A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project

Purpose: Skills in selecting and designing strategies for implementing research-supported interventions (RSIs) within specific local contexts are important for progressing a wider RSI adoption and application in human and social services. This also applies to a particular role in implementation, the implementation support practitioner (ISP). This study examines which strategies have been reported as being used by ISPs across multiple bodies of research on implementation support and how these strategies were applied in concrete practice settings. Methods: A systematic integrative review was conducted. Data analysis utilized the Expert Recommendations for Implementing Change compilation of implementation strategies. Results: Studies reported on 18 implementation strategies commonly used by different ISPs, who require mastery in selecting, operationalizing, and detailing these. Two further strategies not included in the ERIC compilation could be identified. Discussion: Given the use of primarily more feasible implementation support strategies among ISPs, their potential as agents of change may be underutilized.

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Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study

Implementation Science ◽

10.1186/s13012-015-0295-0 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 140

Author(s):

Thomas J. Waltz ◽

Byron J. Powell ◽

Monica M. Matthieu ◽

Laura J. Damschroder ◽

Matthew J. Chinman ◽

...

Keyword(s):

Concept Mapping ◽

Implementation Strategies ◽

Implementing Change ◽

Expert Recommendations

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Strategies to Integrate Genomic Medicine into Clinical Care: Evidence from the IGNITE Network

Journal of Personalized Medicine ◽

10.3390/jpm11070647 ◽

2021 ◽

Vol 11 (7) ◽

pp. 647

Author(s):

Nina R. Sperber ◽

Olivia M. Dong ◽

Megan C. Roberts ◽

Paul Dexter ◽

Amanda R. Elsey ◽

...

Keyword(s):

Precision Medicine ◽

Program Implementation ◽

Clinical Care ◽

Genomic Medicine ◽

Implementation Strategies ◽

Clinical Decision ◽

Implementing Change ◽

Implementation Outcomes ◽

Planning Framework

The complexity of genomic medicine can be streamlined by implementing some form of clinical decision support (CDS) to guide clinicians in how to use and interpret personalized data; however, it is not yet clear which strategies are best suited for this purpose. In this study, we used implementation science to identify common strategies for applying provider-based CDS interventions across six genomic medicine clinical research projects funded by an NIH consortium. Each project’s strategies were elicited via a structured survey derived from a typology of implementation strategies, the Expert Recommendations for Implementing Change (ERIC), and follow-up interviews guided by both implementation strategy reporting criteria and a planning framework, RE-AIM, to obtain more detail about implementation strategies and desired outcomes. We found that, on average, the three pharmacogenomics implementation projects used more strategies than the disease-focused projects. Overall, projects had four implementation strategies in common; however, operationalization of each differed in accordance with each study’s implementation outcomes. These four common strategies may be important for precision medicine program implementation, and pharmacogenomics may require more integration into clinical care. Understanding how and why these strategies were successfully employed could be useful for others implementing genomic or precision medicine programs in different contexts.

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A Strategy Matching Tool for Boosting Implementation of Geriatric Telehealth Services in Rural CBOCs

Innovation in Aging ◽

10.1093/geroni/igab046.458 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 120-120

Author(s):

Laura Kernan ◽

Eileen Dryden ◽

Camilla Pimentel ◽

Kathryn Nearing ◽

Lauren Moo

Keyword(s):

Change Implementation ◽

Outpatient Clinics ◽

Veterans Administration ◽

Community Based ◽

Hub And Spoke ◽

Implementing Change ◽

Medical Centers ◽

Implementation Approach ◽

Facilitators And Barriers ◽

Expert Recommendations

Abstract Fifteen Veterans Administration Medical Centers (VAMCs) offer geriatric specialty care telehealth services through a hub and spoke model to patients at affiliated community-based outpatient clinics (CBOCs). These services are not used to the extent they could be. Through interviews with 50 staff and providers at rural CBOCs we identified several implementation facilitators and barriers. CBOC-level barriers included space constraints, low staffing, internet connection issues, and limited knowledge of services available and referral processes. Patient-level barriers included discomfort with technology, cognitive decline, and inability to travel to the CBOC. We found that champions within the CBOC and iterative, targeted outreach from the hub helped facilitate uptake of services. We entered the identified barriers into the CFIR-ERIC (Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool to help generate targeted strategies that will be used to refine each hub’s implementation approach.

