Browsing by Subject "Implementation strategies"

Now showing 1 - 4 of 4
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    Development and use of a toolkit to facilitate implementation of an evidence-based intervention: a descriptive case study
    (BMC, 2020-10-06) Thoele, Kelli; Ferren, Melora; Moffat, Laura; Keen, Alyson; Newhouse, Robin; School of Nursing
    Background Implementation of evidence-based clinical interventions in real-world settings becomes a futile effort when effective strategies to foster adoption are not used. A toolkit, or a collection of adaptable documents to inform and facilitate implementation, can increase the use of evidence-based interventions. Most available toolkits provide resources about the intervention but lack guidance for adaptation to different contexts or strategies to support implementation. This paper describes the development and use of a toolkit to guide the implementation of an evidence-based intervention to identify and intervene for people with risky substance use. Methods A descriptive case study describes the development and use of a toolkit throughout a two-year study. Investigators and site coordinators from 14 acute care hospitals developed tools and engaged external stakeholders as they prepared for implementation, integrated the clinical intervention into practice, and reflected on implementation. Results The final toolkit included 54 different tools selected or created to define the intervention, engage and communicate with stakeholders, assess for readiness and plan for implementation, train clinical nurses and other stakeholders, evaluate training and implementation effectiveness, create policies and procedures for different contexts, and identify opportunities for reimbursement. Each tool corresponds to one or more implementation strategies. Conclusion The approach used to develop this implementation toolkit may be used to create resources for the implementation of other evidence-based interventions.
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    Integration and evaluation of implementation strategies to improve guideline-concordant bladder cancer surveillance: a prospective observational study
    (Springer Nature, 2025-04-07) Zubkoff, Lisa; Ould Ismail, A. Aziz; Jensen, Laura; Haggstrom, David A.; Kale, Soham; Issa, Muta M.; Tosoian, Jeffrey J.; Siddiqui, Mohummad Minhaj; Bloomquist, Kennedi; Kimball, Elisabeth R.; Zickmund, Susan; Schroeck, Florian R.; Medicine, School of Medicine
    Background: Despite guideline recommendations, our prior work revealed more than half of low-risk bladder cancer patients within the Department of Veterans Affairs (VA) undergo too many surveillance procedures and about a third of high-risk patients do not undergo enough procedures. Thus, we developed and integrated implementation strategies to improve risk-aligned bladder cancer surveillance for the VA. Methods: Prior work used Implementation Mapping to develop nine implementation strategies: change record systems, educational meetings, champions, tailoring, preparing patients to be active participants, external facilitation, remind clinicians, audit & feedback, and a blueprint. We integrated these strategies as improvement approaches across four VA urology clinics. Primary implementation outcomes were qualitatively measured via coding of semi-structured interviews with clinicians and co-occurrence of codes. Implementation outcomes included: appropriateness, acceptability, and feasibility. Exploratory quantitative outcomes included clinicians' recommendations for guideline-concordant bladder cancer surveillance intervals and sustainability. Results: Eleven urologists were interviewed. Co-occurrence analysis of codes across strategies indicated that urologists most commonly reported on the acceptability and appropriateness of changing the record system, preparing patients to be active participants ("surveillance grid"), reminders (i.e., cheat sheet), and educational sessions. We confirmed feasibility of all implementation strategies. Urologists indicated that changing the record system had a high impact, reduced documentation time, and guided resident physicians. Preparing patients to be active participants using the "surveillance grid" was seen as an effective but time-consuming tool. Educational sessions were seen as critical to support implementation. In quantitative analyses, clinicians recommended guideline-concordant surveillance about 65% of the time at baseline for low-risk patients, and this improved to 70% during evaluation. Across all risk levels, the largest improvement was observed at site 2 while site 3 did not improve. All sites sustained use of the changed record system, while sustainability of other strategies was variable. Conclusions: Based on summative interpretation of results, the most appropriate, acceptable, and feasible strategies include changing record systems via a template and educational meetings focused on guideline-concordant surveillance. Future work should assess the impact of the improvement approaches on clinical care processes, particularly on reducing overuse of surveillance procedures among low-risk patients.
