Application of the replicating effective programs framework to design a COPD training program

Portillo, Edward; Gruber, Stephanie; Lehmann, Molly; Kies, Kim; Margolis, Amanda; Kreyer, Kelsey; Milone, Rangana; Kakumanu, Sujani

doi:10.1016/j.japh.2020.10.023

Cited by 4 publications

(8 citation statements)

References 12 publications

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Section: Designmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

“… 22 These modifications were adopted to make the training more dynamic, which clinicians identified in our prior evaluation as an important learning tool for web-based training programmes. 20 …”

Section: Strategymentioning

confidence: 99%

“…Evaluation outcomes will be used to inform further refinement of the COPD implementation package, with the goal of implementing the COPD CARE service for a national implementation effort to other VMACs. 20 Implementation packages have been shown to be effective at promoting adoption of best practices into clinical care and are described in the field of dissemination and implementation (D&I) science, [20][21][22] which promotes the use of theories, models and frameworks aimed at facilitating adoption of evidence-based practices across health settings. 23 24 This evaluation applied a D&I knowledge translation framework called Replicating Effective Programmes (REP) to guide the implementation and Open access evalution of the COPD CARE implementation package.…”

Section: Designmentioning

confidence: 99%

“…The REP framework is comprised of four phases, the first of which considers the local setting where implementation will occur (phase 1: preconditions), followed by design of an interprofessional training package (phase 2: preimplementation), implementation of COPD CARE training (phase 3: implementation) and evaluation of opportunities for further training refinement (phase 4: maintenance and evolution). Initial design of the virtual COPD CARE training occurred in 2017 and has since been revised using REP. 20 This formative evaluation assesses the implementation package to facilitate uptake of COPD CARE at two VAMCs and five community-based outpatient clinics ( This evaluation was a prospective mixed-methods quality improvement project. Two PDCA cycles occurred over a 24-month period where the training methods were: (1) refined (2) implemented and (3) evaluated for impact on incorporation of best practices into primary care.…”

Section: Designmentioning

confidence: 99%

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Evaluation of an implementation package to deliver the COPD CARE service

et al. 2023

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Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is estimated to be the leading cause of death in the next 15 years. Patients with COPD suffer from persistent chronic cough, sputum production and exacerbations leading to deteriorating lung function, worsening quality of life and loss of independence. While evidence-based interventions exist to improve the well-being of patients with COPD, incorporation of these interventions into routine clinical care is challenging. Chronic Obstructive Pulmonary Disease Coordinated Access to Reduce Exacerbations (COPD CARE) is a team-based, coordinated care transitions service integrating evidence-based interventions for COPD management within the patient care delivery model to reduce readmissions. This evaluation considers the process of scaling the COPD CARE service across medical facilities using an implementation package designed for service expansion. The implementation package was developed at the United States Veterans Health Administration and implemented at two medical centres. Core dissemination and implementation science methods were applied to guide design and delivery of the implementation package.The aims of this evaluation were to (1) evaluate the impact of the implementation package on use of evidence-based interventions for COPD management and (2) explore clinician perceptions of the implementation package. This prospective mixed-methods quality improvement project included two Plan Do Check Act (PDCA) cycles conducted over a 24-month period. Electronic health record data demonstrated significant improvements in the count of evidence-based interventions incorporated into routine clinical care after training completion (p<0.001), offering preliminary effectiveness of the package to improve uptake of best practices for COPD management. Clinician perceptions of the implementation package, measured by questionnaire at multiple time points, demonstrated significant improvements for all scales at the end of the final PDCA cycle. Clinicians described the implementation package as positively impacting clinician confidence, interprofessional collaboration and patient care delivery.

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Section: Designmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

Section: Strategymentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

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Evaluation of an implementation package to deliver the COPD CARE service

et al. 2023

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Integration of the patient-centered medical home to deliver a care bundle for chronic obstructive pulmonary disease management

Portillo

Lehmann²,

Hagen³

et al. 2023

Journal of the American Pharmacists Association

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Applying RE-AIM to examine the impact of an implementation facilitation package to scale up a program for Veterans with chronic obstructive pulmonary disease

Portillo,

Maurer,

Kettner

et al. 2023

Implement Sci Commun

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Background US Veterans are four times more likely to be diagnosed with chronic obstructive pulmonary disease (COPD) compared to the civilian population with no care model that consistently improves Veteran outcomes when scaled. COPD Coordinated Access to Reduce Exacerbations (CARE) is a care bundle intended to improve the delivery of evidence-based practices to Veterans. To address challenges to scaling this program in the Veterans’ Health Administration (VA), the COPD CARE Academy (Academy), an implementation facilitation package comprised of five implementation strategies was designed and implemented. Methods This evaluation utilized a mixed-methods approach to assess the impact of the Academy’s implementation strategies on the RE-AIM framework implementation outcomes and the extent to which they were effective at increasing clinicians’ perceived capability to implement COPD CARE. A survey was administered one week after Academy participation and a semi-structured interview conducted 8 to 12 months later. Descriptive statistics were calculated for quantitative items and thematic analysis was used to analyze open-ended items. Results Thirty-six clinicians from 13 VA medical centers (VAMCs) participated in the Academy in 2020 and 2021 and 264 front-line clinicians completed COPD CARE training. Adoption of the Academy was indicated by high rates of Academy session attendance (90%) and high utilization of Academy resources. Clinicians reported the Academy to be acceptable and appropriate as an implementation package and clinicians from 92% of VAMCs reported long-term utilization of Academy resources. Effectiveness of the Academy was represented by clinicians’ significant increases (p < 0.05) in their capability to complete ten implementation tasks after Academy participation. Conclusions This evaluation found that the use of implementation facilitation paired with additional strategies enhanced the capacity of clinicians to implement COPD CARE. Future assessments are needed to explore post-academy resources that would help VAMCs to strategize localized approaches to overcome barriers.

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Application of the replicating effective programs framework to design a COPD training program

Cited by 4 publications

References 12 publications

Evaluation of an implementation package to deliver the COPD CARE service

Evaluation of an implementation package to deliver the COPD CARE service

Integration of the patient-centered medical home to deliver a care bundle for chronic obstructive pulmonary disease management

Applying RE-AIM to examine the impact of an implementation facilitation package to scale up a program for Veterans with chronic obstructive pulmonary disease

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