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Implementation Science at UW

Keywords: facilitation

✪ Implementation of a Telemental Health Training Program Across a Mental Health Department

Authors:

Bradford L. Felker, Meghan M. McGinn, Erika M. Shearer, Gina T. Raza, Sari D. Gold, Jean M. Kim, Sasha M. Rojas, Milena S. Roussev, Ruth L. Varkovitzky, Huiting Liu, Kate L. Morrison, and Russell A. McCann

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: January 2021

Read the full text in the open access journal Telemedicine Reports

Abstract:

Introduction

Telemental health (TMH) has increased substantially. However, health care systems have found it challenging to implement TMH ubiquitously. A quality improvement project guided by implementation science methodology was used to design and implement a TMH training program.

Materials and Methods

Implementation science methodology (Promoting Access to Research Implementation in Health Services, Reach-Effectiveness-Adoption-Implementation-Maintenance, Implementation/Facilitation) provided the framework to design and implement the training program. A total of 100 interdisciplinary mental health providers from outpatient mental health clinics participated.

Results

Providers reported satisfaction with the training program. Results indicated that the training increased providers' TMH knowledge and competence. The number of providers using TMH and patients who received TMH nearly doubled.

Conclusions

Implementation science methodology was important in creating an organizational framework at this facility to design, evaluate, and implement an innovative TMH training program.

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

✪ Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration

Authors:

Mona J. Ritchie, JoAnn E. Kirchner, James C. Townsend, Jeffery A. Pitcock, Katherine M. Dollar, & Chuan-Fen Liu

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: December 2019

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

Abstract:

Background

Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost.

Objective

To examine the time and organizational cost of facilitating implementation of primary care mental health integration.

Design

Descriptive analysis.

Participants

One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics.

Intervention

Implementation facilitation tailored to the needs and resources of the setting and its stakeholders.

Main Measures

We documented facilitators’ and stakeholders’ time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost.

Key Results

The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other.

Conclusions

Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.

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

✪ Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review

Authors:

Cecilie Varsi, Lise Solberg Nes, Olöf Birna Kristjansdottir, Saskia M Kelders, Una Stenberg, Heidi Andersen Zangi, Elin Børøsund, Karen Elizabeth Weiss, Audun Stubhaug, Rikke Aune Asbjørnsen, Marianne Westeng, Marte Ødegaard, Hilde Eide

University of Washington affiliated authors are displayed in bold.

Published: September 2019

Read the full text in the open access Journal of Medical Internet Research

 

BACK TO THE ARCHIVE

Abstract:

Background

There is growing evidence of the positive effects of electronic health (eHealth) interventions for patients with chronic illness, but implementation of such interventions into practice is challenging. Implementation strategies that potentially impact implementation outcomes and implementation success have been identified. Which strategies are actually used in the implementation of eHealth interventions for patients with chronic illness and which ones are the most effective is unclear.

Objective

This systematic realist review aimed to summarize evidence from empirical studies regarding (1) which implementation strategies are used when implementing eHealth interventions for patients with chronic illnesses living at home, (2) implementation outcomes, and (3) the relationship between implementation strategies, implementation outcomes, and degree of implementation success.

Methods

A systematic literature search was performed in the electronic databases MEDLINE, Embase, PsycINFO, Scopus, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Studies were included if they described implementation strategies used to support the integration of eHealth interventions into practice. Implementation strategies were categorized according to 9 categories defined by the Expert Recommendations for Implementing Change project: (1) engage consumers, (2) use evaluative and iterative strategies, (3) change infrastructure, (4) adapt and tailor to the context, (5) develop stakeholder interrelationships, (6) use financial strategies, (7) support clinicians, (8) provide interactive assistance, and (9) train and educate stakeholders. Implementation outcomes were extracted according to the implementation outcome framework by Proctor and colleagues: (1) acceptability, (2) adoption, (3) appropriateness, (4) cost, (5) feasibility, (6) fidelity, (7) penetration, and (8) sustainability. Implementation success was extracted according to the study authors’ own evaluation of implementation success in relation to the used implementation strategies.

Results

The implementation strategies management support and engagement, internal and external facilitation, training, and audit and feedback were directly related to implementation success in several studies. No clear relationship was found between the number of implementation strategies used and implementation success.

Conclusions

This is the first review examining implementation strategies, implementation outcomes, and implementation success of studies reporting the implementation of eHealth programs for patients with chronic illnesses living at home. The review indicates that internal and external facilitation, audit and feedback, management support, and training of clinicians are of importance for eHealth implementation. The review also points to the lack of eHealth studies that report implementation strategies in a comprehensive way and highlights the need to design robust studies focusing on implementation strategies in the future.

Trial Registration

PROSPERO CRD42018085539

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