Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health

Abstract

Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established in New York State, USA, to fill a gap in rural transgender care and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examined the implementation of the Center of Excellence, a complex intervention, to assess barriers and facilitators to implementation over 18 months. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of CFIR domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multifaceted interventions to overcome such challenges in order to improve care for marginalized populations.

Conceptualising centres of excellence: a scoping review of global evidence

“…CoE is a team of specialised expertise2 7 17 24–47 or organisational environment2 5 24 30 35 36 48–56 that is established to provide outstanding healthcare,2 7 12 17 24–39 41 48 50 51 57–74 research,12 17 24 26–28 31 36 40 41 50 52 58 68 72 74–85 education and training,12 17 24 25 31 36 38 42 43 68 73 74 76 81–83 85–88 regulatory,57 83 89 policy,46 49 54 55 82 90 information technology45 53 91 or industrial44 92 93 services and support in high levels of efficient and effective performance. CoEs are geographically concentrated and focused on high potential in science and industry,46 as a world leader or a catalyst between neighbouring countries,60 72 82 anywhere from the local research and development (R&D) group up to a network of cooperative partners.…”

“…In the healthcare sector, CoEs can provide breakthrough treatments on specific disease conditions 26–33. In line with the current COVID-19 pandemic, some hospitals and universities have established COVID-19-specific CoEs 24 96…”

“…12 81 95 In the healthcare sector, CoEs can provide breakthrough treatments on specific disease conditions. [26][27][28][29][30][31][32][33] In line with the current COVID-19 pandemic, some hospitals and universities have established COVID-19-specific CoEs. 24 96 CoE could be established to provide specific regulatory decision making, including to advance the development and regulation of products 25 83 and to fill in knowledge gaps.…”

Conceptualizing centers of excellence: A global evidence

“…CoE is a team of specialized expertise (25-37, 40-42, 47, 49, 62, 66, 69, 84, 85, 89, 92, 98, 100) or organizational environment (25, 31, 35, 38, 40, 41, 50, 51, 55, 61, 74, 94, 96, 97, 101) that is established to provide outstanding healthcare (24-42, 44-49, 51-64, 69, 73, 75, 79-80), research (25, 27-29, 32, 39, 41, 44, 47, 51, 59, 65-74, 77, 78, 80-83), education and training (25, 26, 32, 41, 47, 49, 59, 67, 75, 77-81, 83, 84-88), regulatory (24, 43, 81), policy (50, 78, 95-98), information technology (92-94) or industrial (89-91) services and support in high levels of efficient and effective performance. CoEs are geographically concentrated and focused on high potential in science and industry (98), as a world leader or a catalyst between neighboring countries (46, 73, 78), anywhere from the local R&D group up to a network of co-operative partners.…”

“…In the healthcare sector, CoEs can provide breakthrough treatments on specific disease conditions (31,(27)(28)(29)(30)(32)(33)(34). In line with the current COVID-19 pandemic, some hospitals and universities have established COVID-19-specific CoES [25,102].…”