Evaluation of the Veterans Affairs Pharmacogenomic Testing for Veterans (PHASER) clinical program at initial test sites

Aim: The first Plan-Do-Study-Act cycle for the Veterans Affairs Pharmacogenomic Testing for Veterans pharmacogenomic clinical testing program is described. Materials & methods: Surveys evaluating implementation resources and processes were distributed to implementation teams, providers, laboratory and health informatics staff. Survey responses were mapped to the Consolidated Framework for Implementation Research constructs to identify implementation barriers. The Expert Recommendation for Implementing Change strategies were used to address implementation barriers. Results: Survey response rate was 23–73% across personnel groups at six Veterans Affairs sites. Nine Consolidated Framework for Implementation Research constructs were most salient implementation barriers. Program revisions addressed these barriers using the Expert Recommendation for Implementing Change strategies related to three domains. Conclusion: Beyond providing free pharmacogenomic testing, additional implementation barriers need to be addressed for improved program uptake.

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Data-driven approach for tailoring facilitation strategies to overcome implementation barriers in community pharmacy

Implementation Science ◽

10.1186/s13012-021-01138-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lydia Moussa ◽

Shalom Benrimoj ◽

Katarzyna Musial ◽

Simon Kocbek ◽

Victoria Garcia-Cardenas

Keyword(s):

Random Forest ◽

Community Pharmacy ◽

Implementation Research ◽

Theoretical Domains Framework ◽

Professional Services ◽

Data Driven ◽

Machine Learning Techniques ◽

Community Pharmacies ◽

Continuous Change ◽

Implementation Barriers

Abstract Background Implementation research has delved into barriers to implementing change and interventions for the implementation of innovation in practice. There remains a gap, however, that fails to connect implementation barriers to the most effective implementation strategies and provide a more tailored approach during implementation. This study aimed to explore barriers for the implementation of professional services in community pharmacies and to predict the effectiveness of facilitation strategies to overcome implementation barriers using machine learning techniques. Methods Six change facilitators facilitated a 2-year change programme aimed at implementing professional services across community pharmacies in Australia. A mixed methods approach was used where barriers were identified by change facilitators during the implementation study. Change facilitators trialled and recorded tailored facilitation strategies delivered to overcome identified barriers. Barriers were coded according to implementation factors derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Tailored facilitation strategies were coded into 16 facilitation categories. To predict the effectiveness of these strategies, data mining with random forest was used to provide the highest level of accuracy. A predictive resolution percentage was established for each implementation strategy in relation to the barriers that were resolved by that particular strategy. Results During the 2-year programme, 1131 barriers and facilitation strategies were recorded by change facilitators. The most frequently identified barriers were a ‘lack of ability to plan for change’, ‘lack of internal supporters for the change’, ‘lack of knowledge and experience’, ‘lack of monitoring and feedback’, ‘lack of individual alignment with the change’, ‘undefined change objectives’, ‘lack of objective feedback’ and ‘lack of time’. The random forest algorithm used was able to provide 96.9% prediction accuracy. The strategy category with the highest predicted resolution rate across the most number of implementation barriers was ‘to empower stakeholders to develop objectives and solve problems’. Conclusions Results from this study have provided a better understanding of implementation barriers in community pharmacy and how data-driven approaches can be used to predict the effectiveness of facilitation strategies to overcome implementation barriers. Tailored facilitation strategies such as these can increase the rate of real-time implementation of innovations in healthcare, leading to an industry that can confidently and efficiently adapt to continuous change.

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Building a Sustainable National Infrastructure to Expand Research Mentor Training

CBE—Life Sciences Education ◽

10.1187/cbe.18-03-0034 ◽

2018 ◽

Vol 17 (3) ◽

pp. ar48 ◽

Cited By ~ 4

Author(s):

Kimberly C. Spencer ◽

Melissa McDaniels ◽

Emily Utzerath ◽

Jenna Griebel Rogers ◽

Christine A. Sorkness ◽

...

