Virginia Wang1,2,3, Kelli Allen4,5, Courtney H Van Houtven4,6, Cynthia Coffman4,7, Nina Sperber4,6, Elizabeth P Mahanna4, Cathleen Colón-Emeric4,8,9, Helen Hoenig4,8,10, George L Jackson4,6,8, Teresa M Damush11,12,13, Erika Price14,15, Susan N Hastings4,8,9. 1. Health Services Research and Development Center of Innovation, Durham Veterans Affairs Health Care System, 508 Fulton St., Durham, NC, 27705, USA. virginia.wang@va.gov. 2. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA. virginia.wang@va.gov. 3. Department of Medicine, Duke University School of Medicine, Durham, NC, USA. virginia.wang@va.gov. 4. Health Services Research and Development Center of Innovation, Durham Veterans Affairs Health Care System, 508 Fulton St., Durham, NC, 27705, USA. 5. Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 6. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA. 7. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA. 8. Department of Medicine, Duke University School of Medicine, Durham, NC, USA. 9. Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA. 10. Physical Medicine and Rehabilitation Service, Durham VA Health Care System, Durham, NC, USA. 11. Health Services Research and Development Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, 1481 W. 10th St., HSRD 11H, Indianapolis, IN, 46202, USA. 12. Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA. 13. Regenstrief Institute, Inc., Indianapolis, IN, USA. 14. San Francisco VA Care System, 94121, 4150 Celement St., Box 111, San Francisco, CA, USA. 15. Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Abstract
BACKGROUND: Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. However, a one-size-fits-all approach is rarely effective. In partnership with VA national clinical leaders and local clinical champions, the Optimizing Function and Independence VA Quality Enhancement Research Initiative program (Function QUERI) will evaluate efforts to implement team-based clinical programs for Veterans at risk for functional decline and disability. METHODS: Function QUERI will implement and evaluate three innovative, evidence-based clinical programs in VA medical centers: (1) a group physical therapy program for knee osteoarthritis (Group PT); (2) assisted early mobility for hospitalized older veterans (STRIDE), a supervised walking program for hospitalized older veterans; and (3) implementation of helping invested family members improve veteran experiences study (iHI-FIVES), a skills training programfor caregivers of disabled Veterans. A common reason for clinical care gaps in these populations is poor communication and coordination among the many interdisciplinary providers involved in their care. To facilitate the implementation of the clinical programs, Function QUERI will evaluate the impact of complexity science-based implementation intervention to promote team readiness (CONNECT), an implementation intervention designed as a bundle of interaction-oriented activities to promote team function and readiness for change, on the implementation of clinical programs across multiple sites. The evaluation will use a mixed methods design. Group PT is a local, single-site quality improvement project where a modified CONNECT intervention will be tested to inform the remaining program implementation projects. For STRIDE and iHI-FIVES projects, we will randomize participating sites to implement the clinical program, with the CONNECT intervention or not, and will use a stepped-wedge cluster randomized trial design. DISCUSSION: Function QUERI will translate its findings across its projects to identify the contextual factors and components from CONNECT that improve team processes and function to optimize effective implementation for future rollout of VA clinical programs. Synthesizing findings within and across projects, we will specify dimensions of team characteristics and function that enhance capacity for clinical innovation and uptake of evidence-based programs. TRIAL REGISTRATION: NCT03300336 Registered September 28, 2017, NCT03474380 Registered March 15, 2018.
RCT Entities:
BACKGROUND: Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. However, a one-size-fits-all approach is rarely effective. In partnership with VA national clinical leaders and local clinical champions, the Optimizing Function and Independence VA Quality Enhancement Research Initiative program (Function QUERI) will evaluate efforts to implement team-based clinical programs for Veterans at risk for functional decline and disability. METHODS: Function QUERI will implement and evaluate three innovative, evidence-based clinical programs in VA medical centers: (1) a group physical therapy program for knee osteoarthritis (Group PT); (2) assisted early mobility for hospitalized older veterans (STRIDE), a supervised walking program for hospitalized older veterans; and (3) implementation of helping invested family members improve veteran experiences study (iHI-FIVES), a skills training program for caregivers of disabled Veterans. A common reason for clinical care gaps in these populations is poor communication and coordination among the many interdisciplinary providers involved in their care. To facilitate the implementation of the clinical programs, Function QUERI will evaluate the impact of complexity science-based implementation intervention to promote team readiness (CONNECT), an implementation intervention designed as a bundle of interaction-oriented activities to promote team function and readiness for change, on the implementation of clinical programs across multiple sites. The evaluation will use a mixed methods design. Group PT is a local, single-site quality improvement project where a modified CONNECT intervention will be tested to inform the remaining program implementation projects. For STRIDE and iHI-FIVES projects, we will randomize participating sites to implement the clinical program, with the CONNECT intervention or not, and will use a stepped-wedge cluster randomized trial design. DISCUSSION: Function QUERI will translate its findings across its projects to identify the contextual factors and components from CONNECT that improve team processes and function to optimize effective implementation for future rollout of VA clinical programs. Synthesizing findings within and across projects, we will specify dimensions of team characteristics and function that enhance capacity for clinical innovation and uptake of evidence-based programs. TRIAL REGISTRATION: NCT03300336 Registered September 28, 2017, NCT03474380 Registered March 15, 2018.
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