Implementation science communications最新文献

{"title":"The Consolidated Approach to Intervention Adaptation (CLARION): Developing and undertaking an empirically and theoretically driven intervention adaptation.","authors":"Lydia Ould Brahim, Sylvie D Lambert, Nancy Feeley, Jane McCusker, Dan Bilsker, Mark J Yaffe, Rosetta Antonacci, Stephanie Robins, John William Kayser, Christine Genest, Haida Paraskevopoulos, Jessica Blair, Andrea Laizner","doi":"10.1186/s43058-025-00731-y","DOIUrl":"10.1186/s43058-025-00731-y","url":null,"abstract":"<p><strong>Background: </strong>Intervention adaptation, the deliberate modification of the design or delivery of interventions to a new context, is more resource efficient than de novo development. However, adaptation must be approached methodically, as some modifications, such as those to the core components, may compromise the intervention's initial efficacy. While adaptation frameworks have been published, none have been identified as more likely to result in successful adaptations. Further, frameworks lack the step-by-step details needed for operationalization. Therefore, the goal of this paper is to share our experience in addressing these methodological limitations in intervention adaptation. The objectives were to describe: 1) our development of a step-by-step, theoretically and empirically driven approach to intervention adaptation labelled the ConsoLidated AppRoach to Intervention adaptatiON (CLARION), 2) the application of CLARION in adapting a depression self-management intervention, 3) the facilitators and challenges encountered when using CLARION.</p><p><strong>Methods: </strong>The development of CLARION was informed by the Medical Research Council guidance, the Method for Program Adaptation through Community Engagement (M-PACE), and a published scoping review identifying the key steps in existing adaptation frameworks. M-PACE was selected for its patient-oriented research principles, its application to a similar complex intervention, and for offering some of the specificity needed for execution. However, the scoping review indicated that M-PACE lacked three critical steps: selecting a candidate intervention, understanding its core components, and pre-testing the adapted intervention. These were added to form CLARION, which was structured in two stages: the first involves selecting an intervention, identifying core components, and deciding on modifications; the second stage solicits interest stakeholder feedback to assess the acceptability of the preliminary adapted intervention (pre-test).</p><p><strong>Results: </strong>Once CLARION was developed, it was put into action to adapt a depression self-management intervention. CLARION demonstrated several strengths: 1) clearly articulating core components before deciding on modifications, 2) mobilizing a diverse steering committee of experts, including patient partners and developers of the original intervention, which balanced input and efficiency, and 3) establishing committee decision-making rules prior to adjudication (specific criteria and 75% supermajority). Key challenges included defining the types of modifications requiring committee input, determining the extent of the committee's involvement, and prioritizing the presence of all committee members at meetings to avoid difficulties integrating incongruent feedback.</p><p><strong>Conclusions: </strong>The development of CLARION contributes to best practices for intervention adaptation by identifying step-by-step guidance as wel","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"59"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a stakeholder selected implementation strategy package - fast tracking, provider re-training, and co-location - on PrEP implementation for pregnant women in antenatal care clinics in western Kenya.","authors":"Joseph Sila, Anjuli Dawn Wagner, Felix Abuna, Julia C Dettinger, Ben Odhiambo, Nancy Ngumbau, George Oketch, Enock Sifuna, Laurén Gómez, Sarah Hicks, Bryan J Weiner, Grace John-Stewart, John Kinuthia","doi":"10.1186/s43058-025-00746-5","DOIUrl":"https://doi.org/10.1186/s43058-025-00746-5","url":null,"abstract":"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) is recommended for HIV prevention in pregnant and postpartum women at substantial ongoing risk for HIV. In resource-limited settings, there exist gaps in the integration of PrEP into antenatal care.