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Implementing a Transitional Care Program to Reduce Hospital Readmissions Among Older Adults

Hung, Dorothy PhD, MA, MPH; Leidig, Robynn Cheng MPH

doi: 10.1097/NCQ.0000000000000091

This research examines the early implementation of an evidence-based intervention, adapted from the Coleman Care Transitions Intervention and community-based models, aimed at reducing preventable hospital readmissions among older adults. To better understand program implementation, we conducted and analyzed in-depth interviews on the basis of the Promoting Action on Research Implementation in Health Services conceptual framework. Contextual factors, evidence support for the intervention, and facilitation techniques should be taken into account when implementing transitional care programs.

Palo Alto Medical Foundation Research Institute, Mountain View, California (Dr Hung); and Illinois Department of Public Health, Division of Patient Safety and Quality, Springfield (Ms Leidig).

Correspondence: Dorothy Hung, PhD, MA, MPH, Palo Alto Medical Foundation Research Institute, Mountain View, CA 94040 (

This work was supported by the Gordon and Betty Moore Foundation under the Betty Irene Moore Nursing Initiative (grant #2981).

The authors thank Ava Wong, MPH, and Meghan Martinez, MPH, for their assistance with manuscript preparation.

The authors declare no conflict of interest.

Accepted for publication: August 31, 2014

Published ahead of print: December 5, 2014

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins