readmission rates over time using a written assessment and elicited details and mechanisms through structured interviews. Two independent reviewers qualitatively coded transcribed interviews. Final ratings for the influence of each CFIR construct on community performance were assigned by consensus, ranging from -2 (strong negative influence) to +2 (strong positive influence). Results Some adaptation of the CFIR, such including codes in a coalition domain, and adding constructs to the outer setting domain, such as healthcare market characteristics, helped fit the framework to the QIN-QIO work. The characteristics of individuals domain was less applicable to this study. Several constructs were found to be associated with improvement, or lack of, in readmission rates in communities. Conclusions The CFIR is an appropriate taxonomy for understanding implementation of care coordination interventions in the QIN-QIO communities, with constructs from the Outer Setting and Process domains having the most influence on successful implementation. Communities effectively reducing readmissions had coalitions with favorable implementation climates, robust stakeholder engagement strategies, and interventions aligned with local concerns and capabilities. The CFIR can help guide, monitor and evaluate community-based improvement initiatives, although further development some constructs is needed." @default.
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• W4234084877 date "2020-09-08" @default.
• W4234084877 modified "2023-10-16" @default.
• W4234084877 title "Understanding What Influences Community-based Care Coordination Improvement: Interpreting Variation in a Medicare Hospital Readmissions Reduction Program Using the Consolidated Framework for Implementation Research (CFIR)" @default.
• W4234084877 doi "https://doi.org/10.21203/rs.3.rs-66069/v1" @default.
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