</p><p><strong>Methods: </strong>We conducted a difference-in-differences analytic approach (3 months pre- and 3 months post) between January 2022 and July 2022 in 8 facilities (4 intervention and 4 comparison) in western Kenya. During the 6-month period, we tested a combination of 2 stakeholder selected implementation strategies - retraining health providers and fast tracking PrEP clients- to improve PrEP delivery. All study facilities dispensed PrEP in the Maternal and Child health clinics (MCH). We evaluated absolute changes in: PrEP penetration, PrEP fidelity, client PrEP knowledge, client satisfaction, and client waiting and service times as outcomes specified a priori while PrEP offer and HIV testing were outcomes specified post hoc. We measured acceptability and appropriateness by providers of the implementation strategies using AIM and IAM respectively.</p><p><strong>Results: </strong>We observed statistically significant improvements in PrEP penetration and PrEP offer (p < 0.05) and non-significant improvements in fidelity. PrEP penetration increased 6 percent points (p = 0.002), PrEP offer increased nearly 6 percentage points (p = 0.002), and PrEP fidelity increased 4 percentage points (p = 0.202) in intervention vs comparison facilities. Client PrEP knowledge increased 0.45 out of 7 total points (p < 0.001) and PrEP screening increased 13 percentage points (p = 0.001). We observed no significant changes in service time (0.13-min increase; p = 0.249), waiting time (0.03-min decrease; p = 0.796), or client satisfaction (0.04/24 total point decrease; p = 0.849) in intervention vs comparison facilities. HIV testing did not significantly change (7 percentage point decrease, p = 0.305). The implementation strategy bundle was deemed appropriate and acceptable by the providers (appropriateness: 18.5/20; acceptability: 18.5/20). Overall, the implementation strategy bundle was associated with larger increases in implementation outcomes among women receiving a visit other than their first ANC visit, as well as among sites without stockouts of HIV test kits.</p><p><strong>Conclusions: </strong>A stakeholder-selected implementation strategy bundle that included retraining healthcare workers, fast tracking PrEP clients to reduce waiting time, and PrEP dispensing in MCH improved several implementation outcomes without significantly affecting waiting time or reducing service time.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationships between internal facilitation processes and implementation outcomes among hospitals participating in a quality improvement collaborative to reduce cesarean births: a mixed-methods embedded case study.","authors":"Jennifer A Callaghan-Koru, Rachel Blankstein Breman, Bonnie DiPietro, Loren Henderson, Geoffrey Curran","doi":"10.1186/s43058-025-00735-8","DOIUrl":"https://doi.org/10.1186/s43058-025-00735-8","url":null,"abstract":"<p><strong>Background: </strong>Quality improvement collaboratives (QICs) are a common strategy for implementing evidence-based practices; however, there is often variable performance between participating organizations. Few studies of QICs assess the internal facilitation (IF) processes engaged in by participating organizations, which may be key to understanding and enhancing the effectiveness of QICs as an implementation strategy. We examined IF processes among hospitals participating in Maryland's perinatal QIC to implement national guidelines for reducing primary cesarean births.</p><p><strong>Methods: </strong>This study followed a mixed-methods embedded case study design. We conducted qualitative interviews with internal implementation leaders at 21 QIC-participating hospitals using a guide informed by the iPARIHS and CFIR frameworks. Two investigators independently coded transcripts in Dedoose using a modified CFIR codebook including seven IF process codes adapted from published categorizations. The investigators also independently applied the CFIR rating system to rate each IF process as a barrier (-2, -1), facilitator (+ 1, + 2), neutral (0), or mixed (X), for each hospital. Final ratings were established through consensus discussions. Average ratings were calculated by hospital and process and charted alongside implementation outcomes from secondary data sources for identification of patterns.</p><p><strong>Results: </strong>Hospital leaders engaged in a variety of activities within each IF process. The average hospital rating across IF processes ranged from -1.1 to + 1.5. The IF process with the highest average rating was project management (average: 1.0; SD: 0.9), the lowest was planning (average: 0.5; SD: 1.0) and the most variable was providing individual support and accountability (average: 0.5; SD: 1.2). Negative ratings resulted from hospital teams not engaging in an IF process or the activities of hospital teams being insufficient to overcome related contextual barriers. Average IF process ratings were significantly higher among hospitals that implemented more than the median number of practice changes. Multiple contextual determinants influenced each IF process; work infrastructure and relational connections were the most frequent influences across IF processes.