Keyword(s):

Junior Faculty ◽

Career Stages ◽

Dissemination And Implementation ◽

Implementation Barriers ◽

Senior Faculty ◽

Mentor Training ◽

Train The Trainer ◽

Multiple Audiences ◽

Research Mentor ◽

Implementation Resources

An evidence-based research mentor training (RMT) curricular series has been shown to improve the knowledge and skills of research mentors across disciplines and career stages. A train-the-trainer model was used in the context of several targeted approaches aimed at sustainability to support national dissemination of RMT and expand the network of facilitators prepared to implement the curricula. These infrastructure elements included 1) an expansion initiative to increase the number of trained facilitators able to deliver train-the-trainer workshops nationwide; 2) adaptation of RMT curricula for multiple audiences and career stages to increase accessibility; 3) implementation resources to support facilitators and help them overcome implementation barriers; and 4) standardized evaluation of training. This approach to dissemination and implementation has resulted in the preparation of nearly 600 trained facilitators, a large percentage of whom have implemented mentor training for more than 4000 graduate student, junior faculty, and senior faculty mentors. Implications for and challenges to building and sustaining the national dissemination of RMT are discussed.

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Implementing dedicated education units in 6 European undergraduate nursing and midwifery students clinical placements

BMC Nursing ◽

10.1186/s12912-021-00576-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sara Pedregosa ◽

Núria Fabrellas ◽

Ester Risco ◽

Mariana Pereira ◽

Małgorzata Stefaniak ◽

...

Keyword(s):

Clinical Education ◽

Implementation Research ◽

Clinical Placement ◽

Healthcare Team ◽

Implementation Barriers ◽

Clinical Placements ◽

Dedicated Education Unit ◽

Undergraduate Nursing ◽

Unit Model ◽

Education Model

Abstract Background Undergraduate students’ clinical experience, working directly with patients and the healthcare team is essential to ensure students acquire the necessary competence for practice. There are differences in the quality of clinical environments and in students’ clinical placement experiences and not all clinical sites are optimal learning environments. The Dedicated Education Unit clinical education model allows students to develop the practical knowledge, skills and professionalism they will need as nurses/midwives. Methods We employed the Consolidated Framework for Implementation Research to identify and compare barriers and facilitators in the implementation of the Dedicated Education Unit in 6 European undergraduate nursing/midwifery student clinical placement settings and to describe the experience of nurses/midwives involved in the Dedicated Education Unit model implementation and evaluation. A pre-post implementation interpretive assessment was based on participants’ responses to the Consolidated Framework for Implementation Research construct questions. Results Although Dedicated Education Unit model implementation in our project was heterogeneous, no main implementation barriers were perceived. Qualitative data showed that educational-service collaboration, including a focus on mutual goals, organizational communication and networking, satisfaction of educational and healthcare professionals, and the establishment of a safe space for professional discussion and feedback, were considered facilitators. Conclusions This study describes the key elements guiding educational and healthcare stakeholders in Dedicated Education Unit implementation, engaging participants in the entire process, and offering other organizations the opportunity to consider the benefits of this clinical education model.

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Implementation of Evidence-Based Practice and the PARIHS Framework

Healthcare Administration ◽

10.4018/978-1-4666-6339-8.ch017 ◽

2015 ◽

pp. 323-340 ◽

Cited By ~ 3

Author(s):

Shahram Zaheer

Keyword(s):

Knowledge Translation ◽

Health Informatics ◽

Clinical Decision Making ◽

Evidence Based Practice ◽

Healthcare Setting ◽

Outcome Data ◽

Evidence Based ◽

Sources Of Information ◽

Implementing Change ◽

Parihs Framework

Patients receiving healthcare are commonly exposed to harm that is systematic and often severe. Clinical decisions based on inaccurate sources of information can lead to medical errors, high treatment costs, and poor patient outcomes. Evidence-based practice has the potential to overcome these problems by improving clinical decision-making processes. The PARIHS framework was developed to address the inability of traditional unidimensional models to successfully implement evidence-based practice. The PARIHS framework proposes that successful implementation of evidence into practice is a function of evidence, culture, and facilitation. The PARIHS framework can be used to design, implement, and evaluate knowledge translation projects at both acute and chronic care facilities. This chapter discusses the PARIHS framework as well as its advantages for implementing change at a healthcare setting compared to traditional models. The chapter also outlines a feasible knowledge translation project based on the principles of the PARIHS framework while highlighting health informatics and availability of easily accessible high quality patient outcome data as key enablers in designing and successfully implementing such a project at a healthcare setting.