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How are pharmacists in Ontario adapting to practice change? Results of a qualitative analysis using Kotter’s change management model

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163517701470 ◽

2017 ◽

Vol 150 (3) ◽

pp. 198-205 ◽

Cited By ~ 8

Author(s):

Beatriz Teixeira ◽

Paul A. M. Gregory ◽

Zubin Austin

Keyword(s):

Change Management ◽

Stages Of Change ◽

Implementation Strategies ◽

Community Pharmacists ◽

Practice Change ◽

Scope Of Practice ◽

Management Model ◽

Implementing Change ◽

Context Specific ◽

Specific Implementation

Background: The pace of practice change in community pharmacy over the past decade has been significant, yet there is little evidence documenting implementation of change in the profession. Methods: Kotter’s change management model was selected as a theoretical framework for this exploratory qualitative study. Community pharmacists were interviewed using a semistructured protocol based on Kotter’s model. Data were analyzed and coded using a constant-comparative iterative method aligned with the stages of change management outlined by Kotter. Results: Twelve community pharmacists were interviewed. Three key themes emerged: 1) the profession has successfully established the urgency to, and created a climate conducive for, change; 2) the profession has been less successful in engaging and enabling the profession to actually implement change; and 3) legislative changes (for example, expansion of pharmacists’ scope of practice) may have occurred prematurely, prior to other earlier stages of the change process being consolidated. Interpretation: As noted by most participants, allowing change is not implementing change: pharmacists reported feeling underprepared and lacking confidence to actually make change in their practices and believe that more emphasis on practical, specific implementation tactics is needed. Conclusions: Change management is complex and time and resource intensive. There is a need to provide personalized, detailed, context-specific implementation strategies to pharmacists to allow them to take full advantage of expanded scope of practice.

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

Innovation in Aging ◽

10.1093/geroni/igab046.1409 ◽

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.

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Comparing Output from Two Methods of Participatory Design for Developing Implementation Strategies: Traditional Contextual Inquiry vs. Rapid Crowd Sourcing

10.21203/rs.3.rs-1075424/v1 ◽

2021 ◽

Author(s):

Emily Becker-Haimes ◽

Brinda Ramesh ◽

Jacqueline Buck ◽

Heather J. Nuske ◽

Kelly A. Zentgraf ◽

...

Keyword(s):

Participatory Design ◽

Qualitative Interviews ◽

Implementation Strategies ◽

Design Methods ◽

Crowd Sourcing ◽

Team Members ◽

Implementing Change ◽

Collection Practices ◽

Technological Platform ◽

Innovation Tournament

Abstract BackgroundParticipatory design methods are a key component of designing tailored implementation strategies. These methods vary in the resources required to execute and analyze their outputs. No work to date has examined the extent to which the output obtained from different approaches to participatory design varies.MethodsWe concurrently used two separate participatory design methods: 1) field observations and qualitative interviews and 2) rapid crowd sourcing (an innovation tournament). Our goal was to generate information to tailor implementation strategies to increase the use of evidence-based data collection practices among one-to-one aides working with children with autism. Each method was executed and analyzed by study team members blinded to the output of the other method. We estimated the personnel time and monetary costs associated with each method to further facilitate comparison.ResultsObservations and interviews generated nearly double the number of implementation strategies (n = 26) than did the innovation tournament (n = 14). When strategies were classified into clusters from the Expert Recommendations for Implementing Change (ERIC) taxonomy, there was considerable overlap in the content of identified strategies. Strategies derived from observations and interviews were more specific than those from the innovation tournament. Nine strategies (23%) reflected content unique to observations and interviews and 4 (10%) strategies were unique to the innovation tournament. Only observations and interviews identified implementation strategies related to adapting and tailoring to context; only the innovation tournament identified implementation strategies that used incentives. Observations and interviews required more than three times the personnel hours than the innovation tournament, but the innovation tournament was more costly overall due to the technological platform used.ConclusionsThere was substantial overlap in content derived from observations and interviews and the innovation tournament. However, each yielded unique information. To select the best participatory design approach to inform implementation strategy design for a particular context, researchers should carefully consider what each method may elicit and weigh the resources available to invest in the process.Trial RegistrationN/A

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Tracking Adaptation and Fidelity When Embedding COPE, Evidence-Based Dementia Care, in PACE Sites

Innovation in Aging ◽

10.1093/geroni/igab046.664 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 176-176

Author(s):

Laura Gitlin ◽

Nancy Hodgson

Keyword(s):

Program Implementation ◽

Implementation Strategies ◽

Care Program ◽

Dementia Care ◽

Theory Of Change ◽

Evidence Based ◽

Delivery Methods ◽

Implementing Change ◽

Essential Question ◽

Core Components

Abstract One essential question in moving dementia care interventions to practice is, “What is the optimal balance between fidelity to, and adaptation of, a proven program in “real world” settings?" We present a protocol for measuring the adaptation/fidelity and implementation of an evidence-based dementia care program (Care of Persons in their Environment, COPE) in PACE settings. During pre-implementation, science-based elements of COPE were documented including the theory of change, logic model and core components. Possible adaptations to COPE in its delivery were identified and included program structure (sequence of sessions), content (assessments), and delivery methods (online). During implementation, documentation of implementation strategies is captured using an evidence-informed checklist derived from the Expert Recommendations for Implementing Change (ERIC) workgroup. Ongoing documentation of fidelity/adaptation aspects of program implementation is conducted using the FRAME framework. Understanding methods and measures deployed in adaptation and implementation of evidence-based dementia programs can help guide future translation efforts.

