Browsing by Subject "implementation science"

Now showing 1 - 6 of 6
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    ItemOpen Access
    Diffusion of excellence: evaluating a system to identify, replicate, and spread promising innovative practices across the Veterans health administration.
    (Frontiers in health services, 2023-01) Jackson, George L; Fix, Gemmae M; White, Brandolyn S; Cutrona, Sarah L; Reardon, Caitlin M; Damschroder, Laura J; Burns, Madison; DeLaughter, Kathryn; Opra Widerquist, Marilla A; Arasim, Maria; Lindquist, Jennifer; Gifford, Allen L; King, Heather A; Kaitz, Jenesse; Jasuja, Guneet K; Hogan, Timothy P; Lopez, Jaifred Christian F; Henderson, Blake; Fitzgerald, Blaine A; Goetschius, Amber; Hagan, Danielle; McCoy, Carl; Seelig, Alex; Nevedal, Andrea

    Introduction

    The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program provides a system to identify, replicate, and spread promising practices across the largest integrated healthcare system in the United States. DoE identifies innovations that have been successfully implemented in the VHA through a Shark Tank style competition. VHA facility and regional directors bid resources needed to replicate promising practices. Winning facilities/regions receive external facilitation to aid in replication/implementation over the course of a year. DoE staff then support diffusion of successful practices across the nationwide VHA.

    Methods

    Organized around the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, we summarize results of an ongoing long-term mixed-methods implementation evaluation of DoE. Data sources include: Shark Tank application and bid details, tracking practice adoptions through a Diffusion Marketplace, characteristics of VHA facilities, focus groups with Shark Tank bidders, structured observations of DoE events, surveys of DoE program participants, and semi-structured interviews of national VHA program office leaders, VHA healthcare system/facility executives, practice developers, implementation teams and facilitators.

    Results

    In the first eight Shark Tanks (2016-2022), 3,280 Shark Tank applications were submitted; 88 were designated DoE Promising Practices (i.e., practices receive facilitated replication). DoE has effectively spread practices across the VHA, with 1,440 documented instances of adoption/replication of practices across the VHA. This includes 180 adoptions/replications in facilities located in rural areas. Leadership decisions to adopt innovations are often based on big picture considerations such as constituency support and linkage to organizational goals. DoE Promising Practices that have the greatest national spread have been successfully replicated at new sites during the facilitated replication process, have close partnerships with VHA national program offices, and tend to be less expensive to implement. Two indicators of sustainment indicate that 56 of the 88 Promising Practices are still being diffused across the VHA; 56% of facilities originally replicating the practices have sustained them, even up to 6 years after the first Shark Tank.

    Conclusion

    DoE has developed a sustainable process for the identification, replication, and spread of promising practices as part of a learning health system committed to providing equitable access to high quality care.
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    ItemEmbargo
    Feasibility of Kanasina Gulabi, a Pilot Peer Support Intervention for Young Adults with Type 2 Diabetes in Mysore District, South India
    (2024) Gopisetty, Nikhita Rani

    Background: The global rise in early-onset type 2 diabetes (T2D) is impacting the lives of millions of young individuals around the world. To address the knowledge gap and emotional burden in young adults with T2D, the research team designed a four-week education and goal-based peer support intervention, Kanasina Gulabi (Kannada: My Dream Rose), implemented in Mysore, India between June and July 2023. Methods: The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to assess feasibility. Peer navigators (n=3, mean age: 33 years) were recruited from the community and trained to deliver the intervention. Twenty-eight adults ≤ 40 years of age with T2D were recruited and quasi-randomly allocated to the intervention group (n=14, mean age: 33 years) or the control group (n=14, mean age: 33 years). Hemoglobin A1c, T2D knowledge, diabetes distress, diabetes-related stigma, depression severity, and optimism were assessed at baseline, immediately after the intervention, and at the 2-month follow-up. Attendance, fidelity, and acceptability were also assessed. Results: Intervention participants expressed high satisfaction with Kanasina Gulabi and gratitude for the guided knowledge and mentorship from their peer navigators. Participants displayed excellent attendance and adherence, with an average of 5 hours of Kanasina Gulabi exposure over 4 weeks. Peer navigators delivered the intervention with 100% fidelity. Results immediately following the intervention showed reductions in diabetes distress (Intervention: 30.9%, Control: 6.5%), diabetes-related stigma (Intervention: 25.3%, Control: 14.5%), and depression severity (Intervention: 58.3%, Control: 38.5%). Both groups presented an increase in T2D knowledge (Intervention: 19.7%, Control: 25.2%). Conclusion: Implementing Kanasina Gulabi in Mysore is feasible and acceptable, with intervention participants showing more positive changes on multiple psychosocial outcomes compared to the control group. Results support a full trial to evaluate its effectiveness and sustainability in young adults with T2D.