</p><p><strong>Conclusions: </strong>IF processes played an important role in determining implementation success at hospitals participating in a perinatal QIC. Monitoring and strengthening IF processes at participating organizations may enhance the effectiveness of QICs as an implementation strategy.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing implementation of single session interventions in schools: a protocol for a qualitative study.","authors":"Katherine A Cohen, Eric Bruns, Aaron Lyon, Tali Raviv, Sara Becker, Jessica L Schleider","doi":"10.1186/s43058-025-00742-9","DOIUrl":"https://doi.org/10.1186/s43058-025-00742-9","url":null,"abstract":"<p><strong>Background: </strong>Schools are one of the most common settings in which youth seek mental health services, yet existing school-based mental health interventions are often difficult to implement due to time, cost, and staffing limitations. Digital, self-administered Single Session Interventions (SSIs) are evidence-based supports that are intentionally structured to deliver a clinically-meaningful dosage of evidence-based content within one session. Although multiple studies have demonstrated the clinical effectiveness of school-based SSIs, there have been no systemic efforts to understand how SSIs can be practically implemented in schools. The goal of this project is to partner with students, parents, and school staff to identify factors that impact the implementation of SSIs and understand how SSIs can be sustainably integrated as mental health supports into school mental health infrastructure.</p><p><strong>Methods: </strong>We will conduct focus groups (five groups, total n = 35-45) among community members (i.e., students, parents/caregivers, teachers, school administrators, and school mental health providers) to assess perceived facilitators and barriers to the effective implementation of evidence-based SSIs in schools (Aim 1). We will then work in partnership with community members (n = 10-15) to co-design multi-level implementation strategies (i.e., student-directed, staff-directed, system-directed) for increasing uptake and promoting sustainability of school-based SSIs (Aim 2). We will use inductive coding to thematically analyze qualitative data from group sessions. This study is being conducted within the Lake Washington School District in the Seattle, Washington region.</p><p><strong>Discussion: </strong>The proposed project will be the first to investigate facilitators and barriers to real-world implementation of SSIs in schools and strategies to improve implementation. Future studies may test the effectiveness of the generated implementation strategies on outcomes such as SSI uptake over time.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"54"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging inter-organizational networks to scale up a sepsis recovery program: results from an application of the Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI) method.","authors":"Cheyenne R Wagi, Marc A Kowalkowski, Stephanie P Taylor, Aliza Randazzo, Asha Ganesan, Amit Khanal, Sarah A Birken","doi":"10.1186/s43058-025-00743-8","DOIUrl":"https://doi.org/10.1186/s43058-025-00743-8","url":null,"abstract":"<p><strong>Background: </strong>Nearly two million adults in the United States are hospitalized with sepsis yearly, with survivors facing complications that result in high rates of hospital readmission and mortality after discharge. We demonstrated improved outcomes following discharge among sepsis survivors who participated in the Sepsis Transition And Recovery (STAR) program; however, important differences among hospitals require STAR's adaptation to facilitate its implementation and ensure its effectiveness in new settings.</p><p><strong>Purpose: </strong>The purpose of this study was to adapt STAR to hospitals with diverse characteristics.</p><p><strong>Methods: </strong>We used the Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI) approach. We identified STAR core functions (i.e., effectiveness-driving features) using semi-structured key informant interviews (n = 7). We identified adaptations using semi-structured interviews with clinicians and leaders with expertise and oversight of resources related to transitions of care after sepsis hospitalization (n = 7) from four hospitals that systematically differed from the hospitals in which we originally found STAR to be effective.</p><p><strong>Results: </strong>Network theory, which proposes that performance improves with more efficient flow of information within and across hospitals, underlays STAR's eleven core functions. Adaptation included specific points-of-contact, communication preferences, and methods for achieving buy-in. We used proposed adaptations to tailor STAR protocols to each hospital.