T M Damush1,2,3,4, E J Miech5,6,7,8, N A Rattray5,6,7,8, B Homoya5,6, Lauren S Penney5,9,10, A Cheatham5,6, S Baird5,6, J Myers5,6, C Austin5,6, L J Myers5,6,7,8, A J Perkins5,11, Y Zhang5,11, B Giacherio12, M Kumar12,13, L D Murphy5,6, J J Sico13,14, D M Bravata5,6,7,8,15. 1. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRIS-M) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA. Teresa.Damush@va.gov. 2. VA HSR&D Center for Health Information and Communication (CHIC); Richard L. Roudebush VA Medical Center, 11H, 1481 W 10th St, Indianapolis, IN, 46202, USA. Teresa.Damush@va.gov. 3. Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. Teresa.Damush@va.gov. 4. Regenstrief Institute, Indianapolis, IN, USA. Teresa.Damush@va.gov. 5. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRIS-M) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA. 6. VA HSR&D Center for Health Information and Communication (CHIC); Richard L. Roudebush VA Medical Center, 11H, 1481 W 10th St, Indianapolis, IN, 46202, USA. 7. Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. 8. Regenstrief Institute, Indianapolis, IN, USA. 9. South Texas Veterans Health Care System (STVHCS), San Antonio, TX, USA. 10. University of Texas Health San Antonio, San Antonio, TX, USA. 11. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA. 12. Office of Healthcare Transformation (OHT), Veterans Health Administration (VHA), Washington, DC, 20571, USA. 13. Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT, USA. 14. Departments of Internal Medicine and Neurology and Center for Neuro Epidemiological and Clinical Research, Yale School of Medicine, New Haven, CT, USA. 15. Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
Abstract
BACKGROUND: The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) program was designed to address systemic barriers to providing timely guideline-concordant care for patients with transient ischemic attack (TIA). OBJECTIVE: We evaluated an implementation bundle used to promote local adaptation and adoption of a multi-component, complex quality improvement (QI) intervention to improve the quality of TIA care Bravata et al. (BMC Neurology 19:294, 2019). DESIGN: A stepped-wedge implementation trial with six geographically diverse sites. PARTICIPANTS: The six facility QI teams were multi-disciplinary, clinical staff. INTERVENTIONS: PREVENT employed a bundle of key implementation strategies: team activation; external facilitation; and a community of practice. This strategy bundle had direct ties to four constructs from the Consolidated Framework for Implementation Research (CFIR): Champions, Reflecting & Evaluating, Planning, and Goals & Feedback. MAIN MEASURES: Using a mixed-methods approach guided by the CFIR and data matrix analyses, we evaluated the degree to which implementation success and clinical improvement were associated with implementation strategies. The primary outcomes were the number of completed implementation activities, the level of team organization and > 15 points improvement in the Without Fail Rate (WFR) over 1 year. KEY RESULTS: Facility QI teams actively engaged in the implementation strategies with high utilization. Facilities with the greatest implementation success were those with central champions whose teams engaged in planning and goal setting, and regularly reflected upon their quality data and evaluated their progress against their QI plan. The strong presence of effective champions acted as a pre-condition for the strong presence of Reflecting & Evaluating, Goals & Feedback, and Planning (rather than the other way around), helping to explain how champions at the +2 level influenced ongoing implementation. CONCLUSIONS: The CFIR-guided bundle of implementation strategies facilitated the local implementation of the PREVENT QI program and was associated with clinical improvement in the national VA healthcare system. TRIAL REGISTRATION: clinicaltrials.gov: NCT02769338.
