scholarly journals SIPsmartER delivered through rural, local health districts: adoption and implementation outcomes

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kathleen J. Porter ◽  
Donna Jean Brock ◽  
Paul A. Estabrooks ◽  
Katelynn M. Perzynski ◽  
Erin R. Hecht ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Implementation Strategies ◽  
Health Impact ◽  
Dissemination And Implementation ◽  
High Fidelity ◽  
Local Health ◽  
Implementation Outcomes ◽  
Phone Calls ◽  
Adoption And Implementation ◽  
Health Districts

Abstract Background SIPsmartER is a 6-month evidenced-based, multi-component behavioral intervention that targets sugar-sweetened beverages among adults. It consists of three in-person group classes, one teach-back call, and 11 automated phone calls. Given SIPsmartER’s previously demonstrated effectiveness, understanding its adoption, implementation, and potential for integration within a system that reaches health disparate communities is important to enhance its public health impact. During this pilot dissemination and implementation trial, SIPsmartER was delivered by trained staff from local health districts (delivery agents) in rural, Appalachian Virginia. SIPsmartER’s execution was supported by consultee-centered implementation strategies. Methods In this mixed-methods process evaluation, adoption and implementation indicators of the program and its implementation strategy (e.g., fidelity, feasibility, appropriateness, acceptability) were measured using tracking logs, delivery agent surveys and interviews, and fidelity checklists. Quantitative data were analyzed with descriptive statistics. Qualitative data were inductively coded. Results Delivery agents implemented SIPsmartER to the expected number of cohorts (n = 12), recruited 89% of cohorts, and taught 86% of expected small group classes with > 90% fidelity. The planned implementation strategies were also executed with high fidelity. Delivery agents completing the two-day training, pre-lesson meetings, fidelity checklists, and post-lesson meetings at rates of 86, 75, 100, and 100%, respectively. Additionally, delivery agents completed 5% (n = 3 of 66) and 10% (n = 6 of 59) of teach-back and missed class calls, respectively. On survey items using 6-point scales, delivery agents reported, on average, higher feasibility, appropriateness, and acceptability related to delivering the group classes (range 4.3 to 5.6) than executing missed class and teach-back calls (range 2.6 to 4.6). They also, on average, found the implementation strategy activities to be helpful (range 4.9 to 6.0). Delivery agents identified strengths and weakness related to recruitment, lesson delivery, call completion, and the implementation strategy. Conclusions In-person classes and the consultee-centered implementation strategies were viewed as acceptable, appropriate, and feasible and were executed with high fidelity. However, implementation outcomes for teach-back and missed class calls and recruitment were not as strong. Findings will inform the future full-scale dissemination and implementation of SIPsmartER, as well as other evidence-based interventions, into rural health districts as a means to improve population health.

Adaptation in Dissemination and Implementation Science

2017 ◽  
Author(s):  
Ana A. Baumann ◽  
Leopoldo J. Cabassa ◽  
Shannon Wiltsey Stirman
Keyword(s):  
Implementation Science ◽  
Implementation Research ◽  
Implementation Strategies ◽  
Dissemination And Implementation ◽  
Research And Practice ◽  
Implementation Outcomes ◽  
Dissemination And Implementation Science ◽  
Dissemination And Implementation Research

This chapter focuses on adaptations in the context of dissemination and implementation research and practice. Consistent with the existing literature, the authors recommend that adaptations be proactively and iteratively determined, strongly informed by a variety of stakeholders, and that efforts be made to carefully describe and document the nature of the adaptations and evaluate their impact on desired service, health, and implementation outcomes. While this chapter focuses on adaptations to interventions and the context of practice, the authors also note that adaptations may need to be made to implementation strategies. Following the call by Proctor and colleagues for further precision in defining and operationalizing implementation strategies, and based on evidence that scholars are not necessarily reporting what and how they are adapting the interventions, scholars are urged to define and evaluate the adaptations they are making not only to the interventions and context of practice but also to the implementation strategies.

scholarly journals Integrating implementation science in clinical research to maximize public health impact: a call for the reporting and alignment of implementation strategy use with implementation outcomes in clinical research

