Table 3.

Clinician and Administrator Perspectives of Factors Influencing Implementation of COMPASS-TC

Category	Factors influencing implementation
Facilitators
Organizational readiness	Organizational vision and commitment • Administrative / clinical champions • Commitment to implementing COMPASS-TC • Making COMPASS-TC implementation a priority • Administrators communicating commitment to implementation to frontline clinical staff • Cultivating staff buy-in Organizational capacity • Dedicated and sufficient resources necessary for implementation
Adoption	Hiring staff with appropriate skills / relevant experience • Committed to program and improving outcomes • Autonomous, problem solvers, assertive • Case management / navigator experience
Challenges
Reach	Case ascertainment • Incorrect / lack of diagnosis predischarge • Short lengths of stay 2-Day follow-up call to patients • Inaccurate / nonworking phone numbers
Implementation	Start-up issues • Technical difficulties with COMPASS-TC software • Steep learning curve from training to implementation Staffing challenges • Inadequate number of trained PACs/APPs • Insufficient back-ups • Limited time dedicated to PAC/APP role Inadequate systems to identify and track patients Integrating COMPASS-TC into existing TC programs threatened fidelity Clinic visit • Clinic location • Length of clinic visit • Lack of available clinic appointments and space • Limited transportation • Insurance co-pays • Patient preference to see own primary care provider Billing issues • Competition for Medicare TC Management billing codes • Patients without insurance / under insured Community resources • Hospital clinicians’ unfamiliarity with community resources