</p><p><strong>Conclusions: </strong>We used MODIFI, a state-of-the-science method, to adapt a program that was effective in promoting transition and recovery in sepsis survivors to facilitate its scale-up to diverse hospitals. Future studies will assess STAR's implementation and effectiveness in diverse hospitals.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"56"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-sector determinants of implementation and sustainment for non-specialist treatment of depression and post-traumatic stress disorder in Kenya: a concept mapping study.","authors":"Erika L Crable, Susan M Meffert, Ryan G Kenneally, Linnet Ongeri, David Bukusi, Rachel L Burger, Grace Rota, Ammon Otieno, Raymond Rotai, Muthoni Mathai, Gregory A Aarons","doi":"10.1186/s43058-025-00744-7","DOIUrl":"https://doi.org/10.1186/s43058-025-00744-7","url":null,"abstract":"<p><strong>Background: </strong>The global shortage of trained mental health workers disproportionately impacts mental health care access in low- and middle-income countries. In Kenya, effective strategies are needed to scale-up the workforce to meet the demand for depression and post-traumatic stress disorder treatment. Task-shifting - delegating specific tasks to non-specialist workers - is one workforce expansion approach. However, non-specialist workers remain underutilized in Kenya due to a paucity of research on how to scale-up and sustain such service models.</p><p><strong>Methods: </strong>Purposive sampling was used to recruit experts from policy, healthcare practice, research, and mental health advocacy roles in Kenya (N = 30). Participants completed concept mapping activities to explore factors likely to facilitate or hinder a collaborative Ministry of Health-researcher training of the mental health non-specialist workforce. Participants brainstormed 71 statements describing determinants and implementation strategies, sorted and rated the importance and changeability of each. Multidimensional scaling and hierarchical cluster analysis quantified relationships between statements. The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework guided cluster interpretation activities.</p><p><strong>Results: </strong>Twelve determinant clusters were identified: 1) Current workforce characteristics, 2) Exploration considerations, 3) Preparation considerations, 4) Sustainment considerations, 5) Inner context implementation processes and tools, 6) Local capacity and partnerships, 7) Financing for community health teams, 8) Outer context resource allocation/policy into action, 9) Workforce characteristics to enhance during implementation, 10) Workforce implementation strategies, 11) Cross-level workforce strategies, and 12) Training and education recommendations. Cluster 8 was rated the most important and changeable.</p><p><strong>Conclusion: </strong>Concept mapping offers a rapid, community-engaged approach for identifying determinants and implementation strategies to address workforce shortages. Organizing results by EPIS phases can help prioritize strategy deployment to achieve implementation goals. Scale-up and sustainment of the non-specialist workforce in Kenya requires formal partnerships between the Ministry of Health and community health worker teams to distribute financial resources and collaboratively standardize training curriculum.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"55"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants.","authors":"Scott Halliday, Lydia A Chwastiak, Kaitlin Zinsli, Ramona Emerson, Teagan Wood, Meena S Ramchandani, Kenneth Sherr, Judith I Tsui, Bradley H Wagenaar, Deepa Rao, Julia C Dombrowski","doi":"10.1186/s43058-025-00738-5","DOIUrl":"https://doi.org/10.1186/s43058-025-00738-5","url":null,"abstract":"<p><strong>Background: </strong>Low-barrier HIV care is an evidence-based intervention to improve HIV outcomes among those who have complex barriers to care, but the walk-in model poses challenges to integrating behavioral health services. We evaluated the acceptability and feasibility of a Collaborative Care Model (CoCM) for treatment of depression and opioid use disorder in a low-barrier clinic.</p><p><strong>Methods: </strong>In a sequential explanatory mixed methods pilot study, we accessed data from patient records to generate a care cascade for the number of patients enrolled in the first six months of the program and conducted individual interviews with patients and staff to interpret the care cascade findings.</p><p><strong>Results: </strong>Among 175 patients who visited the clinic, 36% were screened for, 24% were referred to, 15% completed an intake for, and 9% engaged in CoCM. The interviews revealed that screening was limited by a lack of clarity among staff about services offered in CoCM, staff forgetting the screening process, and limited time during patent visits. Referrals were limited by low buy-in among staff and patient complexity. Intakes were limited by time and space constraints in the care setting and competing acute patient needs. The care manager's ability to embody the clinic's culture facilitated engagement among patients who completed intakes.