Implementing evidence-based interventions in health care: application of the replicating effective programs framework

Kilbourne, Amy M.; Neumann, Mary Spink; Pincus, Harold Alan; Bauer, Mark S.; Stall, Ronald D.

doi:10.1186/1748-5908-2-42

Cited by 515 publications

(539 citation statements)

References 18 publications

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“…Further efforts are needed to enhance primary care' s capacity to integrate and sustain collaborative care models for delivering high quality behavioral health services to children and adolescents. 44,45 The incorporation of compelling implementation and financial models may help ensure that these evidence-based practices are transported to scale. 39 …”

Section: Resultsmentioning

confidence: 99%

Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial

Kolko¹,

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Integrated or collaborative care intervention models have revealed gains in provider care processes and outcomes in adult, child, and adolescent populations with mental health disorders. However optimistic, conclusions are not definitive due to methodologic limitations and a dearth of studies. WHAT THIS STUDY ADDS:This randomized trial provides further evidence for the efficacy of an on-site intervention (Doctor Office Collaborative Care) coordinated by care managers for children' s behavior problems. The findings provide support for integrated behavioral health care using novel provider and caregiver outcomes.abstract OBJECTIVE: To assess the efficacy of collaborative care for behavior problems, attention-deficit/hyperactivity disorder (ADHD), and anxiety in pediatric primary care (Doctor Office Collaborative Care; DOCC). METHODS:Children and their caregivers participated from 8 pediatric practices that were cluster randomized to DOCC (n = 160) or enhanced usual care (EUC; n = 161). In DOCC, a care manager delivered a personalized, evidence-based intervention. EUC patients received psychoeducation and a facilitated specialty care referral. Care processes measures were collected after the 6-month intervention period. Family outcome measures included the Vanderbilt ADHD Diagnostic Parent Rating Scale, Parenting Stress Index-Short Form, Individualized Goal Attainment Ratings, and Clinical Global Impression-Improvement Scale. Most measures were collected at baseline, and 6-, 12-, and 18-month assessments. Provider outcome measures examined perceived treatment change, efficacy, and obstacles, and practice climate.RESULTS: DOCC (versus EUC) was associated with higher rates of treatment initiation (99.4% vs 54.2%; P , .001) and completion (76.6% vs 11.6%, P , .001), improvement in behavior problems, hyperactivity, and internalizing problems (P , .05 to .01), and parental stress (P , .05-.001), remission in behavior and internalizing problems (P , .01, .05), goal improvement (P , .05 to .001), treatment response (P , .05), and consumer satisfaction (P , .05). DOCC pediatricians reported greater perceived practice change, efficacy, and skill use to treat ADHD (P , .05 to .01).CONCLUSIONS: Implementing a collaborative care intervention for behavior problems in community pediatric practices is feasible and broadly effective, supporting the utility of integrated behavioral health care services. Pediatrics 2014;133:e981-e992

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Section: Resultsmentioning

confidence: 99%

Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial

Kolko¹,

et al. 2014

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“…21 We disseminated the EB-CPM to 7 community hospitals by using the Replicating Effective Programs framework. 26 We secured Intermountain Healthcare leadership support, which led to prioritization of our project as one of the organizational clinical goals, identified local hospital physician champions, and assembled a multidisciplinary implementation team with representatives from each hospital, including physician champions; nursing, respiratory therapy, and pharmacist leaders; hospital administrators; and QI staff. We obtained baseline compliance data for each hospital, which showed suboptimal asthma care, and shared these data with hospital clinical and administrative leaders.…”

Section: Planning the Interventionmentioning

confidence: 99%

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

et al. 2015

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BACKGROUND AND OBJECTIVES: Gaps exist in inpatient asthma care. Our aims were to assess the impact of an evidence-based care process model (EB-CPM) 5 years after implementation at Primary Children's Hospital (PCH), a tertiary care facility, and after its dissemination to 7 community hospitals.METHODS: Participants included asthmatics 2 to 17 years admitted at 8 hospitals between 2003 and 2013. The EB-CPM was implemented at PCH between January 2008 and March 2009, then disseminated to 7 community hospitals between January and June 2011. We measured compliance using a composite score (CS) for 8 quality measures. Outcomes were compared between preimplementation and postimplementation periods. Confounding was addressed through multivariable regression analyses.RESULTS: At PCH, the CS increased and remained at .90% for 5 years after implementation. We observed sustained reductions in asthma readmissions (P = .026) and length of stay (P , .001), a trend toward reduced costs (P = .094), and no change in hospital resource use, ICU transfers, or deaths. The CS also increased at the 7 community hospitals, reaching 80% to 90% and persisting .2 years after dissemination, with a slight but not significant readmission reduction (P = .119), a significant reduction in length of stay (P , .001) and cost (P = .053), a slight increase in hospital resource use (P = .032), and no change in ICU transfers or deaths.CONCLUSIONS: Our intervention resulted in sustained, long-term improvement in asthma care and outcomes at the tertiary care hospital and successful dissemination to community hospitals.

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“…While understanding healthcare administrative and organizational factors is critical to the implementation of integrated behavioral medicine and specialist care, incorporating patient variables, such as the factors that enable access to care and resources, is particularly relevant when implementation is planned for vulnerable populations, such as underserved urban and rural poor [19,[23][24][25][26][27][28]. Both urban and rural poor experience unique access to care difficulties, including geographic barriers or financial limitations, that may influence health outcomes even when integrated behavioral medicine and specialty care are successfully implemented to others [29].…”

Section: Introductionmentioning

confidence: 99%

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

Rongey

Asch

Knight

2011

Behav. Med. Pract. Policy Res.

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The Veterans Health Administration (VHA) is the largest single provider of medical care to people with hepatitis C (HCV) in the USA. Given the advent of promising new HCV therapies, the VHA is now faced with a large number of chronically HCV-infected veterans with concomitant psychiatric or substance use comorbid conditions who will need to either be retreated or newly treated for HCV or will require management for chronic liver disease. There is a critical need in the VHA for behavioral medicine and hepatology specialists, along with infectious disease and primary care providers with an interest in hepatitis C, to provide coordinated care for these complex patients. The VHA Health Services Research and Development Service has advocated for the application of strong implementation science theories and methods to translate new models of healthcare delivery in clinical practice. To inform the delivery and evaluation of integrated behavioral medicine and specialty care for vulnerable patient populations, we sought to develop an enriched framework which incorporates implementation science theory and strong conceptual models for access to care. In this paper, we present a hybrid conceptual framework that accomplishes this goal. To illustrate how this hybrid model could inform the translation of a novel method of healthcare delivery, we provide a case study of a VHA initiative to improve access to integrated behavioral medicine and specialty care among veterans with HCV.

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Implementing evidence-based interventions in health care: application of the replicating effective programs framework

Abstract: Background: We describe the use of a conceptual framework and implementation protocol to prepare effective health services interventions for implementation in community-based (i.e., nonacademic-affiliated) settings.

Cited by 515 publications

References 18 publications

Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial

Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

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