What does it take to scale‐up a complex intervention? Lessons learned from the Connect‐Home transitional care intervention

Leeman, Jennifer; Toles, Mark

doi:10.1111/jan.14239

Cited by 8 publications

(6 citation statements)

References 37 publications

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“…This involvement enabled the researcher to observe and simultaneously support the implementation strategies throughout the project. Although this dual role may introduce bias, it has been used in similar implementation studies for an in-depth perspective of the implementation process [ 43 , 53 ]. All participants regularly interacted with/collaborated with the first author.…”

Section: Discussionmentioning

confidence: 99%

“…In the next phase of program scale-up, implementation strategies will be executed by community organization staff. This tiered approach has been successful in prior research [ 53 ], after building off an initial study with strong involvement of the researcher [ 43 , 52 , 53 ]. The two sites where the project was conducted are well-suited to take on such leadership responsibilities having closely collaborated and shaped the current form of the program and will be invited to share lessons learned with new scale-up sites.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of a diabetes prevention program within two community sites: a qualitative assessment

Dineen

Bean

Jung

2022

Implement Sci Commun

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Background Despite numerous translations of diabetes prevention programs, implementation evaluations are rarely conducted. The purpose of this study was to examine the implementation process and multilevel contextual factors as an evidence-based diabetes prevention program was implemented into two local community organization sites to inform future scale-up. To build the science of implementation, context and strategies must be identified and explored to understand their impact. Methods The program was a brief-counseling diet and exercise modification program for individuals at risk of developing type 2 diabetes. A 1-year collaborative planning process with a local not-for-profit community organization co-developed an implementation plan to translate the program. A pragmatic epistemology guided this research. Semi-structured interviews were conducted with staff who delivered the program (n = 8), and a focus group was completed with implementation support staff (n = 5) at both community sites. Interviews were transcribed verbatim and thematically analyzed using a template approach. The consolidated framework for implementation research (CFIR) is a well-researched multilevel implementation determinant framework and was used to guide the analysis of this study. Within the template approach, salient themes were first inductively identified, then identified themes were deductively linked to CFIR constructs. Results Implementation strategies used were appropriate, well-received, and promoted effective implementation. The implementation plan had an impact on multiple levels as several CFIR constructs were identified from all five domains of the framework: (a) process, (b) intervention characteristics, (c) outer setting, (d) inner setting, and (e) individual characteristics. Specifically, results revealed the collaborative 1-year planning process, program components and structure, level of support, and synergy between program and context were important factors in the implementation. Conclusion This study offers insights into the process of implementing a community-based diabetes prevention program in two local sites. Successful implementation benefited from a fully engaged, partnered approach to planning, and subsequently executing, an implementation effort. The CFIR was a useful and thorough framework to evaluate and identify multilevel contextual factors impacting implementation. Results can be used to inform future implementation and scale-up efforts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementation of a diabetes prevention program within two community sites: a qualitative assessment

Dineen

Bean

Jung

2022

Implement Sci Commun

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“…Greater attention to NH internal strategies also has the potential to build capacity of NH staff to apply QI when new problems arise [ 44 ]. Describing internal QI strategies also is critical to understanding the causal pathway through which external QI strategies affect change in service and client outcomes [ 45 ]. For example, to what extent do NH staff who participate in a QI collaborative complete the recommended internal QI strategies (e.g., conduct PDSA cycles to iteratively develop and test potential solutions)?…”

