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Implementation of Complex Interventions: Lessons Learned From the Patient-Centered Outcomes Research Institute Transitional Care Portfolio.

  • Gesell, Sabina B1, 2
  • Prvu Bettger, Janet3
  • Lawrence, Raymona H4
  • Li, Jing5
  • Hoffman, Jeanne6
  • Lutz, Barbara J7
  • Grudzen, Corita8
  • Johnson, Anna M9
  • Krishnan, Jerry A10
  • Hsu, Lewis L11
  • Zwart, Dorien12
  • Williams, Mark V13
  • Schnipper, Jeffrey L14
  • 1 Department of Social Sciences and Health Policy.
  • 2 Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem.
  • 3 Duke University School of Medicine, Duke Roybal Center on Aging, Durham, NC.
  • 4 Department Health Policy and Community Health, Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA. , (Georgia)
  • 5 Department of Internal Medicine, Center for Health Services Research (CHSR), University of Kentucky, Lexington, KY.
  • 6 Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
  • 7 School of Nursing, University of North Carolina-Wilmington, Wilmington, NC.
  • 8 Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY.
  • 9 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
  • 10 Institute for Healthcare Delivery Design, Office of the Vice Chancellor for Health Affairs.
  • 11 Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.
  • 12 Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. , (Netherlands)
  • 13 Department of Internal Medicine, Center for Health Services Research, University of Kentucky HealthCare, Lexington, KY.
  • 14 Brigham Health Hospital Medicine Unit and Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Published Article
Medical care
Publication Date
Aug 01, 2021
Suppl 4
DOI: 10.1097/MLR.0000000000001591
PMID: 34228016


Despite the well-documented risks to patient safety associated with transitions from one care setting to another, health care organizations struggle to identify which interventions to implement. Multiple strategies are often needed, and studying the effectiveness of these complex interventions is challenging. The objective of this study was to present lessons learned in implementing and evaluating complex transitional care interventions in routine clinical care. Nine transitional care study teams share important common lessons in designing complex interventions with stakeholder engagement, implementation, and evaluation under pragmatic conditions (ie, using only existing resources), and disseminating findings in outlets that reach policy makers and the people who could ultimately benefit from the research. Lessons learned serve as a guide for future studies in 3 areas: (1) Delineating the function (intended purpose) versus form (prespecified modes of delivery of the intervention); (2) Evaluating both the processes supporting implementation and the impact of adaptations; and (3) Engaging stakeholders in the design and delivery of the intervention and dissemination of study results. These lessons can help guide future pragmatic studies of care transitions. Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

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