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Brittany N. Rudd ◽  
Molly Davis ◽  
Rinad S. Beidas
Keyword(s):  
Public Health ◽  
Clinical Research ◽  
Implementation Research ◽  
Implementation Strategy ◽  
Health Impact ◽  
Strategy Use ◽  
Reporting Guidelines ◽  
Public Health Impact ◽  
Main Body ◽  
Implementation Outcomes

Abstract Background Although comprehensive reporting guidelines for implementation strategy use within implementation research exist, they are rarely used by clinical (i.e., efficacy and effectiveness) researchers. In this debate, we argue that the lack of comprehensive reporting of implementation strategy use and alignment of those strategies with implementation outcomes within clinical research is a missed opportunity to efficiently narrow research-to-practice gaps. Main body We review ways that comprehensively specifying implementation strategy use can advance science, including enhancing replicability of clinical trials and reducing the time from clinical research to public health impact. We then propose that revisions to frequently used reporting guidelines in clinical research (e.g., CONSORT, TIDieR) are needed, review current methods for reporting implementation strategy use (e.g., utilizing StaRI), provide pragmatic suggestions on how to both prospectively and retrospectively specify implementation strategy use and align these strategies with implementation outcomes within clinical research, and offer a case study of using these methods. Conclusions The approaches recommended in this article will not only contribute to shared knowledge and language among clinical and implementation researchers but also facilitate the replication of efficacy and effectiveness research. Ultimately, we hope to accelerate translation from clinical to implementation research in order to expedite improvements in public health.

scholarly journals The Tennessee Medicaid medication therapy management program: early stage contextual factors and implementation outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kenneth C. Hohmeier ◽  
Chelsea Renfro ◽  
Kea Turner ◽  
Parin Patel ◽  
Estrella Ndrianasy ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Early Stage ◽  
Implementation Strategies ◽  
Medication Therapy Management ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Pilot Program ◽  
Individual Level ◽  
Medication Therapy ◽  
Implementation Outcomes

Abstract Background First investigated in the 1990s, medication therapy management (MTM) is an evidence-based practice offered by pharmacists to ensure a patient’s medication regimen is individualized to include the safest and most effective medications. MTM has been shown to a) improve quality of patient care, b) reduces health care costs, and c) lead to fewer medication-related adverse effects. However, there has been limited testing of evidence-based, a-priori implementation strategies that support MTM implementation on a large scale. Methods The study has two objectives assessed at the organizational and individual level: 1) to determine the adoption, feasibility, acceptability and appropriateness of a multi-faceted implementation strategy to support the MTM pilot program in Tennessee; and 2) to report on the contextual factors associated with program implementation based on the Consolidated Framework for Implementation Research (CFIR). The overall design of the study was a hybrid type 2 effectiveness-implementation study reporting outcomes of Tennessee state Medicaid’s (TennCare) MTM Pilot program. This paper presents early stage implementation outcomes (e.g., adoption, feasibility, acceptability, appropriateness) and explores implementation barriers and facilitators using the CFIR. The study was assessed at the (a) organizational and (b) individual level. A mixed-methods approach was used including surveys, claims data, and semi-structured interviews. Interview data underwent initial, rapid qualitative analysis to provide real time feedback to TennCare leadership on project barriers and facilitators. Results The total reach of the program from July 2018 through June 2020 was 2033 MTM sessions provided by 17 Medicaid credentialed pharmacists. Preliminary findings suggest participants agreed that MTM was acceptable (μ = 16.22, SD = 0.28), appropriate (μ = 15.33, SD = 0.03), and feasible (μ = 14.72, SD = 0.46). Each of the scales had an excellent level of internal (> 0.70) consistency (feasibility, α = 0.91; acceptability, α = 0.96; appropriateness, α = 0.98;). Eight program participants were interviewed and were mapped to the following CFIR constructs: Process, Characteristics of Individuals, Intervention Characteristics, and Inner Setting. Rapid data analysis of the contextual inquiry allowed TennCare to alter initial implementation strategies during project rollout. Conclusion The early stage implementation of a multi-faceted implementation strategy to support delivery of Tennessee Medicaid’s MTM program was found to be well accepted and appropriate across multiple stakeholders including providers, administrators, and pharmacists. However, as the early stage of implementation progressed, barriers related to relative priority, characteristics of the intervention (e.g., complexity), and workflow impeded adoption. Programmatic changes to the MTM Pilot based on early stage contextual analysis and implementation outcomes had a positive impact on adoption.