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The VA Point-of-Care Precision Oncology Program: Balancing Access with Rapid Learning in Molecular Cancer Medicine

Biomarkers in Cancer ◽

10.4137/bic.s37548 ◽

2016 ◽

Vol 8 ◽

pp. BIC.S37548 ◽

Cited By ~ 9

Author(s):

Louis D. Fiore ◽

Mary T. Brophy ◽

Sara Turek ◽

Valmeek Kudesia ◽

Nithya Ramnath ◽

...

Keyword(s):

New England ◽

Point Of Care ◽

Veterans Affairs ◽

Molecular Medicine ◽

Precision Oncology ◽

Patient Centered ◽

Rapid Learning ◽

Clinical Program ◽

Oncology Practice ◽

Modern Genomic

The Department of Veterans Affairs (VA) recognized the need to balance patient-centered care with responsible creation of generalizable knowledge on the effectiveness of molecular medicine tools. Embracing the principles of the rapid learning healthcare system, a new clinical program called the Precision Oncology Program (POP) was created in New England. The POP integrates generalized knowledge about molecular medicine in cancer with a database of observations from previously treated veterans. The program assures access to modern genomic oncology practice in the veterans affairs (VA), removes disparities of access across the VA network of clinical centers, disseminates the products of learning that are generalizable to non-VA settings, and systematically presents opportunities for patients to participate in clinical trials of targeted therapeutics.

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Planning for Implementation Success of an Electronic Cross-Facility Health Record for Pediatric Palliative Care Using the Consolidated Framework for Implementation Research (CFIR)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010453 ◽

2022 ◽

Vol 19 (1) ◽

pp. 453

Author(s):

Theresa Sophie Busse ◽

Sven Kernebeck ◽

Larissa Alice Dreier ◽

Dorothee Meyer ◽

Daniel Zenz ◽

...

Keyword(s):

Palliative Care ◽

Implementation Research ◽

Positive Impact ◽

Pediatric Palliative Care ◽

Successful Implementation ◽

Health Record ◽

Implementation Barriers ◽

Related Information ◽

Facilitators And Barriers

Pediatric palliative care (PPC) patients require years of care across professions and sectors. Sharing treatment-related information and communicating among different PPC professionals is critical to ensure good quality of care. In Germany, this communication is mostly paper-based and prone to errors. Therefore, an electronic cross-facility health record (ECHR) was participatorily designed with users, wherein information can be shared and PPC professionals can communicate with each other. As this form of electronic health record differs from existing models in Germany, there is a need for successful implementation to ensure a positive impact. Therefore, the facilitators and barriers to the implementation of ECHR in PPC were examined. Using the consolidated framework for implementation research (CFIR), transcripts of 32 interviews, 3 focus groups, and 20 think-aloud studies with PPC professionals were analyzed. CFIR indicated that the ECHR-design was viewed positively by users and can be a facilitator for implementation. Barriers exist, mainly due to the fact that the implementation is not planned, the use of the ECHR involves effort, costs are not covered, and all users must be motivated to use the ECHR for functionality. CFIR helps uncover the crux of the issues that need to be considered when planning ECHR implementation to improve care in PPC.

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Identifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening

Implementation Science Communications ◽

10.1186/s43058-021-00150-9 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Helen Lam ◽

Michael Quinn ◽

Toni Cipriano-Steffens ◽

Manasi Jayaprakash ◽

Emily Koebnick ◽

...

Keyword(s):

