{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:20:07Z","timestamp":1788355207468,"version":"build-2803163510"},"reference-count":0,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Understanding the factors that enable or hinder successful implementation is essential for improving patient outcomes. Hospital in Home (HiH) programs provide hospital-level care in patients' homes to reduce hospitalization, enhance satisfaction, and improve resource use. Within the Veterans Health Administration (VHA), 14 sites have implemented HiH programs, yet limited research has examined implementation within a large integrated system. This study identifies factors that can support or hinder HiH implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Design and Methods<\/jats:title>\n                    <jats:p>We conducted interviews with 48\u2009key informants across 14 VHA HiH sites. Guided by the Consolidated Framework for Implementation Research (CFIR) 2.0, we applied directed content analysis using a priori constructs, then developed site-level matrices to summarize findings and compare patterns across sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 18 CFIR constructs\u2014nine that primarily facilitated implementation and nine mixed factors that acted as both facilitators and barriers. Key facilitators included two Individual-level factors (HiH lead capability and motivation, team motivation), one Innovation factor (relative advantage of HiH), and four Implementation Process factors (planning, teaming, reflecting and evaluating, adapting). Mixed factors were mostly within the inner setting, reflecting medical center context, along with two Individual-level mixed factors (leader and recipient motivation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Implications<\/jats:title>\n                    <jats:p>HiH programs hold strong potential to transform care for older adults, but success depends on addressing barriers and leveraging facilitators, particularly within the inner setting. Understanding key implementation determinants can enhance adoption, improve outcomes, and strengthen healthcare delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/geront\/gnag218","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:49:30Z","timestamp":1788353370000},"source":"Crossref","is-referenced-by-count":0,"title":["Identifying Contextual Factors affecting Hospital In Home Program Implementation within the Veterans Health Administration"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-2232","authenticated-orcid":false,"given":"Jennifer L","family":"Sullivan","sequence":"first","affiliation":[{"name":"Transformative Health Systems Research to Improve Veteran Equity and Independence Center of Innovation (THRIVE COIN) Providence VA Healthcare System, VA Providence Healthcare System, Capt. Jonathan H. Harwood Jr. Center for Research , 385 Niagara Street, Providence, RI 02907","place":["USA"]},{"name":"Brown University School of Public Health Department of Health Services, Policy and Practice, , Providence. RI,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5555-6258","authenticated-orcid":false,"given":"Marlena H","family":"Shin","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research, VA Boston Healthcare System , Boston, MA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7590-0316","authenticated-orcid":false,"given":"Emily","family":"Franzosa","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center James J. Peters VA Medical Center , Bronx, NY,","place":["USA"]},{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai , New York, NY","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1336-3594","authenticated-orcid":false,"given":"A Alex","family":"Levine","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health Department of Health Law Policy and Management, , Boston, MA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8051-9539","authenticated-orcid":false,"given":"Jessica","family":"Barth","sequence":"additional","affiliation":[{"name":"Transformative Health Systems Research to Improve Veteran Equity and Independence Center of Innovation (THRIVE COIN) Providence VA Healthcare System, VA Providence Healthcare System, Capt. Jonathan H. Harwood Jr. Center for Research , 385 Niagara Street, Providence, RI 02907","place":["USA"]},{"name":"Brown University School of Medicine , Providence. RI,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9002-7121","authenticated-orcid":false,"given":"Reza","family":"Yousefi-Nooraie","sequence":"additional","affiliation":[{"name":"University of Rochester Department of Public Health Science, , Rochester, New York,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0866-3557","authenticated-orcid":false,"given":"Porooshat","family":"Dadgostar","sequence":"additional","affiliation":[{"name":"University of Rochester Department of Public Health Science, , Rochester, New York,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunjae","family":"Park","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai , New York, NY","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayna","family":"Cooper","sequence":"additional","affiliation":[{"name":"Cincinnati VA Medical Center Department of Veterans Affairs, , Cincinnati, Ohio,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0613-1987","authenticated-orcid":false,"given":"Shivani","family":"Jindal","sequence":"additional","affiliation":[{"name":"Cincinnati VA Medical Center Department of Veterans Affairs, , Cincinnati, Ohio,","place":["USA"]},{"name":"University of Cincinnati College of Medicine Department of Internal Medicine, , Cincinnati, Ohio,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2905-3188","authenticated-orcid":false,"given":"Derek","family":"D\u2019Arcy","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center James J. Peters VA Medical Center , Bronx, NY,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8283-3643","authenticated-orcid":false,"given":"William","family":"Hung","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center James J. Peters VA Medical Center , Bronx, NY,","place":["USA"]},{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai , New York, NY","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4173-0662","authenticated-orcid":false,"given":"Orna","family":"Intrator","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center James J. Peters VA Medical Center , Bronx, NY,","place":["USA"]},{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai , New York, NY","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,2]]},"container-title":["The Gerontologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/gerontologist\/advance-article-pdf\/doi\/10.1093\/geront\/gnag218\/70922615\/gnag218.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/advance-article-pdf\/doi\/10.1093\/geront\/gnag218\/70922615\/gnag218.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:49:31Z","timestamp":1788353371000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/gerontologist\/advance-article\/doi\/10.1093\/geront\/gnag218\/8779984"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/geront\/gnag218","relation":{},"ISSN":["0016-9013","1758-5341"],"issn-type":[{"value":"0016-9013","type":"print"},{"value":"1758-5341","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]},"article-number":"gnag218"}}