Tiffany Courtnage, Nicole E. Bates, Anne A. Armstrong, M. Katherine Seitz, Tammy S. Weitzman, & Jesse R. Fann
University of Washington affiliated authors are displayed in bold.
Published: October 2020
Grace Kuo Chair, Jennifer L. Bacci, Michelle A. Chui, Joel Farley, Peter M. Gannett, Sheldon G. Holstad, Melanie Livet, and Dorothy Farrell
University of Washington affiliated authors are displayed in bold.
Published: October 2020
Amy Drahota, Rosemary D. Meza, Tatiana E. Bustos, Aksheya Sridhar, Jonathan I. Martinez, Brigitte Brikho, Aubyn C. Stahmer, Gregory A. Aarons
University of Washington affiliated authors are displayed in bold.
Published: September 2020
Gloria D. Coronado, Jennifer L. Schneider, Beverly B. Green, Jennifer K. Coury, Malaika R. Schwartz, Yogini Kulkarni-Sharma & Laura Mae Baldwin
University of Washington affiliated authors are displayed in bold.
Published: September 2020
Promoting uptake of evidence-based innovations in healthcare systems requires attention to how innovations are adapted to enhance their fit with a given setting. Little is known about real-world variation in how programs are delivered over time and across multiple populations and contexts, and what motivates adaptations.
As part of the BeneFIT study of mailed fecal immunochemical tests (FIT) to increase colorectal cancer screening, we interviewed 9 leaders from two participating Medicaid/Medicare health insurance plans to examine adaptations to their health plan-initiated mailed FIT outreach programs in the second year of implementation. We applied an adaptation and modification model developed by Stirman and colleagues to document content and context modifications made to the two programs.
Both health plans made substantial changes to their programs in the second year; adaptations differed substantially across health plans. In Health Plan Oregon, adaptations generally targeted health centers and member populations, most content adaptations involved tailoring program components, and the program was expanded to four additional health centers. In contrast, Health Plan Washington’s second-year content adaptations were primarily at the level of members, and generally involved adding program components. Moreover, Health Plan Washington undertook large-scale context adaptations to the setting where the program was led (local vs. national), the personnel who administered the program (vendor and staffing), and the population selected for outreach (limiting outreach to dual-eligible members).
Both programs implemented a variety of adaptations that reflected the values and incentives of the broader health plan contexts. Financial incentives for screening allowed Health Plan Oregon to expand but led Health Plan Washington to offer more targeted outreach to a subset of eligible enrollees. The breadth of changes made by each health system reflects the necessity of evaluating programs in context and adjusting to specific challenges as they are identified. Further research is needed to understand the effects of these types of adaptations on program efficiency and enrollee and health system outcomes.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Aditi Sharma, Tyler Sasser, Erin Schoenfelder Gonzalez, Ann Vander Stoep, and Kathleen Myers
University of Washington affiliated authors are displayed in bold.
Published: August 2020
Madeline C. Frost, George N. Ioannou, Judith I. Tsui, E. Jennifer Edelman, Bryan J. Weiner, Olivia V. Fletcher & Emily C. Williams
University of Washington affiliated authors are displayed in bold.
Published: July 2020
Alcohol-related care, including screening, brief intervention, and provision of/referral to medication or behavioral treatments for alcohol use disorder, could be delivered in liver clinics to better reach patients with chronic liver conditions. However, the provision of alcohol-related care in liver clinics is currently suboptimal. Practice facilitation is an evidence-based implementation strategy that may address barriers, harness facilitators, and optimize the implementation of alcohol-related care in liver clinic settings using a clinic-centered approach. We report the protocol of a study to test a practice facilitation intervention to implement alcohol-related care in four Veterans Health Administration liver clinics.
This study will employ a Hybrid Type 3 effectiveness-implementation design, in which implementation outcomes are considered primary and clinical outcomes secondary. Intervention and evaluation design were informed by the Consolidated Framework for Implementation Research. Qualitative data collected from clinical stakeholders and patients were used to tailor the intervention. The intervention involves a 6-month period of external practice facilitation, including regular meetings to identify clinic goals, challenges, and solutions; engagement of clinic champions; provision of training and development of educational materials for clinic staff and patients; and performance monitoring and feedback. Ongoing formative evaluation involves the collection of quantitative facilitator tracking data and qualitative data from meeting notes and patient interviews to describe intervention acceptability, feasibility, and adoption, and adjust implementation as needed. In the summative evaluation, implementation outcomes (clinic rates of screening, brief intervention, and treatment referral/receipt) and clinical outcomes (unhealthy alcohol use, liver health) will be assessed among patients in participating clinics using secondary electronic health record data and interrupted time series analysis.
This will be the first study to our knowledge to test practice facilitation to implement alcohol-related care in liver clinic settings. Results from formative and summative evaluation will inform a framework for the successful implementation of effective alcohol-related care through practice facilitation in liver clinics, which may ultimately lead to better health outcomes for patients with chronic liver disease.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Alexandra L. Quittner, Janice Abbott, Saida Hussain, Thida Ong, Ahmet Uluer, Sarah Hempstead, Paula Lomas, & Beth Smith
University of Washington affiliated authors are displayed in bold.
Published: July 2020
Molly Adrian, Jessica Coifman, Michael D. Pullmann, Jennifer B. Blossom, Casey Chandler, Glen Coppersmith, Paul Thompson, & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: July 2020
Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential.
This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting.
A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES.
Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care.
Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Judy Leong, Sou Hyun Jang, Sonia K. Bishop, Emily V. R. Brown, Eun Jeong Lee, Linda K. Ko
University of Washington affiliated authors are displayed in bold.
Published: June 2020
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.
Published: May 2020