scholarly journals Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
J. Edward Murrell ◽  
Janell L. Pisegna ◽  
Lisa A. Juckett
Keyword(s):  
Occupational Therapy ◽  
Scoping Review ◽  
Stroke Rehabilitation ◽  
Implementation Strategy ◽  
Implementation Strategies ◽  
Stroke Care ◽  
Stroke Survivor ◽  
Educational Outreach ◽  
Evidence Based ◽  
Implementation Outcomes

Abstract Background Stroke survivors often encounter occupational therapy practitioners in rehabilitation practice settings. Occupational therapy researchers have recently begun to examine the implementation strategies that promote the use of evidence-based occupational therapy practices in stroke rehabilitation; however, the heterogeneity in how occupational therapy research is reported has led to confusion about the types of implementation strategies used in occupational therapy and their association with implementation outcomes. This review presents these strategies and corresponding outcomes using uniform language and identifies the extent to which strategy selection has been guided by theories, models, and frameworks (TMFs). Methods A scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies, outcomes, and TMFs in the stroke rehabilitation field. Five electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting the inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer to achieve consensus. The 73-item Expert Recommendations for Implementing Change (ERIC) implementation strategy taxonomy guided the synthesis of implementation strategies. The Implementation Outcomes Framework guided the analysis of measured outcomes. Results The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were described in the included studies. The most used implementation strategies were “distribute educational materials” (n = 11), “assess for readiness and identify barriers and facilitators” (n = 11), and “conduct educational outreach visits” (n = 10). “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings supporting the effectiveness of their implementation strategy or strategies; eleven reported inconclusive findings, and four found that their strategies did not lead to improved implementation outcomes. In twelve studies, at least partially beneficial outcomes were reported, corresponding with researchers using TMFs to guide implementation strategies. Conclusions This scoping review synthesized implementation strategies and outcomes that have been examined in occupational therapy and stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the use of evidence-based practices in routine stroke care and describe those strategies, as well as associated outcomes, using uniform nomenclature. Doing so could advance the occupational therapy field’s ability to draw conclusions about effective implementation strategies across diverse practice settings.

scholarly journals Using Implementation Science Strategy Mapping on the Age-Friendly Health System's 4Ms Journey

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 365-365
Author(s):  
Mary Dolansky ◽  
Anne Pohnert ◽  
Sherry Greenberg
Keyword(s):  
Implementation Science ◽  
Scale Up ◽  
Implementation Strategies ◽  
Mapping Method ◽  
Evidence Based ◽  
Systematic Process ◽  
Implementing Change ◽  
Implementation Outcomes ◽  
Adoption And Implementation ◽  
And Performance

Abstract Background Implementation science is the study of methods to promote the adoption and integration of evidence-based practices into routine health care to improve the quality of care. The purpose of this study was to use Implementation Mapping to guide the implementation of The John A. Hartford evidence-based Age-Friendly Health Systems (AFHS) 4Ms Framework: What Matters, Medications, Mentation, and Mobility. Methods Implementation Mapping, a systematic process for planning implementation strategies, guided the 9-month integration of the 4Ms Framework in the 1,100 MinuteClinics across the US. Implementation Mapping includes five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. Results The implementation plan, developed by the implementation mapping method, was carried out over 9-months. Seven implementation strategies were identified from the Expert Recommendations for Implementing Change (ERIC) project including the provision of education, electronic health record integration, internal champion facilitation, cues to action, and a dashboard to monitor progress. To date, the implementation mapping has resulted in the adoption of the 4Ms by 1145 providers (37%). Monitoring of the adoption of the 4Ms Framework and consideration of future implementation strategies is ongoing. Conclusions Implementation Mapping provided a systematic process to develop strategies to improve the adoption, implementation, sustainment, and scale-up of the evidence-based 4Ms Framework.