</p><p><strong>Conclusions: </strong>Staff perceived CoCM to be acceptable and feasible to implement, but only in the context of multiple barriers to implementation and challenges to systematic screening and measurement-based care.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"53"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing implementation of information and communication technologies for post-discharge care among hospitalized older adult patients: development of a multifaceted implementation intervention package using the behavior change wheel and implementation research logic model.","authors":"Dorothy Yingxuan Wang, Eliza Lai-Yi Wong, Annie Wai-Ling Cheung, Zoe Pui-Yee Tam, Kam-Shing Tang, Eng-Kiong Yeoh","doi":"10.1186/s43058-025-00739-4","DOIUrl":"https://doi.org/10.1186/s43058-025-00739-4","url":null,"abstract":"<p><strong>Background: </strong>The integration of information and communication technologies in clinical practice can supplement traditional care pathways on discharge education and has exhibited evident benefits in improving patient health outcomes. However, healthcare providers have reported difficulties in adopting such technologies. The existing evidence on implementation interventions supporting the implementation of information and communication technologies is insufficient, characterized by infrequent utilization or reporting of implementation theories in implementation intervention designs. This study aims to outline the creation of a theory-informed implementation intervention package to enhance the clinical implementation of information and communication technologies for post-discharge self-care among hospitalized older adults.</p><p><strong>Methods: </strong>This study systematically applies the Behavior Change Wheel (BCW) approach, involving behavior diagnosis, identification of intervention options, and intervention content selection, informed by conceptual frameworks, empirical data, and relevant literature. Additionally, the Implementation Research Logic Model is utilized to synthesize, organize, and visually present the collected data.</p><p><strong>Results: </strong>This structured process identified and selected five intervention functions, 11 behavior change techniques, and four policy categories. A multifaceted implementation intervention package was developed, containing four components: (i) flexible and sustainable training, (ii) mass media and opinion leader campaign, (iii) technology and workflow redesign, and (iv) regular corporate-level audit and feedback.</p><p><strong>Conclusions: </strong>The study addresses the incomplete evidence base for implementation interventions supporting clinical information and communication technology implementation, presenting a practical, evaluable, and scalable theory-informed implementation intervention package. By providing an example of the application of the BCW approach and logic model, this study contributes to the knowledge on implementation intervention design, offering valuable insights for researchers and practitioners aiming to improve healthcare providers' behavior change and post-discharge care management with technology-based interventions.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"52"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating spoke facilitation costs of implementing TelePain in the Veterans Health Administration.","authors":"Alexandra L Rose, Shaina Coogan, Jess Indresano, Steven B Zeliadt, Jessica A Chen","doi":"10.1186/s43058-025-00729-6","DOIUrl":"https://doi.org/10.1186/s43058-025-00729-6","url":null,"abstract":"<p><strong>Background: </strong>The high prevalence and significant morbidity and mortality associated with chronic pain among veterans has made expansion of pain services within the Veterans Health Administration (VHA) a key priority. TelePain, in which services are provided via telehealth from central \"hub\" sites to patients at decentralized \"spoke\" sites, is one such model with positive implementation findings to date. However, the staff effort and cost of implementation have yet to be examined when considering TelePain or similar virtual hub-and spoke models of specialty pain care, information that is critical for expansion of services.