Descriptive Evaluation of SBIRT Adoption, Implementation, and Delivery across a Health System

Abstract Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention used to enhance reductions in alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes. However, SBIRT implementation remains low. Research on implementation of evidence-based interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework that improves the comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to structure findings from analyses of qualitative interview data gathered from local champions leading SBIRT implementation. The purpose of this study was to understand site coordinators’ (SCs) perceptions of SBIRT implementation and employed strategies. Study aims included (1) describe SCs’ perceptions of barriers, facilitators, and outcomes related to SBIRT implementation, and (2) describe strategies perceived as most effective to implement SBIRT. Methods: This was a descriptive study conducted with 14 SCs, representing 14 medical surgical units within a large healthcare system. A semi-structured interview guide was developed by the study team to capture barriers, facilitators, and outcomes related to SBIRT implementation. A follow-up survey, based on 14 commonly identified ERIC strategies during SC interviews, was administered to determine the SC’s perceptions of the most helpful (i.e. effective) implementation strategies on a scale of 1 (least helpful) to 5 (most helpful).Results: All site coordinators participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most highly rated effective ERIC implementation strategies were purposely reexamining the implementation (M=4.38; n=8), providing ongoing consultation (M=4.13; n=8), auditing and providing feedback (M=4.1; n=10), developing education materials (M=4.1; n=10), identifying and preparing champions (M=4; n=7), and tailoring strategies (M=4; n=7). Conclusion: This study applied a common framework (ERIC) to implementation lessons within a large health system that can be replicated in other implementation studies and quality improvement efforts. Adapting and sustaining change are challenging in healthcare settings. However, understanding and using the most helpful implementations strategies may support healthcare teams to adopt and sustain interventions such as SBIRT.

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Perceptions of the Barriers, Facilitators, Outcomes, and Helpfulness of Strategies to Implement Screening, Brief Intervention, and Referral to Treatment in Acute Care

10.21203/rs.3.rs-61664/v2 ◽

2021 ◽

Author(s):

Alyson Keen ◽

Kelli M Thoele ◽

Ukamaka Oruche ◽

Robin Newhouse

Keyword(s):

Acute Care ◽

Brief Intervention ◽

Qualitative Data ◽

Implementation Strategies ◽

Implementation Process ◽

Clinical Intervention ◽

Structured Interview ◽

Evidence Based ◽

Positive Health

Abstract Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based clinical intervention used to reduce alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes; however, SBIRT implementation remains low. Research on implementing evidence-based interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework to guide comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to qualitative feedback gathered from site coordinators (SCs) leading SBIRT implementation. The purpose of this study was to describe the SCs’ experiences pertaining to SBIRT implementation across a health system. Methods: Within the context of a larger parent study, a semi-structured interview guide was used to capture 14 SCs’ perceptions of the barriers, facilitators, and outcomes pertaining to SBIRT implementation. This qualitative data was analyzed using standard content analytic procedures. A follow-up survey was developed based on 14 ERIC strategies identified from qualitative data and was administered electronically to determine the SC’s perceptions of the most helpful implementation strategies on a scale of 1 (least helpful) to 5 (most helpful). Results: All 14 invited SCs participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most helpful ERIC implementation strategies were purposely reexamining the implementation (M=4.38; n=8), providing ongoing consultation (M=4.13; n=8), auditing and providing feedback (M=4.1; n=10), developing education materials (M=4.1; n=10), identifying and preparing champions (M=4; n=7), and tailoring strategies (M=4; n=7). Conclusion: SCs who led implementation efforts within a large healthcare system identified several barriers and facilitators to the implementation of SBIRT. Additionally, they identified clinician-related outcomes associated with SBIRT implementation into practice as well as strategies that were helpful in the implementation process. This information can inform the implementation of SBIRT and other interventions in acute care settings.

