Applying the consolidated framework for implementation research to guide the development, implementation, and evaluation of a cardiology transitions of care program (RECARD trial).

backgroundTransition of care (ToC) for patients following acute type 1 myocardial infarction or coronary revascularisation procedures is complex, often resulting in medication-related harm and hospital readmissions. Current ToC models lack comprehensive, system-wide approaches, especially in Australia, and often fail to address patient-centred needs and cultural considerations. This theoretical paper aims to outline a multidimensional implementation science approach that will underpin the design and implementation a pharmacy-led ToC intervention to reduce hospital readmissions and improve medication safety.

methodInformed by Guyatt et al. (2021), the REduce hospital readmissions for high-risk CARDiology patients (RECARD) ToC model, will integrate six key elements: (1) guiding implementation with the Consolidated Framework for Implementation Research (CFIR), including a patient domain; (2) co-design with patients and healthcare professionals; (3) understanding local needs using Bradshaw’s taxonomy; (4) designing an evidence-informed intervention based on health behaviour theories; (5) planning and executing implementation using the Expert Recommendations for Implementing Change (ERIC) and the Behaviour Change Wheel (BCW); and (6) evaluating and sustaining the intervention using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. This approach will involve a pre-post interventional trial across three quaternary Queensland hospitals, informed by focus groups, semi-structured interviews, and Yarning circles to refine the literature-informed intervention design.

resultsWe present our synthesised RECARD ToC model planned to be delivered as an “Adaptive ToC Pathway,” involving a collaborative team of pharmacists, nurse practitioners, and Indigenous health workers. The intervention will incorporate inpatient and post-discharge activities, tailored to local needs and patient preferences. The implementation plan will address barriers and enablers identified through stakeholder engagement, and RE-AIM will guide the evaluation.

conclusionsOur novel theory-informed approach, integrating CFIR, Bradshaw’s model, ERIC, BCW, and RE-AIM, provides a comprehensive framework for designing and implementing the RECARD ToC model. This will allow comparison of a prospective cohort receiving evidence-informed ToC activities to optimise medication management and patient safety, guided by a risk prediction model to predict unplanned readmissions due to medication harm within 30 days, with a retrospective historical cohort who received usual care. By understanding local needs and engaging stakeholders, this project seeks to create a sustainable and impactful intervention that addresses the gaps in current ToC practices, particularly for Indigenous populations, and enhances patient safety in the Australian healthcare setting. CLINICAL TRIAL NUMBER: Not applicable.