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Implementation Science at UW

Keywords: Christian D. Helfrich

✪ VA’s EHR transition and health professions trainee programs: Findings and impacts of a multistakeholder learning community

Authors:

Julian Brunner, Ellen A. Ahlness, Ekaterina Anderson, Brianne K. Molloy-Paolillo, Alexandre Braga, Sarah L. Cutrona, Christian D. Helfrich, Deborah Levy, Erin Matteau, Edward Walton, George Sayre, Seppo T. Rinne

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: October 2024

Read the full text in the open access journal Learning Health System

Abstract:

Introduction

The Department of Veterans Affairs (VA) is undergoing an unprecedented electronic health record (EHR) transition, switching from its homegrown EHR to a commercial system. The transition affects nearly every clinical employee but is particularly disruptive to health professions trainees (HPTs)—an often-overlooked population in EHR transitions. To better understand and address trainee challenges with the EHR transition, we formed a multistakeholder learning community. In this study, we describe the findings of this learning community and the practices and policies developed in response.

Methods

In the qualitative study designed and executed by our learning community, we conducted 51 interviews with HPTs, program leaders, and preceptors before and multiple times after an EHR transition site's go-live (February 16, 2022 to April 7, 2023). We merged interview transcripts with 125 survey free-text responses from a survey conducted with preceptors 2 months post-go-live and conducted thematic analysis to identify key themes. To complement qualitative findings, we also include a quantitative survey finding, and, where applicable, we note policy and practice responses spurred by our learning community.

Results

Interviews yielded six key themes: (1) High satisfaction with HPT programs, despite negative impacts of the EHR transition; (2) early delays, then substantial improvements, in HPTs' EHR access; (3) persistent challenges with HPTs' EHR training and support, mitigated by local and national efforts; (4) the challenge of learning to use a rapidly evolving EHR during clinical training; (5) reduced visit volume as a continuing barrier to education; and (6) an impression that HPTs' relative lack of exposure to the prior EHR facilitated their proficiency with the new EHR.

Conclusions

Findings highlighted challenges for HPT programs related to the EHR transition, which spurred important changes including the creation of a national VA council to represent the needs of HPTs in the EHR transition, and improvements to HPTs' EHR training and access.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Mapping the organizational readiness to change assessment to the Consolidated Framework for Implementation Research

Authors:

Jennifer Kononowech, Hildi Hagedorn, Carmen Hall, Christian D. Helfrich, Anne C. Lambert-Kerzner, Susan C. Miller, Anne E. Sales, & Laura Damschroder

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: February 2021

Read the full text in the open access journal Implementation Science Communications

Abstract:

Background

Implementation researchers recognize the influential role of organizational factors and, thus, seek to assess these factors using quantitative measurement instruments. However, researchers are hindered by instruments that measure similar constructs but rely on different nomenclature and/or definitions. The Consolidated Framework for Implementation Research (CFIR) provides a taxonomy of constructs derived from prior frameworks and empirical studies of implementation-related constructs. The CFIR includes constructs based on the original Promoting Action on Research Implementation in Health Services (PARiHS) framework which highlights the key roles of strength of evidence for a specific evidence-based intervention (EBI), favorability of organizational context for change, and capacities to facilitate implementation of the EBI. Although the CFIR is among the most frequently used implementation frameworks, it does not include quantitative measures. The Organizational Resource and Context Assessment (ORCA) is a quantitative measurement instrument that was developed based on PARiHS, assessing its three domains. Factors within these three domains are conceptually similar to constructs in the CFIR but do not match directly. The aim of this work was to map ORCA survey items to CFIR constructs to enable direct comparisons and syntheses of findings across studies using the CFIR and/or ORCA.

Methods

Two distinct, independent research teams, each used rigorous constant comparative techniques with deliberation and consensus to map individual items from the ORCA to the five domains and 39 constructs of CFIR.

Results

ORCA items were mapped primarily to three of five CFIR domains: Inner Setting, Process, and Intervention Characteristics. The two research teams agreed on 88% of mappings at the higher domain level; at the lower construct level, their mappings aligned for 62.2% of the ORCA items.

Conclusions

Mapping results reveal that the ORCA focuses measurement prominently on Inner Setting, Process, and Intervention Characteristics. This mapping guide can help improve consistency in measurement and reporting, enabling more efficient comparison and synthesis of findings that use either the ORCA instrument or the CFIR framework. The guide helps advance implementation science utilizing mixed methods by providing CFIR users with quantitative measures for selected constructs and enables ORCA users to map their findings to CFIR constructs.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

Organizational readiness assessment in acute and long-term care has important implications for antibiotic stewardship for asymptomatic bacteriuria

Authors:

Melanie C. Goebel, Barbara W. Trautner, Yiqun Wang, John N. Van, Laura M. Dillon, Payal K. Patel, Dimitri M. Drekonja, Christopher J. Graber, Bhavarth S. Shukla, Paola Lichtenberger, Christian D. Helfrich, Anne Sales, & Larissa Grigoryan

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: May 2020

Read the full text in the subscription access American Journal of Infection Control

ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (the PRECluDE consortium): Combatting chronic disease comorbidities in HIV populations through implementation research

Authors:

Joyonna Carrie Gamble-George, Christopher T. Longenecker, Allison R. Webel, David H. Au, Arleen F. Brown, Hayden Bosworth, Kristina Crothers, William E. Cunningham, Kevin A. Fiscella, Alison B. Hamilton, Christian D. Helfrich, Joseph A. Ladapo, Amneris Luque, Jonathan N. Tobin, Gail E. Wyatt, Implementation Research to Develop Interventions for People Living with HIV (PRECluDE) Consortium

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: March 2020

Read the full text in the subscription access journal Progress in Cardiovascular Diseases