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Perceptions of the barriers, facilitators, outcomes, and helpfulness of strategies to implement screening, brief intervention, and referral to treatment in acute care

Implementation Science ◽

10.1186/s13012-021-01116-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Alyson Keen ◽

Kelli Thoele ◽

Ukamaka Oruche ◽

Robin Newhouse

Keyword(s):

Acute Care ◽

Brief Intervention ◽

Qualitative Data ◽

Implementation Strategies ◽

Implementation Process ◽

Clinical Intervention ◽

Structured Interview ◽

Positive Health ◽

Implementing Change

Abstract Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a clinical intervention used to address alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes; however, SBIRT implementation remains low. Research on implementing interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework to guide comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to qualitative feedback gathered from site coordinators (SCs) leading SBIRT implementation. The purpose of this study was to describe the SCs’ experiences pertaining to SBIRT implementation across a health system. Methods Within the context of a larger parent study, a semi-structured interview guide was used to capture 14 SCs’ perceptions of the barriers, facilitators, and outcomes pertaining to SBIRT implementation. Qualitative data were analyzed using standard content analytic procedures. A follow-up survey was developed based on 14 strategies identified from qualitative data and was administered electronically to determine the SC’s perceptions of the most helpful implementation strategies on a scale of 1 (least helpful) to 5 (most helpful). Results All 14 invited SCs participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most helpful implementation strategies were reexamining the implementation (M = 4.38; n = 8), providing ongoing consultation (M = 4.13; n = 8), auditing and providing feedback (M = 4.1; n = 10), developing education materials (M = 4.1; n = 10), identifying and preparing champions (M = 4; n = 7), and tailoring strategies (M = 4; n = 7). Conclusion SCs who led implementation efforts within a large healthcare system identified several barriers and facilitators to the implementation of SBIRT. Additionally, they identified clinician-related outcomes associated with SBIRT implementation into practice as well as strategies that were helpful in the implementation process. This information can inform the implementation of SBIRT and other interventions in acute care settings.

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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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Implementation Science

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.1338 ◽

2020 ◽

Author(s):

Enola Proctor ◽

Alicia Bunger

Keyword(s):

Social Work ◽

Implementation Science ◽

Implementation Strategies ◽

Work Practice ◽

Social Work Practice ◽

Research Translation ◽

Evidence Based ◽

Implementation Studies ◽

Specific Implementation ◽

Key Terms

Implementation science 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 aim of implementation science 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 to move interventions into specific settings, extending their availability, reach, and benefits to clients and communities. This article provides an overview of implementation science as a component of research translation with an emphasis on traditional social work practice settings. The article begins by defining key terms, including implementation and evidence-based interventions. To inform conceptualization of implementation studies, the article continues with an overview of guiding implementation theories, models, and frameworks that explain the role of the multi-level practice context for implementation. Next, the article defines implementation strategies, identifies sources of implementation strategies, and provides recommendations for specifying and describing strategies that allow for replication. The article then describes methodological issues, including variable measurement, research design, and stakeholder engagement. Given the importance of designing implementation studies that optimize both internal and external validity, there is special attention to creative alternatives to traditional randomized controlled trials, and the potential for participatory and systems approaches. Finally, the article concludes with a discussion of future directions for implementation science in social work.

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P092: Exercise prescription in the emergency department: patient perceptions

CJEM ◽

10.1017/cem.2017.294 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S109

Author(s):

F. Milne ◽

K. Leech-Porter ◽

D. Lewis ◽

J. Fraser ◽

S. Hull ◽

...

Keyword(s):