Colorectal Cancer ◽

Implementation Research ◽

Formative Evaluation ◽

Peer Pressure ◽

Barriers And Facilitators ◽

Structured Interviews ◽

Implementation Barriers ◽

Time Data ◽

Crc Screening ◽

Report Quality

Abstract Background Many evidence-based interventions (EBIs) found to be effective in research studies often fail to translate into meaningful patient outcomes in practice. The purpose of this study was to identify facilitators and barriers that affect the implementation of three EBIs to improve colorectal cancer (CRC) screening in an urban federally qualified health center (FQHC) and offer actionable recommendations to improve future implementation efforts. Methods We conducted 16 semi-structured interviews guided by the Consolidation Framework for Implementation Research (CFIR) to describe diverse stakeholders’ implementation experience. The interviews were conducted in the participant’s clinic, audio-taped, and professionally transcribed for analysis. Results We used the five CFIR domains and 39 constructs and subconstructs as a coding template to conduct a template analysis. Based on experiences with the implementation of three EBIs, stakeholders described barriers and facilitators related to the intervention characteristics, outer setting, and inner setting. Implementation barriers included (1) perceived burden and provider fatigue with EHR (Electronic Health Record) provider reminders, (2) unreliable and ineffectual EHR provider reminders, (3) challenges to providing health care services to diverse patient populations, (4) lack of awareness about CRC screening among patients, (5) absence of CRC screening goals, (6) poor communication on goals and performance, and (7) absence of printed materials for frontline implementers to educate patients. Implementation facilitators included (1) quarterly provider assessment and feedback reports provided real-time data to motivate change, (2) integration with workflow processes, (3) pressure from funding requirement to report quality measures, (4) peer pressure to achieve high performance, and (5) a culture of teamwork and patient-centered mentality. Conclusions The CFIR can be used to conduct a post-implementation formative evaluation to identify barriers and facilitators that influenced the implementation. Furthermore, the CFIR can provide a template to organize research data and synthesize findings. With its clear terminology and meta-theoretical framework, the CFIR has the potential to promote knowledge-building for implementation. By identifying the contextual determinants, we can then determine implementation strategies to facilitate adoption and move EBIs to daily practice.

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Tracking the Randomized Rollout of a Veterans Affairs Opioid Risk Management Tool: A Multi-method Implementation Evaluation Using the Consolidated Framework for Implementation Research

10.21203/rs.3.rs-826458/v1 ◽

2021 ◽

Author(s):

Sharon McCarthy ◽

Matthew Chinman ◽

Shari Rogal ◽

Gloria Klima ◽

Leslie Hausmann ◽

...

Keyword(s):

Implementation Research ◽

Structured Interview ◽

Barriers And Facilitators ◽

Management Tool ◽

Opioid Overdose ◽

Veterans Health ◽

Health Administration ◽

Implementation Barriers ◽

Implementation Climate ◽

The Mean

Abstract BackgroundThe Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard to assist VHA clinicians in identifying Veterans at risk for adverse opioid overdose or suicide-related events. In 2018, a national policy was implemented requiring providers at all VHA facilities to complete case reviews of Veterans identified by STORM as very high risk for adverse events. Nationally, facilities were randomized by the type of oversight required when sufficient case reviews were not completed and also by the timing of an increase in the number of required case reviews. As part of a comprehensive assessment of this policy intervention, we aimed to 1) identify barriers and facilitators to implementing case reviews as required in the policy; 2) assess variation across the four arms of the study; and 3) evaluate associations between facility characteristics and implementation barriers and facilitators.MethodsUsing the Consolidated Framework for Implementation Research (CFIR), we developed a semi-structured interview guide to examine barriers to and facilitators of implementing the STORM policy. Staff from 40 purposefully selected facilities who were involved in implementation were invited to participate in telephone interviews. Interview transcripts were coded and then organized into memos, which were numerically rated using the -2 to +2 CFIR rating system for each construct. Descriptive statistics were used to evaluate the mean ratings on each CFIR construct, the associations between ratings and study arm, and three facility characteristics (size, rurality, and level of academic detailing) associated with CFIR ratings. We used the mean CFIR rating for each site to determine which constructs differed between the sites with highest and lowest overall CFIR scores, and these constructs were described in detail. ResultsInterviews with 78 staff at 39 VHA facilities identified a slightly positive (+0.2) overall mean CFIR rating. CFIR ratings were not significantly different between the four study arms, nor associated with facility characteristics. Overall, two important barriers to implementation were CFIR constructs Access to knowledge and information and Evaluating and reflecting. Having time to complete the reviews was a pervasive barrier. Sites with higher overall CFIR scores showed three important facilitators: Leadership engagement, Engaging, and Implementation climate. ConclusionAlthough there was variability in implementation barriers and facilitators across facilities, these were unrelated to study arms and facility characteristics. Leadership, resources, and overall implementation climate were the strongest facilitators of policy implementation.

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