Browsing by Author "Choate, Ashley"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness
    (BMC, 2022-07-29) Wang, Virginia; D’Adolf, Joshua; Decosimo, Kasey; Robinson, Katina; Choate, Ashley; Bruening, Rebecca; Sperber, Nina; Mahanna, Elizabeth; Van Houtven, Courtney H.; Allen, Kelli D.; Colón-Emeric, Cathleen; Damush, Teresa M.; Hastings, Susan N.; Medicine, School of Medicine
    Background: Clinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare. Still, intervention modifications are often limited in detail and justification, which may prevent rigorous evaluation of interventions and intervention adaptation effectiveness in new contexts. We describe our approach in a case study, combining two complementary intervention adaptation frameworks to modify CONNECT for Quality, a provider-facing team building and communication intervention designed to facilitate implementation of a new clinical program. Methods: This process of intervention adaptation involved the use of the Planned Adaptation Framework and the Framework for Reporting Adaptations and Modifications, for systematically identifying key drivers, core and non-core components of interventions for documenting planned and unplanned changes to intervention design. Results: The CONNECT intervention's original context and setting is first described and then compared with its new application. This lays the groundwork for the intentional modifications to intervention design, which are developed before intervention delivery to participating providers. The unpredictable nature of implementation in real-world practice required unplanned adaptations, which were also considered and documented. Attendance and participation rates were examined and qualitative assessment of reported participant experience supported the feasibility and acceptability of adaptations of the original CONNECT intervention in a new clinical context. Conclusion: This approach may serve as a useful guide for intervention implementation efforts applied in diverse clinical contexts and subsequent evaluations of intervention effectiveness.
  • Thumbnail Image
    Item
    Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals : A Stepped-Wedge, Cluster Randomized Trial
    (American College of Physicians, 2023) Hastings, Susan N.; Stechuchak, Karen M.; Choate, Ashley; Van Houtven, Courtney Harold; Allen, Kelli D.; Wang, Virginia; Colón-Emeric, Cathleen; Jackson, George L.; Damush, Teresa M.; Meyer, Cassie; Kappler, Caitlin B.; Hoenig, Helen; Sperber, Nina; Coffman, Cynthia J.; Medicine, School of Medicine
    Background: In trials, hospital walking programs have been shown to improve functional ability after discharge, but little evidence exists about their effectiveness under routine practice conditions. Objective: To evaluate the effect of implementation of a supervised walking program known as STRIDE (AssiSTed EaRly MobIlity for HospitalizeD VEterans) on discharge to a skilled-nursing facility (SNF), length of stay (LOS), and inpatient falls. Design: Stepped-wedge, cluster randomized trial. (ClinicalTrials.gov: NCT03300336). Setting: 8 Veterans Affairs hospitals from 20 August 2017 to 19 August 2019. Patients: Analyses included hospitalizations involving patients aged 60 years or older who were community dwelling and admitted for 2 or more days to a participating medicine ward. Intervention: Hospitals were randomly assigned in 2 stratified blocks to a launch date for STRIDE. All hospitals received implementation support according to the Replicating Effective Programs framework. Measurements: The prespecified primary outcomes were discharge to a SNF and hospital LOS, and having 1 or more inpatient falls was exploratory. Generalized linear mixed models were fit to account for clustering of patients within hospitals and included patient-level covariates. Results: Patients in pre-STRIDE time periods (n = 6722) were similar to post-STRIDE time periods (n = 6141). The proportion of patients with any documented walk during a potentially eligible hospitalization ranged from 0.6% to 22.7% per hospital. The estimated rates of discharge to a SNF were 13% pre-STRIDE and 8% post-STRIDE. In adjusted models, odds of discharge to a SNF were lower among eligible patients hospitalized in post-STRIDE time periods (odds ratio [OR], 0.6 [95% CI, 0.5 to 0.8]) compared with pre-STRIDE. Findings were robust to sensitivity analyses. There were no differences in LOS (rate ratio, 1.0 [CI, 0.9 to 1.1]) or having an inpatient fall (OR, 0.8 [CI, 0.5 to 1.1]). Limitation: Direct program reach was low. Conclusion: Although the reach was limited and variable, hospitalizations occurring during the STRIDE hospital walking program implementation period had lower odds of discharge to a SNF, with no change in hospital LOS or inpatient falls.
  • Thumbnail Image
    Item
    Implementing a Mandated Program Across a Regional Health Care System: A Rapid Qualitative Assessment to Evaluate Early Implementation Strategies
    (Wolters Kluwer, 2019-09-01) Sperber, Nina R.; Bruening, Rebecca A.; Choate, Ashley; Mahanna, Elizabeth; Wang, Virginia; Powell, Byron J.; Damush, Teresa; Jackson, George L.; Van Houtven, Courtney H.; Allen, Kelli D.; Hastings, Susan N.; Medicine, School of Medicine
    Rapid qualitative assessement was used to describe early strategies to implement an evidence-based walking program for hospitalized older adults, assiSTed eaRly mobIlity for hospitalizeD older vEterans (STRIDE), mandated by a regional Veterans Affairs health care system office (VISN). Data were collected from 6 hospital sites via semi-structured interviews with key informants, observations of telephone-based technical assistance (TA), and review of VISN-requested program documents (e.g., initial implementation plans). An overaching framework of actionable feedback for VISN leadership and specification of locally initiated implementation strategies, using the Expert Recommendations for Implementing Change (ERIC) compilation, was used. Actionable feedback was shared with VISN leadership one month after the initiative. ERIC implementation strategies identified were: 1) Promoting Adaptability- Four sites had physical therapists (PT)/ kinesiotherapists (KT) instead of assistants walk patients, 2) Promoting Network Weaving- Strengthening nursing and PT/ KT partnership with regular communication opportunities or a point person was important for implementation, 3) Distributing Educational Materials – Two sites distributed information about STRIDE via email and in-person, and 4) Organizing Clinician Implementation Team Meetings – Three sites used interdisciplinary team meetings to communicate with clinical staff about STRIDE. This qualitative study sheds light on early experiences with implementing STRIDE; the results have been instructive for ongoing implementation and future dissemination of STRIDE, and the approach can be applied across contexts to inform implementation of other programs.