Emergency Department ◽

Pilot Study ◽

Exercise Prescription ◽

Tertiary Care ◽

Intervention Group ◽

Emergency Department Patient ◽

Likert Scale ◽

Structured Interview ◽

Positive Health

Introduction: The positive health outcomes of exercise have been well-studied, and exercise prescription has been shown to reduce morbidity in several chronic health conditions. However, patient attitudes around the prescription of exercise in the emergency department (ED) have not been explored. The aim of our pilot study is to explore patients’ willingness and perceptions of exercise being discussed and prescribed in the ED. Methods: This study is a survey of patients who had been previously selected for exercise prescription in a pilot study conducted at a tertiary care ED. This intervention group were given a standardized provincial written prescription to perform moderate exercise for 150 minutes per week. Participants answered a discharge questionnaire and were followed up by a telephone interview 2 months later. A structured interview of opinions around exercise prescription was conducted. Questions included a combination of non-closed style interview questions and Likert scale. Patients rated prescription detail, helpfulness and likelihood on a Likert scale from 1-5 (1 being strongly disagree and 5 being strongly agree). Median values (+/-IQRs) are presented, along with dominant themes. Results: 17 people consented to exercise prescription and follow up surveys. 2 were excluded due to hospital admission. 15 participants were enrolled and completed the discharge survey. Two-month follow up survey response rate was 80%. Patients rated the detail given in their prescription as 5 (+/-1). Helpfulness of prescription was rated as 4 (+/-2). Likelihood to continue exercising based on the prescription was rated as 4 (+/-2). 11/12 participants felt that exercise should be discussed in the Emergency Department either routinely or on a case-by-case basis.1 participant felt it should not be discussed at all. Conclusion: Our study demonstrates that most patients are open to exercise being discussed during their Emergency Department visit, and that the prescription format was well-received by study participants.

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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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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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Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies

International Psychogeriatrics ◽

10.1017/s1041610220001702 ◽

2020 ◽

pp. 1-29

Author(s):

Sally Bennett ◽

Kate Laver ◽

Margaret MacAndrew ◽

Elizabeth Beattie ◽

Lindy Clemson ◽

...

Keyword(s):

Systematic Review ◽

Quantitative Methods ◽

Psychological Symptoms ◽

Implementation Strategies ◽

Practice Change ◽

Evidence Based ◽

Pharmacological Interventions ◽

People With Dementia ◽

Implementation Studies ◽

Behavioral And Psychological Symptoms

ABSTRACT Objective This study aimed to identify the nature and effects of implementation strategies to increase the use of evidence-based, non-pharmacological interventions designed to reduce the frequency and/or severity of behavioral and psychological symptoms associated with dementia, for people living in the community. Design This was a systematic review of implementation studies. We searched six databases (in January 2019) and hand-searched reference lists of reports. Studies were included if they used quantitative methods evaluating the use of implementation strategies to increase the use of non-pharmacological interventions. These interventions had to have been tested in a randomized controlled trial (RCT) and found to reduce behavioral and psychological symptoms of dementia, for those living in the community. Studies needed to report the effect of the implementation on clinical practice, for example, a change in practice or the adoption of the intervention in community settings. Results Twelve studies were included: 11 one-group pre-post design studies and 1 cluster RCT. All studies reported practice change – the majority implementing a new intervention, with six different types of interventions implemented. All studies reported including using partnerships, new funding, educational strategies, and ongoing support and consultation. Seven implementation studies reported positive outcomes for clients on some aspect of behavior or depression for the person with dementia. Conclusions Implementation studies using multiple implementation strategies to increase the use of non-pharmacological interventions have demonstrated improvements in behavioral and psychological symptoms common in people with dementia, when provided by clinicians as part of their everyday work routines.

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What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-19-00171 ◽

2020 ◽

Vol 29 (2) ◽

pp. 688-704

Author(s):

Katrina Fulcher-Rood ◽

Anny Castilla-Earls ◽

Jeff Higginbotham

Keyword(s):

Clinical Practice ◽

Research Evidence ◽

Evidence Based Practice ◽

Evidence Based ◽

Clinical Expertise ◽

Speech Language Pathologists ◽

School Based ◽

Research Findings ◽

Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

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Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol-related disorders: a project protocol

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911/a000629 ◽

2019 ◽

Vol 65 (6) ◽

pp. 373-381 ◽

Cited By ~ 2

Author(s):

Bernd Schulte ◽

Christina Lindemann ◽

Angela Buchholz ◽

Anke Rosahl ◽

Martin Härter ◽

...

Keyword(s):

Alcohol Use ◽

Guideline Implementation ◽

Implementation Strategies ◽

Organizational Factors ◽

Diagnosis And Treatment ◽

Primary Data ◽

Routine Practice ◽

Evidence Based ◽

Advisory Boards ◽

Prevention And Treatment

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

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