Fidelity and Adaptation of Implementation Strategies to Support - - PowerPoint PPT Presentation
Fidelity and Adaptation of Implementation Strategies to Support Primary Care in Improving Cardiovascular Preventive Care Bijal Balasubramanian, MBBS, PhD 10 th Annual Conference on the Science of Dissemination and Implementation in Health Dec
Fidelity and Adaptation of Implementation Strategies to Support Primary Care in Improving Cardiovascular Preventive Care
Bijal Balasubramanian, MBBS, PhD
10th Annual Conference on the Science of Dissemination and Implementation in Health Dec 5, 2017
guidelines and innovative care delivery models
provide tools and approaches to reach these goals
combination of modes
associated with:
primary care clinics (Ritchie et al., 2017)
cancer care (Armstrong et al., 2016)
care (Baskerville et al., 2011)
improvement trials and of scrupulous implementation and dissemination
fideli lity and fle flexi xibil ilit ity1
rigor and rele levance2
transportability and effectiveness of practice change interventions3 through local adaptation and tailoring
dose in a large D&I initiative called EvidenceNOW
1Cohen DJ, Crabtree BF, Etz RS, Balasubramnaian, et al. Fidelity versus flexibility: translating evidence-based research into practice. Am J
Prev Med. 2008;35:S381-S389.Werner JJ,
2Stange KC. Praxis-based research networks: An emerging paradigm for research that is rigorous, relevant, and inclusive. J Am Board Fam
EvidenceNOW is focusing on helping primary care practices use the latest evidence to improve the heart health of Americans
to Scale
and quality improvement strategies are most effective across the seven regional cooperatives participating in this initiative.
2-5 clinicians 46.6% Clinician owned 40.4% Urban core 63.5% Solo practice 23.9% Hospital, HS 22.9% Rural area 15.8% 6-10 clinicians 13.7% FQHC,RHC, IHS,Fed 21.6% Large town 13.5% 11+ clinicians 10.7% Other/none 9.9% Suburban 7.2%
0% 20% 40% 60% 80% 100% Practice size Practice ownership Location
length of vis isit its or amount of tim ime per in interval
In-person, , web, , phone, , etc.
interval l of contact
Site vis isit its to cooperatives and practices
line dia iary ry entrie ies
Semi-structured in interviews
Cooperative Name Healthy Hearts in the Heartland Heart Health Now! Healthy Hearts Northwest HealthyHearts NYC Healthy Hearts for Oklahoma Evidence NOW Southwest Heart of Virginia Healthcare Cooperative Region Illinois Indiana Wisconsin North Carolina Idaho Oregon Washington New York City Oklahoma Colorado New Mexico Virginia Median Distance to Practices in Miles (range) 26 (0-331) 116 (2-290) 107 (1-819) 10 (0-24) 107 (0-351) 61 (5-380) 104 (1-375) # of Organizations Providing Facilitation 6 9 2 2 2 14 2* # of Practice Facilitators 17 15 16 17 24 32 21 # of Practices Enrolled 227 245 209 315 254 211 249
*One system used 5 internal PFs
Cooperativ ives var arie ied in in th their ir philo ilosophie ies rela lated to
adaptation
s an art rt, and you have to decipher what your team needs, what their gaps are… we wanted to make sure that each intervention was as s si simil ilar as s poss ssib ible le, and then we also understood that there was going ing to be e devi viatio ions based on what the practice needs were.” (Interview, Cooperative 3; Implementation Lead)
visit t number that we're trying to meet by the end of their 12-month intervention. At first I'm like, ‘I'm never going to be able to meet that. How am I going to do that?’ Then, it's like, ‘Whoa. Wait on. I have to slow down.’” (Interview, Cooperative 7; PF)
rescrip iptiv ive about a few of the visits the coaches would have with their sites during the intervention. The other visits should and will be determin ined by th the e nee eeds of f th the e si site/team, the relationship of the coach with the team, the data, the knowledge of the coach about how the site is doing, etc...” (Diaries, Cooperative 4; Implementation Lead)
PFs s vie viewed determ rmin inin ing the needs of the practic ice and tail ilorin ing the in interv rventio ion to th those needs as s im important
is a huge part of f th this pro
where they are, and work forward from there. And we are always looking for little successes to help keep our practices on track with their intervention, and understand that change is a process.” (Diaries, Cooperative 5; PF)
the same tools, I I don't 't th think we use th them th the same ways. Also, the teams are different too. So one experience that you have at one health center is not going to be the same at a different health center.” (Interview, Cooperative 3; PF)
N=75
N=195
N=189
N=161
N=116
Planned # of PF visits
12 13 5 to 15 18 to 20 as needed
% practices receiving planned # of PF visits
19 98 14 20
Mean (SD) number of received touches
9.27 (4.95) 17.02 (4.23) 15.01 (6.91) 12.36 (7.67)
Minimum and maximum number of received touches
1, 28 12, 53 1, 46 1, 31
Number of hours of facilitation per month
their philosophy about adapting practice facilitation, but all expected some level of adaptation
initiative focused on scaling up PF as an implementation strategy to improve ABCS of heart health and practice capacity
supporting practices to improve process and outcomes
variations in intended frequency and dose of PF strategy
llows furt rther exp xplo loratio ion of reasons for r var aria iatio ions
facilitators/coaches are providing to practices and why
Thus, , dif iffic icult lt to as assess nature of ad adaptatio ions they mak ake
adapt im implementation strategy to practice needs is is im important for:
l dose, fr frequency, and duratio ion of f PF needed for im improving outcomes such as ABCS of f heart health
idelity to pla lanned in interv rvention (ri (rigor) an and
lexibili lity/adaptation to practice needs (r (relevance)
CONTACT INFORMATION
BIJAL BALASUBRAMANIAN, MBBS,PHD QUANTITATIVE TEAM LEAD
BIJAL.A.BALASUBRAMANIAN@UTH.TMC.EDU
@BIJALBALA
PI: DEBORAH COHEN, PH.D. COHENDJ@OHSU.EDU
escalates@ohsu.edu escalates.org @ESCALATESorg AHRQ Grant #: R01 HS023940-01
escalates@ohsu.edu escalates.org @ESCALATESorg AHRQ Grant #: R01 HS023940-01