We conducted 18 interviews with a range of stakeholders at three COPD/ CHF programs from January to March 2018 to understand what implementation challenges were encountered and how they were resolved as programs evolved. Participants (six at each program) included organizational leaders who helped conceptualize programs, clinical and financial administrators, and clinicians such as integrated care coordinators, navigators, and physicians tasked with implementing programs across the hospital-community spectrum. We asked participants how their programs had evolved over time, what was working well, and what needed to be addressed to foster program sustainability. Data were coded and analyzed thematically.
All three programs contended with three key issues: a) how to increase patient enrollment, b) engage primary care physicians, and c) negotiate differences, while building trust across organizations, professions, and sectors. However, their unique local program contexts also resulted in different model development journeys. Their unique and shared concerns are explored below. We conclude with stakeholders’ thoughts on how they would like to see these models evolving as they mature.