scholarly journals The U.S. State of Tennessee's Medicaid Medication Therapy Management Program: Early Stage Contextual Factors and Implementation Outcomes

2021 ◽  
Author(s):  
Kenneth C Hohmeier ◽  
Chelsea Renfro ◽  
Kea Turner ◽  
Parin Patel ◽  
Estrella Ndrianasy ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Early Stage ◽  
Implementation Strategies ◽  
Medication Therapy Management ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Pilot Program ◽  
Individual Level ◽  
Medication Therapy ◽  
Implementation Outcomes

Abstract Background First investigated in the 1990s, medication therapy management (MTM) is an evidence-based practice offered by pharmacists to ensure a patient’s medication regimen is individualized to include the safest and most effective medications. MTM has been shown to a) improve quality of patient care, b) reduces health care costs, and c) lead to fewer medication-related adverse effects. However, there has been limited testing of evidence-based, a-priori implementation strategies that support MTM implementation on a large scale. Methods The study has two objectives assessed at the organizational and individual level: 1) to determine the adoption, feasibility, acceptability and appropriateness of a multi-faceted implementation strategy to support the MTM pilot program in Tennessee; and 2) to report on the contextual factors associated with program implementation based on the Consolidated Framework for Implementation Research (CFIR). The overall design of the study was a hybrid type 2 effectiveness-implementation study reporting outcomes of Tennessee state Medicaid’s (TennCare) MTM Pilot program. This paper presents early stage implementation outcomes (e.g., adoption, feasibility, acceptability, appropriateness) and explores implementation barriers and facilitators using the CFIR. The study was assessed at the (a) organizational and (b) individual level. A mixed-methods approach was used including surveys, claims data, and semi-structured interviews. Interview data underwent initial, rapid qualitative analysis to provide real time feedback to TennCare leadership on project barriers and facilitators. Results The total reach of the program through June 2020 was 2,033 MTM sessions provided by 17 Medicaid credentialed pharmacists. Preliminary findings suggest participants agreed that MTM was acceptable (µ = 16.22, SD = 0.28), appropriate (µ = 15.33, SD = 0.03), and feasible (µ = 14.72, SD = 0.46) (Table 4). Each of the scales had an excellent level of internal (> 0.70) consistency (feasibility, α=0.91; acceptability, α=0.96; appropriateness, α=0.98;). Eight program participants were interviewed and were mapped to the following CFIR constructs: Process, Characteristics of Individuals, Intervention Characteristics, and Inner Setting. Rapid data analysis of the contextual inquiry allowed TennCare to alter initial implementation strategies during project rollout. Conclusion The early stage implementation of a multi-faceted implementation strategy to support delivery of Tennessee Medicaid’s MTM program was found to be well accepted and appropriate across multiple stakeholders including providers, administrators, and pharmacists. However, as the early stage of implementation progressed, barriers related to relative priority, characteristics of the intervention (e.g., complexity), and workflow impeded adoption. Programmatic changes to the MTM Pilot based on early stage contextual analysis and implementation outcomes had a positive impact on adoption.

scholarly journals Implementation of the National Action Plan Health Literacy in Germany—Lessons Learned

2020 ◽  
Vol 17 (12) ◽  
pp. 4403 ◽  
Author(s):  
Doris Schaeffer ◽  
Svea Gille ◽  
Klaus Hurrelmann
Keyword(s):  
Health Literacy ◽  
Implementation Strategy ◽  
Action Plan ◽  
Implementation Strategies ◽  
Lessons Learned ◽  
Dissemination And Implementation ◽  
Policy Agenda ◽  
Action Plans ◽  
National Action Plan ◽  
Science And Research

The promotion of health literacy (HL) has become an important task in public health. In response, in many countries, strategies and action plans to strengthen HL have been developed. Systematic discussion of implementation strategies of action plans on HL is scarce. This paper presents the implementation strategy and the methodical process of its realization of the National Action Plan HL in Germany which was published in 2018. The implementation strategy was based on considerations of implementation science and research. A process consisting of a continuum of various overlapping methodical and strategic steps of diffusion, dissemination and implementation based on collaboration and co-production was chosen. According to this, the Action Plan was widely diffused via various channels, disseminated through numerous publications and presentations, and implemented in several settings by holding workshops with stakeholders from politics, science and practice, as well as by cooperating with the Alliance for Health Literacy. This three-part collaborative and co-productive implementation strategy has helped to place HL and the National Action Plan on the health policy agenda in Germany. Experience demonstrates that implementation should be also considered, systematically planned, and addressed when developing strategies to strengthen HL.

