Using Im Implementation Strategy Designs to Promote Adaptation Amy - - PowerPoint PPT Presentation

▶
using im implementation strategy designs
SMART_READER_LITE
LIVE PREVIEW

Using Im Implementation Strategy Designs to Promote Adaptation Amy - - PowerPoint PPT Presentation

Oct 13, 2022 229 likes •321 views

Using Im Implementation Strategy Designs to Promote Adaptation Amy M. Kilbourne, PhD, MPH Quality Enhancement Research Initiative (QUERI), US Dept. of Veterans Affairs Department of Psychiatry, University of Michigan Medical School

slide-1
SLIDE 1

Using Im Implementation Strategy Designs to Promote Adaptation

Amy M. Kilbourne, PhD, MPH Quality Enhancement Research Initiative (QUERI), US Dept. of Veterans Affairs Department of Psychiatry, University of Michigan Medical School amykilbo@umich.edu 9th Annual Conference on the Science of Dissemination and Implementation, 2016

slide-2
SLIDE 2

Current Adaptation Initiatives in VA

  • “Real-time” adaptation of evidence-based practices: Triple Aim QUERI
  • Modified Stirman Adaptations and Modifications Framework/RE-AIM
  • QUERI-wide Special Interest Group on Fidelity, Adaptation, and Tailoring
  • Adaptation of the implementation process: Virtual Specialty Care QUERI
  • SMART stepped-wedge designs
  • Implementation strategies for PTSD telehealth
  • Promoting Positive Deviance: VHA Diffusion of Excellence Initiative (DEI)
  • Launched by VHA in 2015 to promote bottom-up ID, spread of best practices
  • QUERI investigators collaborating with VHA leadership on DEI national evaluation

Refs: Chambers and Norton, The Adaptome: Advancing the Science of Intervention Adaptation; AJPM 2016 Shulkin D, Beyond the VA Crisis--Becoming a High-Performance Network, NEJM 2016 Atkins, Kilbourne, Shulkin, Role of Research in a Learning Health Care System, ARPH, in press, 2017

slide-3
SLIDE 3

Allowing adaptation of EBPs enables ownership of the QI process

e.g., Dynamic Adaptation Process Model, Replicating Effective Programs (REP)

Pre-implementation

Multilevel assessment ID adaptations- stakeholder input Prepare adaptations e.g., Core elements Menu options

Implementation

Training Technical assistance

Provider/System Strategies

Coaching Facilitation Strategic thinking

Ongoing feedback

Sustainability

Monitor fidelity Response Retention Business case Refs: Aarons et al. (2012) Dynamic Adaptation Process Model Wiltsey-Stirman et al. (2013) framework Kilbourne (2007, 2012) Enhanced Replicating Effective Programs Framework

slide-4
SLIDE 4

Run-In Phase

All sites offered REP to implement EBP; Patients start EBP by

Month 3

REP

sites

Non- Responders

(<10 out of 20 enrolled patients receiving EBP

  • r <75%

sessions completed)

REP+EF

Add External Facilitation

REP+EF/IF

Add Internal & External Facilitation

R Continue follow- up assessments Continue

REP+EF

Continue

REP+EF/IF

Responders Non- responders Non- responders R

Add IF

REP+EF/IF

Continue follow-up assessments (A)

Continue REP+EF/IF (C) Continue REP+EF (B) Continue REP+EF/IF (E)

Responders

Month 18 and 24

Assessments

Continue follow- up assessments Continue follow-up assessments (D)

Responders

Continue follow- up assessments Continue follow-up assessments (F) 6 Month follow- up assessment

Month 6

Assessment

Month 12

Assessment

Phase 2 Follow Up ADEPT Study Start Kilbourne, Almirall, et al Adaptive Implementation of Effective Programs Trial (ADEPT), Imp Sci 2014

SMART Designs: Tailor Implementation Strategies

slide-5
SLIDE 5

SMART Designs Inform Adaptive Implementation Interventions

An example using Standard REP & Facilitation in community practices:

Adapted from NIMH ADEPT Trial: R01 MH099898 (PI: Kilbourne)

slide-6
SLIDE 6

Enabling Adaptation of the Implementation Process: Examples of QUERI Implementation Strategies

Tim ime/ In Intensit ity

  • f
  • f Im

Imp. Str trategy Sit ite e Factors (Ne (Need, Ba Barrie iers)

0.2 0.4 0.6 0.8 1 1.2

Replicating Effective Programs Audit & Feedback Barrier Buster Learning Collaboratives Community Engagement Systems Redesign Facilitation Un-learning:

Academic Detailing

LEAP

(Learn, Engage, Act, Process)

EBQI

(Evidence-based Quality Improvement)

slide-7
SLIDE 7

Promoting Positive Deviance: VA’s Diffusion of Excellence Initiative Infrastructure

Social media platform promotes conversation and sharing about promising practices Virtual VA “Shark Tank” style event enabled virtual engagement in unique opportunity to ‘pitch’ promising practices

Diffusion Hub provides robust project management and

tracking tools to manage replication and implementation of

best practices, all based on LEAN principles and frameworks

Acknowledgements: Shereef Elnahal, MD, Deputy Undersecretary for Quality & Safety, VA Office of Organizational Excellence Diffusion of Excellence-QUERI Evaluation leads: George Jackson, Laura Damschroder, Tom Houston

slide-8
SLIDE 8

10

THANK YOU!

VA Quality Enhancement Research Initiative (QUERI) http://www.queri.research.va.gov/

“Let the other person feel that the idea was his or hers”- Dale Carnegie