Implementing the MIRROR-TCM Randomised Control Trial During the COVID-19 Pandemic: A Mixed-Methods Evaluation.
Molly McHugh, Karen B Hirschman, Mark P Toles and 8 others
PMID 39582355WHAT IT FOUND
In a nurse-led transitional care model for older adults, time-sensitive post-discharge visits were often missed during COVID-19.
Only 14.3% of patients for whom a skilled nursing facility visit was relevant received it within 24 hours.
Key findings
01Fidelity was high for promoting continuity, maintaining relationships and self-management education, but low for hospital-to-home visits.
02Only 14.3% of patients for whom a skilled nursing facility visit was relevant received it within 24 hours of hospital discharge, and 16.7% received a home visit within 24 hours of discharge from a skilled nursing facility or rehabilitation centre.
03Common barriers were patient and caregiver preferences, lack of engagement, declining needed services, care delivery by multidisciplinary teams and APRN availability; common responses were telehealth, phone visits, schedule changes, network building and enhanced coordination.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an implementation evaluation, not a test of whether the transitional care model improved patient outcomes. Fidelity data came from only 78 patients assigned to the intervention group during the first year, across sites that started at different times. Fidelity was documented by the APRNs who delivered the care, and some elements were not applicable to every patient, so percentages depend on how many patients needed that element. Qualitative data came from scheduled meetings with the study team, not independent interviews, and the meeting agenda was partly set by the study team. The analysis covers only the first year, so it cannot show whether strategies improved fidelity over time.
Declared interests
The authors declare no conflicts of interest. Funding came from Arnold Ventures, the United States Department of Veterans Affairs Health Services Research and Development Service, the Missouri Foundation for Health, and the National Institute of Nursing Research.
The easy way to misread this
Do not read the high fidelity for education and continuity as proof that the transitional care model worked for patients. This paper measured whether nurses delivered the model as intended, not patient outcomes. Only 14.3% of patients for whom a skilled nursing facility visit was relevant received it within 24 hours, so delivery was incomplete in key settings.