BACKGROUND: The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) program was designed to address systemic barriers to providing timely guideline-concordant care for patients with transient ischemic attack (TIA). OBJECTIVE: We evaluated an implementation bundle used to promote local adaptation and adoption of a multi-component, complex quality improvement (QI) intervention to improve the quality of TIA care Bravata et al. (BMC Neurology 19:294, 2019). DESIGN: A stepped-wedge implementation trial with six geographically diverse sites. PARTICIPANTS: The six facility QI teams were multi-disciplinary, clinical staff. INTERVENTIONS: PREVENT employed a bundle of key implementation strategies: team activation; external facilitation; and a community of practice. This strategy bundle had direct ties to four constructs from the Consolidated Framework for Implementation Research (CFIR): Champions, Reflecting & Evaluating, Planning, and Goals & Feedback. MAIN MEASURES: Using a mixed-methods approach guided by the CFIR and data matrix analyses, we evaluated the degree to which implementation success and clinical improvement were associated with implementation strategies. The primary outcomes were the number of completed implementation activities, the level of team organization and > 15 points improvement in the Without Fail Rate (WFR) over 1 year. KEY RESULTS: Facility QI teams actively engaged in the implementation strategies with high utilization. Facilities with the greatest implementation success were those with central champions whose teams engaged in planning and goal setting, and regularly reflected upon their quality data and evaluated their progress against their QI plan. The strong presence of effective champions acted as a pre-condition for the strong presence of Reflecting & Evaluating, Goals & Feedback, and Planning (rather than the other way around), helping to explain how champions at the +2 level influenced ongoing implementation. CONCLUSIONS: The CFIR-guided bundle of implementation strategies facilitated the local implementation of the PREVENT QI program and was associated with clinical improvement in the national VA healthcare system. TRIAL REGISTRATION: clinicaltrials.gov: NCT02769338.
Entities:
Keywords:
quality of care; implementation science; implementation strategy; audit and feedback; CFIR; transient ischemic attack; mixed methods
Authors: Dawn M Bravata; Laura J Myers; Greg Arling; Edward J Miech; Teresa Damush; Jason J Sico; Michael S Phipps; Alan J Zillich; Zhangsheng Yu; Mathew Reeves; Linda S Williams; Jason Johanning; Seemant Chaturvedi; Fitsum Baye; Susan Ofner; Curt Austin; Jared Ferguson; Glenn D Graham; Rachel Rhude; Chad S Kessler; Donald S Higgins; Eric Cheng Journal: JAMA Neurol Date: 2018-04-01 Impact factor: 18.302
Authors: Walter N Kernan; Bruce Ovbiagele; Henry R Black; Dawn M Bravata; Marc I Chimowitz; Michael D Ezekowitz; Margaret C Fang; Marc Fisher; Karen L Furie; Donald V Heck; S Claiborne Clay Johnston; Scott E Kasner; Steven J Kittner; Pamela H Mitchell; Michael W Rich; DeJuran Richardson; Lee H Schwamm; John A Wilson Journal: Stroke Date: 2014-05-01 Impact factor: 7.914
Authors: Alison B Hamilton; Julian Brunner; Cindy Cain; Emmeline Chuang; Tana M Luger; Ismelda Canelo; Lisa Rubenstein; Elizabeth M Yano Journal: Transl Behav Med Date: 2017-09 Impact factor: 3.046
Authors: Barbara J Homoya; Teresa M Damush; Jason J Sico; Edward J Miech; Gregory W Arling; Laura J Myers; Jared B Ferguson; Michael S Phipps; Eric M Cheng; Dawn M Bravata Journal: J Gen Intern Med Date: 2018-11-27 Impact factor: 5.128
Authors: M Alexis Kirk; Caitlin Kelley; Nicholas Yankey; Sarah A Birken; Brenton Abadie; Laura Damschroder Journal: Implement Sci Date: 2016-05-17 Impact factor: 7.327
Authors: Teresa M Damush; Lauren S Penney; Edward J Miech; Nicholas A Rattray; Sean A Baird; Ariel J Cheatham; Charles Austin; Ali Sexson; Laura J Myers; Dawn M Bravata Journal: BMC Health Serv Res Date: 2021-05-12 Impact factor: 2.655
Authors: Dawn M Bravata; Edward J Miech; Laura J Myers; Anthony J Perkins; Ying Zhang; Nicholas A Rattray; Sean A Baird; Lauren S Penney; Curt Austin; Teresa M Damush Journal: BMC Health Serv Res Date: 2022-07-04 Impact factor: 2.908