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Refined conceptual model for implementing dementia risk reduction: incorporating perspectives from Australian general practice

Australian Journal of Primary Health ◽

10.1071/py19249 ◽

2020 ◽

Vol 26 (3) ◽

pp. 247

Author(s):

Kali Godbee ◽

Jane Gunn ◽

Nicola T. Lautenschlager ◽

Victoria J. Palmer

Keyword(s):

General Practice ◽

Risk Reduction ◽

Conceptual Model ◽

Implementation Strategies ◽

Lessons Learned ◽

Routine Practice ◽

Practice Nurses ◽

Implementing Change ◽

Dementia Risk ◽

Australian General Practice

Dementia is now a global health priority. With no known cure, the best way to reduce the number of people who will be living with dementia is by promoting dementia risk reduction (DRR). However, despite evidence-based guidelines, DRR is not yet routinely promoted in Australian general practice. Previously, we proposed a preliminary conceptual model for implementing DRR in primary care based on our scoping review of practitioners’ views. The present study aimed to refine this model for the Australian context by incorporating the current perspectives of Australian general practitioners (GPs) and general practice nurses (GPNs) about DRR. Interviews with 17 GPs and GPNs were analysed using the framework method, underpinned by the Consolidated Framework for Implementation Research (CFIR). We identified 12 barriers to promoting DRR in Australian general practice, along with five facilitators. Using the CFIR–Expert Recommendations for Implementing Change (ERIC) Matching Tool to select prioritised implementation strategies from the ERIC project, the findings were incorporated into a refined conceptual model. The refined model points to an implementation intervention that uses educational materials and meetings to reach consensus with GPs and GPNs on the importance of promoting DRR and an appropriate approach. Champion GPs and GPNs should be prepared to drive the agreed implementation forward, and general practices should share successes and lessons learned. This model is a crucial step in bridging the gap between DRR guidelines and routine practice.

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Implementation strategies to improve statin utilization in individuals with hypercholesterolemia: a systematic review and meta-analysis

Implementation Science ◽

10.1186/s13012-021-01108-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Laney K. Jones ◽

Stephanie Tilberry ◽

Christina Gregor ◽

Lauren H. Yaeger ◽

Yirui Hu ◽

...

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Meta Analysis ◽

Implementation Strategies ◽

Median Number ◽

Cochrane Central Register ◽

Implementing Change ◽

Ovid Medline ◽

Cochrane Database ◽

Statin Adherence

Abstract Background Numerous implementation strategies to improve utilization of statins in patients with hypercholesterolemia have been utilized, with varying degrees of success. The aim of this systematic review is to determine the state of evidence of implementation strategies on the uptake of statins. Methods and results This systematic review identified and categorized implementation strategies, according to the Expert Recommendations for Implementing Change (ERIC) compilation, used in studies to improve statin use. We searched Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from inception to October 2018. All included studies were reported in English and had at least one strategy to promote statin uptake that could be categorized using the ERIC compilation. Data extraction was completed independently, in duplicate, and disagreements were resolved by consensus. We extracted LDL-C (concentration and target achievement), statin prescribing, and statin adherence (percentage and target achievement). A total of 258 strategies were used across 86 trials. The median number of strategies used was 3 (SD 2.2, range 1–13). Implementation strategy descriptions often did not include key defining characteristics: temporality was reported in 59%, dose in 52%, affected outcome in 9%, and justification in 6%. Thirty-one trials reported at least 1 of the 3 outcomes of interest: significantly reduced LDL-C (standardized mean difference [SMD] − 0.17, 95% CI − 0.27 to − 0.07, p = 0.0006; odds ratio [OR] 1.33, 95% CI 1.13 to 1.58, p = 0.0008), increased rates of statin prescribing (OR 2.21, 95% CI 1.60 to 3.06, p < 0.0001), and improved statin adherence (SMD 0.13, 95% CI 0.06 to 0.19; p = 0.0002; OR 1.30, 95% CI 1.04 to 1.63, p = 0.023). The number of implementation strategies used per study positively influenced the efficacy outcomes. Conclusion Although studies demonstrated improved statin prescribing, statin adherence, and reduced LDL-C, no single strategy or group of strategies consistently improved outcomes. Trial registration PROSPERO CRD42018114952.

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