Section: Discussionmentioning

confidence: 99%

Quality improvement studies in nursing homes: a scoping review

Toles

Colón‐Emeric

Moreton

et al. 2021

BMC Health Serv Res

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Background Quality improvement (QI) is used in nursing homes (NH) to implement and sustain improvements in patient outcomes. Little is known about how QI strategies are used in NHs. This lack of information is a barrier to replicating successful strategies. Guided by the Framework for Implementation Research, the purpose of this study was to map-out the use, evaluation, and reporting of QI strategies in NHs. Methods This scoping review was completed to identify reports published between July 2003 through February 2019. Two reviewers screened articles and included those with (1) the term “quality improvement” to describe their methods, or reported use of a QI model (e.g., Six Sigma) or strategy (e.g., process mapping) (2), findings related to impact on service and/or resident outcomes, and (3) two or more NHs included. Reviewers extracted data on study design, setting, population, problem, solution to address problem, QI strategies, and outcomes (implementation, service, and resident). Vote counting and narrative synthesis were used to describe the use of QI strategies, implementation outcomes, and service and/or resident outcomes. Results Of 2302 articles identified, the full text of 77 articles reporting on 59 studies were included. Studies focused on 23 clinical problems, most commonly pressure ulcers, falls, and pain. Studies used an average of 6 to 7 QI strategies. The rate that strategies were used varied substantially, e.g., the rate of in-person training (55%) was more than twice the rate of plan-do-study-act cycles (20%). On average, studies assessed two implementation outcomes; the rate these outcomes were used varied widely, with 37% reporting on staff perceptions (e.g., feasibility) of solutions or QI strategies vs. 8% reporting on fidelity and sustainment. Most studies (n = 49) reported service outcomes and over half (n = 34) reported resident outcomes. In studies with statistical tests of improvement, service outcomes improved more often than resident outcomes. Conclusions This study maps-out the scope of published, peer-reviewed studies of QI in NHs. The findings suggest preliminary guidance for future studies designed to promote the replication and synthesis of promising solutions. The findings also suggest strategies to refine procedures for more effective improvement work in NHs.

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“…To illustrate, we describe application of the five proposed steps to the Connect-Home Transitional Care Intervention (Connect-Home) [ 34 ]. Connect-Home is delivered by multidisciplinary care teams (social worker, nurse, rehabilitation specialists) in skilled nursing facilities (SNFs) to prepare older adults and their caregivers for the transition to home.…”

Section: Main Textmentioning

confidence: 99%

A streamlined approach to classifying and tailoring implementation strategies: recommendations to speed the translation of research to practice

Leeman,

Rohweder,

Lafata

et al. 2024

Implement Sci Commun

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Background Implementation science emerged from the recognized need to speed the translation of effective interventions into practice. In the US, the science has evolved to place an ever-increasing focus on implementation strategies. The long list of implementation strategies, terminology used to name strategies, and time required to tailor strategies all may contribute to delays in translating evidence-based interventions (EBIs) into practice. To speed EBI translation, we propose a streamlined approach to classifying and tailoring implementation strategies. Main text A multidisciplinary team of eight scholars conducted an exercise to sort the Expert Recommendations for Implementing Change (ERIC) strategies into three classes: implementation processes (n = 25), capacity-building strategies (n = 20), and integration strategies (n = 28). Implementation processes comprise best practices that apply across EBIs and throughout the phases of implementation from exploration through sustainment (e.g., conduct local needs assessment). Capacity-building strategies target either general or EBI-specific knowledge and skills (e.g., conduct educational meetings). Integration strategies include “methods and techniques” that target barriers or facilitators to implementation of a specific EBI beyond those targeted by capacity building. Building on these three classes, the team collaboratively developed recommendations for a pragmatic, five-step approach that begins with the implementation processes and capacity-building strategies practice-settings are already using prior to tailoring integration strategies. A case study is provided to illustrate use of the five-step approach to tailor the strategies needed to implement a transitional care intervention in skilled nursing facilities. Conclusions Our proposed approach streamlines the formative work required prior to implementing an EBI by building on practice partner preferences, expertise, and infrastructure while also making the most of prior research findings.

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What does it take to scale‐up a complex intervention? Lessons learned from the Connect‐Home transitional care intervention

Cited by 8 publications

References 37 publications

Implementation of a diabetes prevention program within two community sites: a qualitative assessment

Implementation of a diabetes prevention program within two community sites: a qualitative assessment

Quality improvement studies in nursing homes: a scoping review

A streamlined approach to classifying and tailoring implementation strategies: recommendations to speed the translation of research to practice

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