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    Implementation challenges to patient safety in Guatemala: a mixed methods evaluation.
    (BMJ quality & safety, 2021-05-26) Hall, Bria J; Puente, Melany; Aguilar, Angie; Sico, Isabelle; Orozco Barrios, Monica; Mendez, Sindy; Baumgartner, Joy Noel; Boyd, David; Calgua, Erwin; Lou-Meda, Randall; Ramirez, Carla C; Diez, Ana; Tello, Astrid; Sexton, J Bryan; Rice, Henry

    Background

    Little is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala.

    Methods

    We used a mixed methods design to examine the implementation of a patient safety programme across 11 paediatric units at the Roosevelt Hospital in Guatemala. The safety programme included: (1) tools to measure and foster safety culture, (2) education of patient safety, (3) local leadership engagement, (4) safety event reporting systems, and (5) quality improvement interventions. Key informant staff (n=82) participated in qualitative interviews and quantitative surveys to identify implementation challenges early during programme deployment from May to July 2018, with follow-up focus group discussions in two units 1 year later to identify opportunities for programme modification. Data were analysed using thematic analysis, and integrated using triangulation, complementarity and expansion to identify emerging themes using the Consolidated Framework for Implementation Research. Salience levels were reported according to coding frequency, with valence levels measured to characterise the degree to which each construct impacted implementation.

    Results

    We found several facilitators to safety programme implementation, including high staff receptivity, orientation towards patient-centredness and a desire for protocols. Key barriers included competing clinical demands, lack of knowledge about patient safety, limited governance, human factors and poor organisational incentives. Modifications included use of tools for staff recognition, integration of education into error reporting mechanisms and designation of trained champions to lead unit-based safety interventions.

    Conclusion

    Implementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation.
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    ItemOpen Access
    Increasing contraception use among women receiving teratogenic medications in a rheumatology clinic.
    (BMJ open quality, 2018-01) Sadun, Rebecca E; Wells, Melissa A; Balevic, Stephen J; Lackey, Victoria; Aldridge, Erica J; Holdgagte, Nicholas; Mohammad, Samya; Criscione-Schreiber, Lisa G; Clowse, Megan EB; Yanamadala, Mamata
    Teratogenic medications are often prescribed to women of childbearing age with autoimmune diseases. Literature suggests that appropriate use of contraception among these women is low, potentially resulting in high-risk unintended pregnancies. Preliminary review in our clinic showed suboptimal documentation of women's contraceptive use. We therefore designed a quality improvement initiative to target three process measures: documentation of contraception usage and type, contraception counselling and provider action after counselling. We reviewed charts of rheumatology clinic female patients aged 18-45 over the course of 10 months; for those who were on teratogenic medications (methotrexate, leflunomide, mycophenolate and cyclophosphamide), we looked for evidence of documentation of contraception use. We executed multiple plan-do-study-act (PDSA) cycles to develop and evaluate interventions, which centred on interprofessional provider education, modification of electronic medical record (EMR) templates, periodic provider reminders, patient screening questionnaires and frequent feedback to providers on performance. Among eligible patients (n=181), the baseline rate of documentation of contraception type was 46%, the rate of counselling was 30% and interventions after counselling occurred in 33% of cases. Averaged intervention data demonstrated increased provider performance in all three domains: documentation of contraception type increased to 64%, counselling to 45% and provider action to 46%. Of the patients with documented contraceptives, 50% used highly effective, 27% used effective and 23% used ineffective contraception methods. During this project, one unintentional pregnancy occurred in a patient on methotrexate not on contraception. Our interventions improved three measures related to contraception counselling and documentation, but there remains a need for ongoing quality improvement efforts in our clinic. This high-risk population requires increased provider engagement to improve contraception compliance, coupled with system-wide EMR changes to increase sustainability.
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    ItemOpen Access
    Use of the consolidated framework for implementation research in a mixed methods evaluation of the EQUIPPED medication safety program in four academic health system emergency departments.
    (Frontiers in health services, 2022-01) Kegler, Michelle C; Rana, Shaheen; Vandenberg, Ann E; Hastings, S Nicole; Hwang, Ula; Eucker, Stephanie A; Vaughan, Camille P

