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Implementation Science at UW

Keywords: Lauren A. Beste

✪ Getting to Implementation: applying data-driven implementation strategies to improve guideline concordant surveillance for hepatocellular carcinoma

Authors:

Vera Yakovchenko, Chaeryon Kang, Brittney Neely, Carolyn Lamorte, Heather McCurdy, Dawn Scott, Anna Nobbe, Gwen Robins, Nsikak R. Ekanem, Monica Merante, Sandra Gibson, Patrick Spoutz, Linda Chia, Rachel I. Gonzalez, Matthew J. Chinman, David Ross, Maggie Chartier, Lauren A. Beste, Jasmohan S. Bajaj, Tamar Taddei, Timothy R. Morgan & Shari S. Rogal

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: December 2025

Read the full text in the open access journal Implementation Science

Abstract:

Background

While guidelines recommend twice-yearly liver cancer (hepatocellular carcinoma, HCC) surveillance for people with cirrhosis, adherence to these guidelines remains variable. We aimed to empirically identify and apply successful implementation strategies through Getting to Implementation (GTI), a manualized facilitation approach.

Method

A hybrid type III, stepped-wedge, cluster-randomized trial was conducted at 12 underperforming Veterans Health Administration (VA) sites between October 2020 and October 2022. GTI included a stepwise approach to guide sites to detail their current state, set implementation goals, identify implementation barriers, select implementation strategies, make a work plan, conduct an evaluation, and sustain their work. Outcomes were defined using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Results

Facilitators supported site teams with an average of 20±6 facilitation hours over a 12-month period. Ten of 12 sites (83%) adopted GTI and applied a median of five strategies (e.g., dashboard use, small tests of change, direct patient outreach). Reach, the primary outcome, increased from mean 29.1% to mean 38.8% at-risk Veterans receiving HCC surveillance from pre- to post-intervention, and further increasing to 41.3% in the sustainment period. In both unadjusted and adjusted models, the odds of HCC surveillance were significantly higher during intervention (adjusted odds ratio, aOR=1.67, 95% CI:1.59, 1.75) and during sustainment (aOR=1.69, 95% CI:1.60, 1.78) compared with baseline, and with difference between active and sustainment periods, indicating sustained improvement after active facilitation ended.

Conclusions

GTI sustainably improved HCC surveillance, suggesting that applying data-driven implementation strategies within a manualized facilitation approach can improve care.

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

✪ Getting to Implementation for HIV Pre-Exposure Prophylaxis (GTI-PrEP): A data-driven approach to PrEP prescribing

Authors:

Shari S. Rogal, Brittney Neely, Monica Merante, Karen Slazinski, Lorenzo McFarland, Christina Brodkorb, Jada Cooper, Carolyn Lamorte, Sandra Gibson, Emily Comstock, Jamie Morano, Marissa Maier, Lauren A. Beste, Karine Rozenberg, Maggie Chartier, Matthew J. Chinman, David Ross & Vera Yakovchenko

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: June 2025

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

Abstract:

Background

Pre-Exposure Prophylaxis (PrEP) dramatically reduces the likelihood of acquiring human immunodeficiency virus (HIV), yet it remains under-prescribed, particularly for people in communities with high HIV incidence. While implementation science and health services researchers aim to address disparities in care, few interventions have proven effective in doing so. We aimed to identify implementation strategies associated with higher PrEP prescribing rates and pilot test a tailored intervention as a proof-of-concept in a single Veterans Health Administration (VA) facility.

Methods

VA clinicians were surveyed using an instrument derived from the Evidence-based Recommendations for Implementing Change taxonomy to assess the use of various strategies for PrEP in fiscal years 2019–2021. Correlational analyses identified the strategies associated with the frequency of PrEP prescribing and semi-structured interviews with personnel from 11 VA medical facilities with high PrEP prescribing refined and manualized these strategies into the Getting to Implementation (GTI)-PrEP playbook. The playbook was subsequently pilot tested in a VA facility with high new HIV diagnosis rates and low PrEP prescribing rates.

Results

The clinician survey collected 157 responses from 95 unique VA facilities on implementation strategy use. Analysis identified eight strategies significantly associated with PrEP prescribing, including: networking, clinician education, clinical support tools, dashboard utilization, telehealth, pharmacist involvement, direct patient engagement, and enhanced sexual health history taking. In the pilot study, the site completed the GTI-PrEP Playbook with high fidelity and newly implemented seven of the eight strategies, achieving a 363% increase in PrEP prescribing rates among Black Veterans over the one-year period.

Conclusions

This multi-year national evaluation identified a core subset of effective implementation strategies for increasing PrEP prescribing. The process of empirically specifying these strategies and pilot testing them through the GTI-PrEP playbook demonstrates a promising, data-driven approach to improve PrEP prescribing rates and reduce racial disparities in HIV prevention.

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