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    Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review
    (BMC, 2021-05-11) Thoele, Kelli; Moffat, Laura; Konicek, Stephanie; Lam-Chi, Monika; Newkirk, Erica; Fulton, Janet; Newhouse, Robin; School of Nursing
    Background: Screening, brief intervention, and referral to treatment (SBIRT), is an approach for the prevention and treatment of substance use disorders, but is often underutilized in healthcare settings. Although the implementation of SBIRT is challenging, the use of multi-faceted and higher intensity strategies are more likely to result in the successful incorporation of SBIRT into practice in primary care settings. SBIRT may be used in different healthcare settings, and the context for implementation and types of strategies used to support implementation may vary by setting. The purpose of this scoping review is to provide an overview regarding the use of strategies to support implementation of SBIRT in all healthcare settings and describe the associated outcomes. Methods: A scoping review was conducted using CINAHL Complete, HealthBusiness FullTEXT, PsycINFO, PubMed, and Embase to search for articles published in English prior to September 2019. The search returned 462 citations, with 18 articles included in the review. Two independent reviewers extracted data from each article regarding the theory, design, timeline, location, setting, patient population, substance type, provider, sample size and type, implementation strategies, and implementation outcomes. The reviewers entered all extracted data entered into a table and then summarized the results. Results: Most of the studies were conducted in the United States in primary care or emergency department settings, and the majority of studies focused on SBIRT to address alcohol use in adults. The most commonly used strategies to support implementation included training and educating stakeholders or developing stakeholder interrelationships. In contrast, only a few studies engaged patients or consumers in the implementation process. Efforts to support implementation often resulted in an increase in screening, but the evidence regarding the brief intervention is less clear, and most studies did not assess the reach or adoption of the referral to treatment. Discussion: In addition to summarizing the strategies used to increase reach and adoption of SBIRT in healthcare settings, this scoping review identified multiple gaps in the literature. Two major gaps include implementation of SBIRT in acute care settings and the application of implementation theories to inform healthcare efforts to enable use of SBIRT.
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    Utility of the Leadership and Organizational Change for Implementation-Systems Level (LOCI-SL) strategy for a statewide substance use treatment implementation effort
    (Elsevier, 2024) Crable, Erika L.; Sklar, Marisa; Kandah, Alexandra; Samuels, Hannah C.; Ehrhart, Mark G.; Aalsma, Matthew C.; Hulvershorn, Leslie; Willging, Cathleen E.; Aarons, Gregory A.; Pediatrics, School of Medicine
    Introduction: Multi-level and cross-context implementation strategies are needed to support health systems, healthcare delivery organizations, and providers to adopt evidence-based practice (EBP) for substance use disorder (SUD) treatment. However, misalignment between state oversight agencies and healthcare organizations about which services to prioritize and which outcomes are reasonable to expect can hinder implementation success and widespread access to high-quality care. This study investigated the utility of the Leadership and Organizational Change for Implementation-System Level (LOCI-SL) strategy for supporting statewide EBP implementation for SUD treatment. Methods: Nine community mental health centers (CMHCs) contracted by a state agency participated in a combined motivational-enhancement therapy and cognitive behavioral therapy (MET/CBT) implementation effort. Five of the CMHCs also received the LOCI-SL strategy to obtain ongoing implementation support. We conducted 21 individual interviews and three small group interviews with 30 participants across CMHCs and state health agencies to investigate the utility of LOCI-SL in supporting their EBP implementation efforts. Deductive thematic analysis was guided by the Exploration, Preparation, Implementation, Sustainment Framework. Results: Five themes described CMHCs' LOCI-SL and broader contextual experiences implementing EBPs: (1) LOCI-SL supported executives in Preparation phase activities that holistically considered organizational needs and capacity to implement and sustain EBPs; (2) LOCI-SL facilitated trust and communication processes across Preparation, Implementation, and Sustainment phases to improve EBP uptake; (3) LOCI-SL increased CMHCs' use of implementation climate strengthening activities throughout the Implementation phase; (4) state contracts did not emphasize quality and thus were not sufficient bridging factors to enforce EBP fidelity during Implementation; and, (5) limited funding and low Medicaid reimbursement rates hindered EBP use throughout the Implementation and Sustainment phases. Conclusions: LOCI-SL was viewed as a favorable and useful implementation strategy for supporting statewide adoption of EBPs. However, outer context barriers, including limited financial investments in the treatment system, impeded implementation and sustainment efforts. While previous research suggests that contracts are viable alignment-promoting bridging factors, this study demonstrates the importance of articulating implementation outcome expectations to aid state-contracted organizations in achieving EBP implementation success. This study also highlights the need for multi-level implementation strategies to effectively align implementation expectations between outer- and inner-context entities.