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

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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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