Association of intervention fidelity and outcomes in implementation of the Thrive transitional care program for Medicaid-insured individuals.

Abstract

Intervention fidelity specifies core components and measures adherence. Thrive, an evidence-based transitional care program providing 30-day post-discharge support to Medicaid-insured individuals, was evaluated for intervention fidelity. To (1) evaluate the coverage, content, dose, and overall adherence to Thrive, and (2) examine associations between fidelity and 30-day post-discharge utilization. We evaluated Thrive's intervention fidelity from 2023 to 2025 within four hospitals in an urban health system. Fidelity measures developed using expert consensus included content (9 components), dose (up to 4 weeks), overall adherence, and coverage. High fidelity was defined as receiving ≥80% of all components. Logistic regression models adjusted for patient characteristics and hospital examined fidelity and 30-day post-discharge utilization (primary care, specialty care, readmissions, emergency department (ED) visits). Of 1,301 referred patients, 709 received Thrive services (55% coverage); 75.9% achieved high fidelity. Average content score was 7.6, and 78.8% received 4 weeks of Thrive. In adjusted models, higher content was associated with higher odds of primary care (odds ratio [OR] = 1.30; 95% confidence interval [CI]: 1.10-1.54; p < .01) and lower odds of ED visits (OR = 0.80; 95% CI: 0.64-0.99; p < .05). Receiving 4 weeks of Thrive was associated with higher odds of primary care (OR = 1.79; 95% CI: 1.21-2.65; p < .01), specialty care (OR = 1.56; 95% CI: 1.06-2.31; p < .05), and lower odds of readmissions (OR = 0.53; 95% CI: 0.33-0.86; p < .05). Thrive achieved high intervention fidelity. Patients receiving all 4 weeks of Thrive experienced increased primary and specialty care engagement and fewer readmissions. Routine intervention fidelity assessments of complex, multi-component interventions can reinforce protocols, promoting equitable participation and outcomes. ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605 and ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509.