Key result
Thrive transitional care is linked to ~47% lower 30-day readmission odds and increased care engagement.
Why the study?
The study sought to evaluate adherence and fidelity to Thrive, a transitional care program providing 30-day post-discharge support to Medicaid-insured individuals, and examine associations between fidelity and post-discharge healthcare utilization.
Does high intervention fidelity to the Thrive transitional care program improve 30-day post-discharge healthcare utilization in Medicaid-insured individuals?
Cohort (n=1,301)
Yes
Does high intervention fidelity to the Thrive transitional care program improve 30-day post-discharge healthcare utilization in Medicaid-insured individuals?
Higher intervention fidelity to a 30-day transitional care program for Medicaid-insured patients is associated with increased outpatient care engagement and reduced hospital readmissions.
Higher program content fidelity may enhance post-discharge primary care engagement; leaves open whether scaling improves outcomes.
BACKGROUND: 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. OBJECTIVES: To (1) evaluate the coverage, content, dose, and overall adherence to Thrive, and (2) examine associations between fidelity and 30-day post-discharge utilization. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605 and ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509.
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Hl et al. (2026) conducted a cohort in Medicaid-insured individuals requiring post-discharge support (n=1,301). Thrive transitional care program (4 weeks) vs. Less than 4 weeks of Thrive / lower fidelity was evaluated on 30-day post-discharge readmissions (OR 0.53, 95% CI 0.33-0.86, p=<.05). Receiving 4 weeks of the Thrive transitional care program was associated with lower odds of 30-day readmissions (OR 0.53; 95% CI 0.33-0.86; p<0.05) and increased primary and specialty care engagement.
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