Successful Translation of a Diabetes Care Quality Initiative From Integrated Care Into Safety Net Clinic Settings
Friday 2:30 – 3:45 Breakout C3
Presentor: Rachel Gold, PhD, MPH
Rachel Gold, Kaiser Permanente – Center for Health Research; Christine Nelson, OCHIN, Inc.; Arwen Bunce, Kaiser Permanente – Center for Health Research; Celine Hollombe, Kaiser Permanente – Center for Health Research; James Davis, Kaiser Permanente – Center for Health Research; Jon Puro, OCHIN, Inc. ; Nancy Perrin, Kaiser Permanente – Center for Health Research; Stuart Cowburn, OCHIN, Inc.; Jennifer DeVoe, Oregon Health & Science University (OHSU) and OCHIN, Inc.
Purpose. A Kaiser Permanente (KP) diabetes quality improvement intervention uses EHR-based tools to improve guideline-based cardioprotective prescribing. We assessed the feasibility of implementing this intervention in community health centers (CHCs).
Methods. We adapted and implemented KP’s intervention in 11 CHCs. Our translational trial randomly assigned clinics with six ‘early’ clinics implemented one year before five ‘late’ clinics. Through segmented regression analyses, we tested differences in trends in prescribing rates over time.
Results. Rates of guideline-based prescribing improved significantly: over 12 months the rate of ‘early’ patients with appropriate prescriptions increased from 59% to 68% (statins) and 69% to 76% (ACE-inhibitors). In the same period, the ‘late’ CHCs had little change Conclusions. It is feasible to adapt an intervention developed in the private sector for implementation in CHCs. Our results illustrate the impact of doing so, and challenges involved in using EHR-based tools to support practice change and quality improvement efforts in CHCs. Friday 2:30 – 3:45 Breakout C3 Presentor: Arwen Bunce, MA Arwen Bunce, Kaiser Permanente – Center for Health Research; Rachel Gold, Kaiser Permanente – Center for Health Research; Deborah Cohen, Oregon Health & Science University; Celine Hollombe, Kaiser Permanente – Center for Health Research; Christine Nelson, OCHIN, Inc.; Enola Proctor, Washington University ; Jill Pope, Kaiser Permanente – Center for Health Researce; Jennifer DeVoe, OHSU and OCHIN, Inc. Purpose: Implementation strategies – the approaches, methods, structures, and resources used to introduce and encourage uptake of a given intervention’s components – are rarely reported in the implementation literature. This lack of reporting hinders efforts at efficient future dissemination. We demonstrate how a framework for describing implementation strategies, recently proposed by Proctor and colleagues, can be used to standardize reporting and therefore advance appropriate and timely implementation and dissemination. Methods. We use the Proctor framework to report on the implementation of one intervention in two care settings. We describe how we used the framework to refine our understanding of the strategies’ impact, and clarify our reporting on the strategies. Results. Differences in organizational resources and culture necessitated adapting the implementation strategies across care settings. Proctor’s framework facilitated our analysis and reporting on these adaptations. Per the framework: the target (clinic staff) and outcome (prescribing rates) of the implementation strategies remained the same; the actor, action, temporality and dose were adapted to fit local context. Conclusions. Proctor and colleagues’ framework supports standardized reporting on how interventions are implemented and adapted across care settings. Researchers should consistently report this information, which could be crucially important to enhancing intervention uptake and dissemination. Friday 2:30 – 3:45 Breakout C3 Presentor: Arwen Bunce, MA Arwen Bunce, Kaiser Permanente – Center for Health Research; Rachel Gold, Kaiser Permanente – Center for Health Research; James Davis, Kaiser Permanente – Center for Health Research; MaryBeth Mercer, Virginia Garcia Memorial Health Centers; Victoria Jaworski, Multnomah County Health Department; Christine Nelson, OCHIN, Inc. ; Celine Hollombe, Kaiser Permanente – Center for Health Research Purpose: Implementation researchers commonly provide study data updates to participant clinics to stimulate performance around the metric in question. Such data could be a powerful tool to improve both uptake and care quality, but reactions to and / or use of these feedback data is rarely explored. Methods: Ethnographic process evaluation of the translation of a diabetes-focused quality improvement intervention from an integrated care setting to community clinics. Analysis guided by the constant comparative method. Results: Diverse factors contribute to use of study data, including: 1) perceived gap between desire and ability to use data to improve patient care; 2) tension between good patient care and meeting performance metrics; 3) concerns that data do not accurately reflect care provided; and 4) availability of guidance, resources to act on findings. Provider suggestions include: 1) ensure measured actions under provider’s control; 2) include individual patient-level clinical data in addition to metrics targeted by study; 3) provide data in a customizable format; and 4) include concrete guidelines for action. Conclusion: Despite its apparent simplicity, making study data available to clinicians in a way that is both appreciated and helpful is a complex undertaking that deserves careful thought. Friday 2:30 – 3:45 Breakout C3 Presentor: Celine Hollombe, MPH Rachel Gold, PhD, MPH, Kaiser Permanente – Center for Health Research; Christine Nelson, PhD, RN, OCHIN, Inc.; Arwen Bunce, MA, Kaiser Permanente – Center for Health Research; Celine Hollombe, MPH, Kaiser Permanente – Center for Health Research; James Davis, Kaiser Permanente – Center for Health Research; Jon Puro, MPA, OCHIN, Inc. ; Nancy Perrin, PhD, Kaiser Permanente – Center for Health Research; Stuart Cowburn, PhD, MPH, OCHIN, Inc. and OCHIN, Inc.; Jennifer DeVoe, MD, PHD, OHSU and OCHIN, Inc.; Michael Horberg, MD, MAS, FACP, FIDSA, Kaiser Permanente – Mid-Atlantic Permanen Purpose. Care guidelines and effective interventions are rarely integrated into everyday practices in a timely manner, diminishing their population-level potential. Little is known about how best to implement evidence-based interventions across care settings, or about which ‘implementation strategies’ (the components used to introduce interventions into new care settings, and support interventions’ uptake and sustainment) best support implementation of interventions in Community Health Centers (CHCs). Research is needed to compare the effectiveness of strategies for supporting implementation of evidence-based care in CHCs. Methods. Our pragmatic cluster-randomized trial will compare how three increasingly hands-on implementation strategies (Arm 1: toolkit; Arm 2: toolkit plus training; Arm 3: toolkit and training, plus facilitation) support adoption of a diabetes quality improvement initiative, among 30 CHCs that share an EHR. Results. We plan to assess the comparative effectiveness of these implementation strategies in CHCs, and impact on diabetes care quality, how these strategies may be used to support widespread dissemination of effective interventions, and the cost effectiveness of the different support strategies. We will present our planned methods in detail. