The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

Damschroder, Laura J.; Yankey, Nicholas; Robinson, Claire; Freitag, Michelle B; Burns, Joseph E.; Raffa, Susan D.; Lowery, Julie C.

doi:10.1007/s11606-020-06133-1

Cited by 13 publications

(21 citation statements)

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“…This was a serendipitous finding that deserves further study. Other researchers in the field are increasingly recognizing the importance of the knowledge about EBPs competencies needed for technical assistance providers (Morin et al, 2021), competencies needed for personnel supporting implementation (Schultes et al, 2021), and training models for implementation teams (Damschroder et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with implementation of a school-based comprehensive program for students with autism

Odom

Sam

Tomaszewski

2022

Autism

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The purpose of this study was to examine influences on the implementation of a school-based comprehensive program for autistic children. Following the conceptual framework suggested by the Exploration, Preparation, Implementation, Sustainment (EPIS) model, variables from the outer context, inner context, and also that were part of the comprehensive program were explored. An index approach was employed for assessing implementation. The study was part of a larger cluster randomized control trial and took place in 39 elementary schools in a southeastern state within the United States. Variables associated with implementation were transformational leadership style of the principal, percentage of students in the school who were white, and adequacy of coaching. Implications for practice and future research were identified. Lay abstract The purpose of this study was to identify influences on the implementation of a school-based, comprehensive program for autistic students. Influences from the community context, from within the school organization, and from features of the intervention itself were examined. The study took place in 39 elementary schools in a southeastern state in the United States. Transformational leadership style of the building principal, percentage of white students at the school (which was proposed as a broader community socioeconomic variable), and adequacy of coaching were all associated with implementation.

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Section: Discussionmentioning

confidence: 99%

Factors associated with implementation of a school-based comprehensive program for students with autism

Odom

Sam

Tomaszewski

2022

Autism

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“…A limitation of the pCAT, is that we do not clearly state what respondents are to do with the information that comes from use of the tool. Within the LEAP program (23), coaches work with teams and highlight the value of identifying barriers and facilitators when implementing improvements or changes, so that barriers can be avoided or minimized, and facilitators can be leveraged for success. One next step users can take, draws on the work of Waltz et al, who elicited recommended strategies from implementation researchers and practitioners that would best address each CFIR construct when they manifest as a barrier (1).…”

Section: Discussionmentioning

confidence: 99%

A Pragmatic Context Assessment Tool (pCAT): Using a think aloud method to develop a practical assessment of contextual barriers to change

Robinson

Damschroder

2022

Preprint

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Background: The Consolidated Framework for Implementation Research (CFIR) is a determinant framework that can be used to guide context assessment prior to implementing change. Though a few quantitative measurement instruments have been developed based on the CFIR, most assessments using the CFIR have relied on qualitative methods. One challenge to measurement is to translate conceptual constructs which are often described using highly abstract, technical language into lay language that is clear, concise, and meaningful yet generalizable. The purpose of this study was to develop a pragmatic quantitative context assessment tool based on the CFIR for use by frontline teams in a clinical setting. Methods: Twenty-seven interviews based on the Think Aloud (TA) method (asking participants to verbalize thoughts as they respond to assessment questions) were conducted with frontline employees to identify areas of disconnect, misinterpretation, and misunderstanding of assessment questions. Interviews were recorded and transcribed verbatim. CFIR constructs were deductively applied as codes. Results: Participants identified several areas where language in the assessment tool needed to be modified, clarified, or made more nuanced and thus more useful and applicable for frontline employees. Participants found it easier to respond to elements in the tool when they had a recent, specific project in mind. They found it much more difficult to give meaningful responses when being asked to answer questions based on an abstract, general change; barriers and facilitators tend to be unique to each specific implementation. Participants also identified new concepts they felt were missing from the tool or that were conflated, leading to refinements that made the tool more comprehensive, accurate, and useful. Conclusions: Quantitative context assessment instruments must be designed to be practical and better align with everyday language used by frontline employees. The pCAT is short (14 items), freely available, uses accessible language, requires little proficiency or experience in assessment, and is designed to draw on the expertise and knowledge of individuals most familiar with their own clinical context. If rapid assessment tools are to have wide-spread use and utility, technical implementation science language must be translated using everyday language so frontline employees can capture accurate assessments of their context.

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“…In phase 1, we used QI training as a strategy for implementing DecisionPrecision as part of a hybrid type 3 implementation study design [ 14 ]. Specifically, we used a multisite, cluster-based randomization trial to compare the effectiveness of standard implementation versus the effectiveness of standard implementation plus the Learn, Engage, Act, and Process (LEAP) QI training program [ 15 ]. The standard implementation comprised integrating a link to the tool into the VA computerized patient record system (CPRS) and providing educational materials on the tool to a local LCS champion.…”

Section: Methodsmentioning

confidence: 99%

Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation

Lowery¹,

Fagerlin²,

Wiener³

et al. 2022

JMIR Hum Factors

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Background Lung cancer risk and life expectancy vary substantially across patients eligible for low-dose computed tomography lung cancer screening (LCS), which has important consequences for optimizing LCS decisions for different patients. To account for this heterogeneity during decision-making, web-based decision support tools are needed to enable quick calculations and streamline the process of obtaining individualized information that more accurately informs patient-clinician LCS discussions. We created DecisionPrecision, a clinician-facing web-based decision support tool, to help tailor the LCS discussion to a patient’s individualized lung cancer risk and estimated net benefit. Objective The objective of our study is to test two strategies for implementing DecisionPrecision in primary care at eight Veterans Affairs medical centers: a quality improvement (QI) training approach and academic detailing (AD). Methods Phase 1 comprised a multisite, cluster randomized trial comparing the effectiveness of standard implementation (adding a link to DecisionPrecision in the electronic health record vs standard implementation plus the Learn, Engage, Act, and Process [LEAP] QI training program). The primary outcome measure was the use of DecisionPrecision at each site before versus after LEAP QI training. The second phase of the study examined the potential effectiveness of AD as an implementation strategy for DecisionPrecision at all 8 medical centers. Outcomes were assessed by comparing absolute tool use before and after AD visits and conducting semistructured interviews with a subset of primary care physicians (PCPs) following the AD visits. Results Phase 1 findings showed that sites that participated in the LEAP QI training program used DecisionPrecision significantly more often than the standard implementation sites (tool used 190.3, SD 174.8 times on average over 6 months at LEAP sites vs 3.5 SD 3.7 at standard sites; P<.001). However, this finding was confounded by the lack of screening coordinators at standard implementation sites. In phase 2, there was no difference in the 6-month tool use between before and after AD (95% CI −5.06 to 6.40; P=.82). Follow-up interviews with PCPs indicated that the AD strategy increased provider awareness and appreciation for the benefits of the tool. However, other priorities and limited time prevented PCPs from using them during routine clinical visits. Conclusions The phase 1 findings did not provide conclusive evidence of the benefit of a QI training approach for implementing a decision support tool for LCS among PCPs. In addition, phase 2 findings showed that our light-touch, single-visit AD strategy did not increase tool use. To enable tool use by PCPs, prediction-based tools must be fully automated and integrated into electronic health records, thereby helping providers personalize LCS discussions among their many competing demands. PCPs also need more time to engage in shared decision-making discussions with their patients. Trial Registration ClinicalTrials.gov NCT02765412; https://clinicaltrials.gov/ct2/show/NCT02765412

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The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

Cited by 13 publications

References 50 publications

Factors associated with implementation of a school-based comprehensive program for students with autism

Factors associated with implementation of a school-based comprehensive program for students with autism

A Pragmatic Context Assessment Tool (pCAT): Using a think aloud method to develop a practical assessment of contextual barriers to change

Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation

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