Comparing variations in implementation processes and influences across multiple sites: What works, for whom, and how?

Kim, Bo; Sullivan, Jennifer L.; Ritchie, Mona J.; Connolly, Samantha L.; Drummond, Karen L.; Miller, Christopher J.; Greenan, Mary Alexis; Bauer, Mark S.

doi:10.1016/j.psychres.2019.112520

Cited by 23 publications

(24 citation statements)

References 24 publications

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“…While sites developed many different approaches to the task, some had greater resources and capacity to accomplish this, and some were simply exhausted and frustrated. Although recent work by Kim et al points to the importance of heterogeneity in implementation efforts [16], the complexity of this innovation points to a need for greater task clarity and speci city. In addition, although the task was complex, the evaluation of the task was extremely simple, a correctly titled note in the medical record.…”

Section: Discussionmentioning

confidence: 99%

Tracking the Randomized Rollout of a Veterans Affairs Opioid Risk Management Tool: A Multi-method Implementation Evaluation Using the Consolidated Framework for Implementation Research

McCarthy

Chinman

Rogal

et al. 2021

Preprint

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BackgroundThe Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard to assist VHA clinicians in identifying Veterans at risk for adverse opioid overdose or suicide-related events. In 2018, a national policy was implemented requiring providers at all VHA facilities to complete case reviews of Veterans identified by STORM as very high risk for adverse events. Nationally, facilities were randomized by the type of oversight required when sufficient case reviews were not completed and also by the timing of an increase in the number of required case reviews. As part of a comprehensive assessment of this policy intervention, we aimed to 1) identify barriers and facilitators to implementing case reviews as required in the policy; 2) assess variation across the four arms of the study; and 3) evaluate associations between facility characteristics and implementation barriers and facilitators.MethodsUsing the Consolidated Framework for Implementation Research (CFIR), we developed a semi-structured interview guide to examine barriers to and facilitators of implementing the STORM policy. Staff from 40 purposefully selected facilities who were involved in implementation were invited to participate in telephone interviews. Interview transcripts were coded and then organized into memos, which were numerically rated using the -2 to +2 CFIR rating system for each construct. Descriptive statistics were used to evaluate the mean ratings on each CFIR construct, the associations between ratings and study arm, and three facility characteristics (size, rurality, and level of academic detailing) associated with CFIR ratings. We used the mean CFIR rating for each site to determine which constructs differed between the sites with highest and lowest overall CFIR scores, and these constructs were described in detail. ResultsInterviews with 78 staff at 39 VHA facilities identified a slightly positive (+0.2) overall mean CFIR rating. CFIR ratings were not significantly different between the four study arms, nor associated with facility characteristics. Overall, two important barriers to implementation were CFIR constructs Access to knowledge and information and Evaluating and reflecting. Having time to complete the reviews was a pervasive barrier. Sites with higher overall CFIR scores showed three important facilitators: Leadership engagement, Engaging, and Implementation climate. ConclusionAlthough there was variability in implementation barriers and facilitators across facilities, these were unrelated to study arms and facility characteristics. Leadership, resources, and overall implementation climate were the strongest facilitators of policy implementation.

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Section: Discussionmentioning

confidence: 99%

Tracking the Randomized Rollout of a Veterans Affairs Opioid Risk Management Tool: A Multi-method Implementation Evaluation Using the Consolidated Framework for Implementation Research

McCarthy

Chinman

Rogal

et al. 2021

Preprint

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“…After reaching consensus on nine site summaries, the study team created a cross-site matrix to compare the extent of CCM implementation across sites. (13)…”

Section: Discussionmentioning

confidence: 99%

Collaborative Chronic Care Model Implementation within Outpatient Behavioral Health Care Teams: Qualitative Results from a Multisite Trial using Implementation Facilitation

Sullivan

Kim

Miller

et al. 2020

Preprint

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Abstract Background: This paper reports on a qualitative evaluation of a hybrid II stepped-wedge trial using implementation facilitation to implement team-based care in the form of the Collaborative Chronic Care Model (CCM) in interdisciplinary outpatient mental health teams. The objective of this study was to compare the alignment of sites’ clinical processes with the CCM elements at baseline (Time 1) and after 12 months of implementation facilitation (Time 2) from the perspective of providers.Methods: We conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis approach at Time 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at Times 1 and 2.Results: We conducted 27 and 31 telephone interviews at Times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At Time 1 and Time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from Time 1 to Time 2 were: work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at Time 2 compared to Time 1, while others had reductions.Conclusions: Sites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes already in place at Time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements—especially in the use of clinical information systems and linking with community resources. Trial Registration: Clinical Trials NCT02543840Registered 7 September 2015.

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“…Indeed, heterogeneity in implementation is expected. This is particularly so within a school setting where adaptation is a necessity for strategies that target one or more levels within the system that support the adoption and implementation of the intervention [ 36 ]. Planned adaptations to the implementation of MK were seen in the current study and are recommended (e.g., issuing of rewards and certificates and logging of laps); however, it is important that the underlying features of the program are maintained [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of the Implementation of a UK School-Based Running Program

et al. 2020

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The adoption of school-based running programs has rapidly increased over the last five years in the UK and globally. However, there is currently a lack of information on how these initiatives are implemented, and whether they are generalizable and/or sustainable. This study evaluated the implementation (including reach, fidelity, and dose) of a school-based running program over seven months to inform future delivery. This observational study used a mixed-method, single-group, before-and-after design strengthened by multiple interim measurements to evaluate the implementation of an optional school-based running program. Five state-funded primary schools in Leicestershire, UK, participated, with 17 teachers and 189 (81 boys (47.4%) and 90 girls (52.6%)) Year 5 pupils (aged 9–10 years) from eight classes. During the 2016/2017 academic year, data were collected via several measures (including interviews, focus groups, observations, questionnaires, and teacher implementation logs) at multiple levels (i.e., school and individual) and at multiple time points during implementation. Follow up qualitative data were also collected during 2017/2018. The school-based running program achieved good reach, with 100% of pupils opting to participate at some point during the academic year. All schools implemented the program with good fidelity, although the level of implementation varied between schools and over time. The average number of sessions held per week ranged from 0.94–3.89 with the average distance accumulated per pupil per week ranging from 0.02 to 2.91 kilometers and boys being more likely than girls to be classed as high-level participators. Despite an initial drop off in participation over time, all schools remained engaged in the program and continued to implement it until the end of the school year. Contextual features (e.g., staff capacity and resources) differed between schools and influenced the quality of implementation and the frequency of delivery. The school-based running program is simple, inexpensive, and versatile and can be implemented by schools with relative ease. However, schools are diverse settings, with unique challenges to ongoing delivery. Thus, planned adaptations, specific to each school’s context, are likely necessary to sustain participation in the longer term and should be considered prior to implementation.

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Comparing variations in implementation processes and influences across multiple sites: What works, for whom, and how?

Cited by 23 publications

References 24 publications

Tracking the Randomized Rollout of a Veterans Affairs Opioid Risk Management Tool: A Multi-method Implementation Evaluation Using the Consolidated Framework for Implementation Research

Tracking the Randomized Rollout of a Veterans Affairs Opioid Risk Management Tool: A Multi-method Implementation Evaluation Using the Consolidated Framework for Implementation Research

Collaborative Chronic Care Model Implementation within Outpatient Behavioral Health Care Teams: Qualitative Results from a Multisite Trial using Implementation Facilitation

An Evaluation of the Implementation of a UK School-Based Running Program

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