Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model

Smith, Shawna N.; Almirall, Daniel; Prenovost, Katherine; Liebrecht, Celeste; Kyle, Julia; Eisenberg, Daniel; Bauer, Mark S.; Kilbourne, Amy M.

doi:10.1097/mlr.0000000000001138

Cited by 23 publications

(44 citation statements)

References 64 publications

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“…Most commonly the facilitation element (e.g., [ 58 , 80 , 92 , 98 , 110 ]) was referred to as guiding an implementation strategy. The articles that provided explicit descriptions of interventions using facilitation employed strategies such as education, reminders, audit-and-feedback, action learning, and evidence-based quality improvement, and roles including internal and external facilitators and improvement teams to enable the uptake of evidence (e.g., [ 23 , 79 , 125 , 142 ]). Some articles drew on the PARIHS framework more specifically, to understand the role of organizational context in implementation (e.g., [ 34 , 63 , 145 , 340 ]).…”

Section: Resultsmentioning

confidence: 99%

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

et al. 2020

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Background: The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. Methods: This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/ countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. Results: The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. Conclusions: In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

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Section: Resultsmentioning

confidence: 99%

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

et al. 2020

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“…This may be for several reasons. First, EF alone may be su cient forcommunity clinics to effectively implement the Life Goals intervention and, thus, in most cases IF may not be necessary (27). Second, many sites had di culty identifying an internal facilitator.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (Adept): Approaches to Adopting Implementation Strategies

Eisman

Hutton

Prosser

et al. 2020

Preprint

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Background Theory-based methods to support clinician uptake of evidence-based practices (EBPs) are critical to improving mental health outcomes. Costs associated with effective implementation strategies can be substantial, and few have been rigorously evaluated. The purpose of this study is to conduct a cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP. Methods We used data from a previously conducted randomized trial to compare the cost-effectiveness of different augmentations to Replicating Effective Programs (REP) combined with external and/or internal facilitation to enhance uptake of Life Goals. REP is a low-level strategy that includes EBP packaging, training, and technical assistance. External facilitation (EF) involves external expert support, and internal facilitation (IF) augments EF with protected time for internal staff to support EBP implementation. We developed a decision tree to assess 1-year costs and outcomes for four implementation strategies: 1) REP only, 2) REP + EF 3) REP + EF add IF if necessary, 4) REP + EF/IF. The analyses used a 1-year time horizon and assumes a health payer perspective. Our outcome was quality-adjusted life years (QALYs). The economic outcome was the incremental cost-effectiveness ratio (ICER). We conducted deterministic and probabilistic sensitivity analysis (PSA). Results Our results indicate that REP + EF add IF is the most cost-effective option with an ICER of $593/QALY. The REP + EF/IF and REP + EF only conditions are dominated. One-way sensitivity analyses indicate that results are sensitive to utilities for REP + EF and REP + EF add IF. The PSA results indicate that REP + EF, add IF is the optimal strategy in 30% of iterations at the threshold of $100,000/QALY. Conclusions Our results suggest that the most cost-effective implementation support begins with a less intensive, less costly strategy initially and increases as needed to enhance EBP uptake. Using this approach, implementation support resources can be judiciously allocated to those clinics that would most benefit. Our results were not robust to changes in the utility measure. Further research is needed that incorporates robust and relevant utilities in implementation research to identify the most cost-effective strategies. This research advances economic evaluation of implementation by assessing costs and utilities across multiple implementation strategy combinations. Trial registration: ClinicalTrials.gov Identifier: NCT02151331, 05/30/2014

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“…This may be for several reasons. First, EF alone may be su cient for community clinics to effectively implement the Life Goals intervention and, thus, in most cases IF may not be necessary (32). Second, many sites had di culty identifying an internal facilitator.…”

Section: Discussionmentioning

confidence: 99%

“…This study will use a simulation modeling approach using data from a previously-conducted clinical trial (19,32). Our results are reported using the Consolidated Health Economic Evaluation Reporting (CHEERS) guidelines (33).…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies

Eisman

Hutton

Prosser

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Theory-based methods to support the uptake of evidence-based practices (EBPs) are critical to improving mental health outcomes. Implementation strategy costs can be substantial, and few have been rigorously evaluated. The purpose of this study is to conduct a cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP. Methods: We used data from a previously conducted randomized trial to compare the cost-effectiveness of Replicating Effective Programs (REP) combined with external and/or internal facilitation among sites non-responsive to REP. REP is a low-level strategy that includes EBP packaging, training, and technical assistance. External facilitation (EF) involves external expert support, and internal facilitation (IF) augments EF with protected time for internal staff to support EBP implementation. We developed a decision tree to assess 1-year costs and outcomes for four implementation strategies: 1) REP only, 2) REP+EF 3) REP+EF add IF if needed, 4) REP+EF/IF. The analysis used a 1-year time horizon and assumed a health payer perspective. Our outcome was quality-adjusted life years (QALYs). The economic outcome was the incremental cost-effectiveness ratio (ICER). We conducted deterministic and probabilistic sensitivity analysis (PSA). Results: Our results indicate that REP+EF add IF is the most cost-effective option with an ICER of $593/QALY. The REP+EF/IF and REP+EF only conditions are dominated (i.e., more expensive and less effective than comparators). One-way sensitivity analyses indicate that results are sensitive to utilities for REP+EF and REP+EF add IF. The PSA results indicate that REP+EF, add IF is the optimal strategy in 30% of iterations at the threshold of $100,000/QALY. Conclusions: Our results suggest that the most cost-effective implementation support begins with a less intensive, less costly strategy initially and increases as needed to enhance EBP uptake. Using this approach, implementation support resources can be judiciously allocated to those clinics that would most benefit. Our results were not robust to changes in the utility measure. Research is needed that incorporates robust and relevant utilities in implementation studies to determine the most cost-effective strategies. This study advances economic evaluation of implementation by assessing costs and utilities across multiple implementation strategy combinations.

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Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model

Cited by 23 publications

References 64 publications

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (Adept): Approaches to Adopting Implementation Strategies

Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies

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