Dissemination and Implementation Research

2014 ◽  
Author(s):  
Enola Proctor
Keyword(s):  
Implementation Research ◽  
Implementation Strategies ◽  
Research Translation ◽  
Dissemination And Implementation ◽  
Methodological Issues ◽  
Implementation Outcomes ◽  
Dissemination And Implementation Research ◽  
Specific Implementation ◽  
Key Terms ◽  
Variable Measurement

Implementation research seeks to inform how to deliver evidence-based interventions, programs, and policies in real-world settings so their benefits can be realized and sustained. The ultimate aim of implementation research is building a base of evidence about the most effective processes and strategies for improving service delivery. Implementation research builds upon effectiveness research and then seeks to discover how to use specific implementation strategies and move those interventions into specific settings, extending their availability, reach, and benefits to clients and communities. This entry provides an overview of implementation research as a component of research translation and defines key terms, including implementation outcomes and implementation strategies, as well as an overview of guiding theories and models and methodological issues including variable measurement, research design, and stakeholder engagement.

scholarly journals The Canadian 24-Hour Movement Guidelines for Children and Youth: Implications for practitioners, professionals, and organizations

2016 ◽  
Vol 41 (6 (Suppl. 3)) ◽  
pp. S328-S335 ◽  
Author(s):  
Amy E. Latimer-Cheung ◽  
Jennifer L. Copeland ◽  
Jonathon Fowles ◽  
Lori Zehr ◽  
Mary Duggan ◽  
...  
Keyword(s):  
Public Health ◽  
Service Provision ◽  
Interdisciplinary Collaboration ◽  
Vigorous Physical Activity ◽  
Implementation Strategies ◽  
Health Impact ◽  
Children And Youth ◽  
Dissemination And Implementation ◽  
Evaluation Plan

The new Canadian 24-Hour Movement Guidelines for Children and Youth emphasize the integration of all movement behaviours that occur over a whole day (i.e., light, moderate, and vigorous physical activity, sedentary behaviour, and sleep). These guidelines shift the paradigm away from considering each behaviour in isolation. This concept of the “whole day matters” not only calls for a change in thinking about movement but also for redevelopment of dissemination and implementation practice. Past guideline launch activities largely have aimed to create awareness through passive dissemination strategies (e.g., Website posts, distribution of print resources). For the integrated guidelines to have public health impact, we must move beyond dissemination and raising of awareness to implementation and behaviour change. Shifting this focus requires new, innovative approaches to intervention, including interdisciplinary collaboration, policy change, and refocused service provision. The purpose of this paper is to identify practitioners, professionals, and organizations with potential to disseminate and/or implement the guidelines, discuss possible implementation strategies for each of these groups, and describe the few resources being developed and those needed to support dissemination and implementation efforts. This discussion makes readily apparent the need for a well-funded, comprehensive, long-term dissemination, implementation, and evaluation plan to ensure uptake and activation of the guidelines.

The Role of Economic Evaluation in Dissemination and Implementation Research

2017 ◽  
Author(s):  
Ramesh Raghavan
Keyword(s):  
Service Providers ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Point Of View ◽  
Dissemination And Implementation ◽  
Economic Point ◽  
Open Questions ◽  
Public Health Organizations ◽  
Quality Health ◽  
Dissemination And Implementation Research

This chapter presents an overview of how D&I research can be evaluated from an economic point of view. Dissemination and implementation imposes costs upon knowledge purveyors, provider organizations, public health organizations, and payers (including governments). However, whether these added costs will result in improved service delivery and, perhaps more importantly, client outcomes and improvements in population health remain as open questions. If emerging studies reveal that defined implementation strategies are more cost effective than “usual” implementation, then policymakers and service providers will need to resource these added costs of implementation in order to assure the success and sustainability of high-quality health services over the long term.

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