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Abstract Details
Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans
Implement Sci. 2020 Oct 21;15(1):92. doi: 10.1186/s13012-020-01050-7.
Shari S Rogal12, Vera Yakovchenko3, Timothy Morgan45, Jasmohan S Bajaj67, Rachel Gonzalez8, Angela Park9, Lauren Beste1011, Edward J Miech12, Carolyn Lamorte13, Brittney Neely13, Sandra Gibson13, Patrick S Malone14, Maggie Chartier15, Tamar Taddei1617, Guadalupe Garcia-Tsao1617, Byron J Powell18, Jason A Dominitz1920, David Ross15, Matthew J Chinman1321
Author information
1Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA. Shari.Rogal@va.gov.
2Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA, USA. Shari.Rogal@va.gov.
3Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA.
4Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA.
5Division of Gastroenterology, Department of Medicine, University of California, Irvine, CA, USA.
6Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.
7Division of Gastroenterology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.
8Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA, USA.
9Office of Healthcare Transformation, Veterans Engineering Resource Center, Washington, DC, USA.
10Division of General Internal Medicine, Department of Medicine, VA Puget Sound Healthcare System, Seattle, WA, USA.
11Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
12Department of Veterans Affairs, Roudebush VA Medical Center, HSR&D Center for Health Information & Communication, VA PRIS-M QUERI, Indianapolis, IN, USA.
13Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA.
14Duke University, Durham, NC, USA.
15HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA.
16VA Connecticut Healthcare System, West Haven, CT, USA.
17Department of Medicine, Yale University, West Haven, CT, USA.
18Brown School, Washington University in St. Louis, St. Louis, MO, USA.
19Gastroenterology Section, VA Puget Sound Health Care System, Seattle, WA, USA.
20Department of Medicine, University of Washington, Seattle, WA, USA.
21RAND Corporation, Pittsburgh, PA, USA.
Abstract
Background: Cirrhosis is a rapidly increasing cause of global mortality. To improve cirrhosis care, the Veterans Health Administration (VHA) developed the Hepatic Innovation Team (HIT) Collaborative to support VA Medical Centers (VAMCs) to deliver evidence-based cirrhosis care. This randomized HIT program evaluation aims to develop and assess a novel approach for choosing and applying implementation strategies to improve the quality of cirrhosis care.
Methods: Evaluation aims are to (1) empirically determine which combinations of implementation strategies are associated with successful implementation of evidence-based practices (EBPs) for Veterans with cirrhosis, (2) manualize these "data-driven" implementation strategies, and (3) assess the effectiveness of data-driven implementation strategies in increasing cirrhosis EBP uptake. Aim 1 will include an online survey of all VAMCs' use of 73 implementations strategies to improve cirrhosis care, as defined by the Expert Recommendations for Implementing Change taxonomy. Traditional statistical as well as configurational comparative methods will both be employed to determine which combinations of implementation strategies are associated with site-level adherence to EBPs for cirrhosis. In aim 2, semi-structured interviews with high-performing VAMCs will be conducted to operationalize successful implementation strategies for cirrhosis care. These data will be used to inform the creation of a step-by-step guide to tailoring and applying the implementation strategies identified in aim 1. In aim 3, this manualized implementation intervention will be assessed using a hybrid type III stepped-wedge cluster randomized design. This evaluation will be conducted in 12 VAMCs, with four VAMCs crossing from control to intervention every 6 months, in order to assess the effectiveness of using data-driven implementation strategies to improve guideline-concordant cirrhosis care.
Discussion: Successful completion of this innovative evaluation will establish the feasibility of using early evaluation data to inform a manualized, user-friendly implementation intervention for VAMCs with opportunities to improve care. This evaluation will provide implementation support tools that can be applied to enhance the implementation of other evidence-based practices.
Trial registration: This project was registered at ClinicalTrials.Gov ( NCT04178096 ) on 4/29/20.