    Background

    Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) is an effective quality improvement program initially designed in the Veterans Administration (VA) health care system to reduce potentially inappropriate medication prescribing for adults aged 65 years and older. This study examined factors that influence implementation of EQUIPPED in EDs from four distinct, non-VA academic health systems using a convergent mixed methods design that operationalized the Consolidated Framework for Implementation Research (CFIR). Fidelity of delivery served as the primary implementation outcome.

    Materials and methods

    Four EDs implemented EQUIPPED sequentially from 2017 to 2021. Using program records, we scored each ED on a 12-point fidelity index calculated by adding the scores (1-3) for each of four components of the EQUIPPED program: provider receipt of didactic education, one-on-one academic detailing, monthly provider feedback reports, and use of order sets. We comparatively analyzed qualitative data from focus groups with each of the four implementation teams (n = 22) and data from CFIR-based surveys of ED providers (108/234, response rate of 46.2%) to identify CFIR constructs that distinguished EDs with higher vs. lower levels of implementation.

    Results

    Overall, three sites demonstrated higher levels of implementation (scoring 8-9 of 12) and one ED exhibited a lower level (scoring 5 of 12). Two constructs distinguished between levels of implementation as measured through both quantitative and qualitative approaches: patient needs and resources, and organizational culture. Implementation climate distinguished level of implementation in the qualitative analysis only. Networks and communication, and leadership engagement distinguished level of implementation in the quantitative analysis only.

    Discussion

    Using CFIR, we demonstrate how a range of factors influence a critical implementation outcome and build an evidence-based approach on how to prime an organizational setting, such as an academic health system ED, for successful implementation.

    Conclusion

    This study provides insights into implementation of evidence-informed programs targeting medication safety in ED settings and serves as a potential model for how to integrate theory-based qualitative and quantitative methods in implementation studies.
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    Walking All over COVID-19: The Rapid Development of STRIDE in Your Room, an Innovative Approach to Enhance a Hospital-Based Walking Program during the Pandemic.
    (Geriatrics (Basel, Switzerland), 2021-11) Hughes, Jaime M; Bartle, John T; Choate, Ashley L; Mahanna, Elizabeth P; Meyer, Cassie L; Tucker, Matthew C; Wang, Virginia; Allen, Kelli D; Van Houtven, Courtney H; Hastings, Susan Nicole
    Hospitalization is common among older adults. Prolonged time in bed during hospitalization can lead to deconditioning and functional impairments. Our team is currently working with Department of Veterans Affairs (VA) medical centers across the United States to implement STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans), a hospital-based walking program designed to mitigate the risks of immobility during hospitalization. However, the COVID-19 pandemic made in-person, or face-to-face, walking challenging due to social distancing recommendations and infection control concerns. In response, our team applied principles of implementation science, including stakeholder engagement, prototype development and refinement, and rapid dissemination and feedback, to create STRIDE in Your Room (SiYR). Consisting of self-guided exercises, light exercise equipment (e.g., TheraBands, stress ball, foam blocks, pedometer), the SiYR program provided safe alternative activities when face-to-face walking was not available during the pandemic. We describe the methods used in developing the SiYR program; present feedback from participating sites; and share initial implementation experiences, lessons learned, and future directions.