</p><p><strong>Methods: </strong>Using an established time-based activity tracker designed for implementation facilitation, study staff tracked minutes spent on implementation activities at 11 spoke sites. Annual salaries were extracted to calculate an average cost per minute for each personnel type. Costs per personnel minute were combined with activity data to calculate costs of implementation activities at spoke sites. Implementation reach outcomes for the first 36 months of implementation were extracted from the electronic health record. Service utilization data was combined with cost data to calculate cost per patient reached and per clinical encounter achieved at each site.</p><p><strong>Results: </strong>Total facilitation costs (range: $1,746-$7,978) and unique patients reached (range: 2-46) varied considerably across spoke sites and greater staff implementation efforts (measured in time or cost) were not associated with greater numbers of patients reached. Therefore, costs per patient reached also varied widely (range: $120-2,569) across spoke sites. Key challenges included high rurality and small clinic size; insufficient engagement of frontline providers; lack of referral options for high acuity patients; and lack of existing programming within which to situate pain services.</p><p><strong>Conclusions: </strong>At spoke sites where patients were consistently referred and reached, costs were relatively modest, particularly compared to the high cost of untreated chronic pain, suggesting the potential impact of this model at scale. However, in spoke sites where referrals and encounters were low during initial implementation, cost per patient was high. Findings highlight the need for better methods for tailoring of facilitation interventions to spoke site's individual needs to maximize impact.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"51"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a pragmatic measure of context at the organizational level: The Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS).","authors":"Hélène Chokron Garneau, Hannah Cheng, Jane Kim, Maryam Abdel Magid, Lia Chin-Purcell, Mark McGovern","doi":"10.1186/s43058-025-00726-9","DOIUrl":"https://doi.org/10.1186/s43058-025-00726-9","url":null,"abstract":"<p><strong>Background: </strong>Successful implementation and sustainment of interventions is heavily influenced by context. Yet the complexity and dynamic nature of context make it challenging to connect and translate findings across implementation efforts. Existing methods to assess context are typically qualitative, limiting potential replicability and utility. Existing quantitative measures and the siloed nature of implementation efforts limit possibilities for data poolinXg and harmonization. The Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) was developed to be a pragmatic, quantitative, organizational-level assessment of contextual factors. The intention is to characterize context with a measure that may enhance replication and reproducibility of findings beyond single implementation case studies. Here, we present the development and validation of the IFASIS.</p><p><strong>Methods: </strong>A literature review was conducted to identify major concepts of established theories and frameworks to be retained. IFASIS data were examined in relation to implementation outcomes gathered from two studies. Psychometric validation efforts included content and face validity, reliability, internal consistency, and predictive and concurrent validity. Predictive validity was evaluated using generalized estimating equations (GEE) for longitudinal data on three implementation outcomes: reach, effectiveness, and implementation quality. Pragmatic properties were also evaluated.</p><p><strong>Results: </strong>The IFASIS is a 27-item, team-based, instrument that quantitatively operationalizes context. Two rating scales capture current state and importance of each item to an organization. It demonstrated strong reliability, internal consistency, and predictive and concurrent validity. There were significant associations between higher IFASIS scores and improved implementation outcomes. A one-unit increase in total IFASIS score corresponded to a 160% increase in the number of patients receiving a medication (reach). IFASIS domains of factors outside the organization, factors within the organization, and factors about the intervention, and subscales of organizational readiness, community support, and recipient needs and values, were predictive of successful implementation outcomes. IFASIS scores were also significantly associated with measures of implementation quality.</p><p><strong>Conclusions: </strong>The IFASIS is a psychometrically and pragmatically valid instrument to assess contextual factors in implementation endeavors. Its ability to predict key implementation outcomes and facilitate data pooling across projects suggests it can play an important role in advancing the field.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"50"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}