Development of a Wellness Committee Implementation Index for Workplace Health Promotion Programs in Small Businesses

Authors:

Meagan C. Brown, Jeffrey R. Harris, Kristen Hammerback, Marlana J. Kohn, Amanda T. Parrish, Gary K. Chan, India J. Ornelas, Christian D. Helfrich, Peggy A. Hannon

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: February 2020

Read the full text in the subscription access American Journal of Health Promotion

De-implementing Inhaled Corticosteroids to Improve Care and Safety in COPD Treatment: Primary Care Providers’ Perspectives

Authors:

Krysttel Stryczek, Colby Lea, Chris Gillespie, George Sayre, Scott Wanner, Seppo T. Rinne, Renda Soylemez Wiener, Laura Feemster, Edmunds Udris, David H. Au, & Christian D. Helfrich

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: January 2020

Read the full text in the subscription access Journal of General Internal Medicine

✪ Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study

Authors:

Alvaro Sanchez, Jose Ignacio Pijoan, Susana Pablo, Marta Mediavilla, Rita Sainz de Rozas, Itxasne Lekue, Susana Gonzalez-Larragan, Gaspar Lantaron, Jon Argote, Arturo García-Álvarez, Pedro Maria Latorre, Christian D. Helfrich & Gonzalo Grandes

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: January 2020

Read the full text in the open access journal Implementation Science

Abstract:

Background

De-implementation or abandonment of ineffective or low-value healthcare is becoming a priority research field globally due to the growing empirical evidence of the high prevalence of such care and its impact in terms of patient safety and social inefficiency. Little is known, however, about the factors, barriers, and facilitators involved or about interventions that are effective in promoting and accelerating the de-implementation of low-value healthcare. The De-imFAR study seeks to carry out a structured, evidence-based, and theory-informed process involving the main stakeholders (clinicians, managers, patients, and researchers) for the design, deployment, and assessment of de-implementation strategies for reducing low-value pharmacological prescribing.

Methods

A phase I formative study using a systematic and comprehensive framework based on theory and evidence for the design of implementation strategies—specifically, the Behavior Change Wheel (BCW)—will be conducted to design and model de-implementation strategies to favor reductions in low-value pharmacological prescribing of statins in primary prevention of cardiovascular disease (CVD) by main stakeholders (clinicians, managers, patients, and researchers) in a collegiate way. Subsequently, a phase II comparative hybrid trial will be conducted to assess the feasibility and potential effectiveness of at least one active de-implementation strategy to reduce low-value pharmacological prescribing of statins in primary prevention of CVD compared to the usual procedures for dissemination of clinical practice guidelines (“what-not-to-do” recommendations). A mixed-methods evaluation will be used: quantitative for the results of the implementation at the professional level (e.g., adoption, reach and implementation or execution of the recommended clinical practice); and qualitative to determine the feasibility and perceived impact of the de-implementation strategies from the clinicians’ perspective, and patients’ experiences related to the clinical care received.

Discussion

The DE-imFAR study aims to generate valid scientific knowledge about the design and development of de-implementation strategies using theory- and evidence-based methodologies suggested by implementation science. It will explore the effectiveness of these strategies and their acceptability among clinicians, policymakers, and patients. Its ultimate goal is to maximize the quality and efficiency of our health system by abandoning low-value pharmacological prescribing.

Trial Registration

Clinicaltrials.gov identifier: NCT04022850. Registered 17 July 2019

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Readiness to Change Over Time: Change Commitment and Change Efficacy in a Workplace Health-Promotion Trial

Authors:

Christian D. Helfrich, Marlana J. Kohn, Austin Stapleton, Claire L. Allen, Kristen Elizabeth Hammerback, K. C. Gary Chan, Amanda T. Parrish, Daron E. Ryan, Bryan J. Weiner, Jeffrey R. Harris, & Peggy A. Hannon

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2018

Read the full text in the open access journal Frontiers in Public Health

Abstract:

Introduction

Organizational readiness to change may be a key determinant of implementation success and a mediator of the effectiveness of implementation interventions. If organizational readiness can be reliably and validly assessed at the outset of a change initiative, it could be used to assess the effectiveness of implementation-support activities by measuring changes in readiness factors over time.

Methods

We analyzed two waves of readiness-to-change survey data collected as part of a three-arm, randomized controlled trial to implement evidence-based health promotion practices in small worksites in low-wage industries. We measured five readiness factors: context (favorable broader conditions); change valence (valuing health promotion); information assessment (demands and resources to implement health promotion); change commitment (an intention to implement health promotion); and change efficacy (a belief in shared ability to implement health promotion). We expected commitment and efficacy to increase at intervention sites along with their self-reported effort to implement health promotion practices, termed wellness-program effort. We compared means between baseline and 15 months, and between intervention and control sites. We used linear regression to test whether intervention and control sites differed in their change-readiness scores over time.

Results

Only context and change commitment met reliability thresholds. Change commitment declined significantly for both control (−0.39) and interventions sites (−0.29) from baseline to 15 months, while context did not change for either. Only wellness program effort at 15 months, but not at baseline, differed significantly between control and intervention sites (1.20 controls, 2.02 intervention). Regression analyses resulted in two significant differences between intervention and control sites in changes from baseline to 15 months: (1) intervention sites exhibited significantly smaller change in context scores relative to control sites over time and (2) intervention sites exhibited significantly higher changes in wellness program effort relative to control sites.

Discussion

Contrary to our hypothesis, change commitment declined significantly at both Healthlinks and control sites, even as wellness-program effort increased significantly at HealthLinks sites. Regression to the mean may explain the decline in change commitment. Future research needs to assess whether baseline commitment is an independent predictor of wellness-program effort or an effect modifier of the HealthLinks intervention.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**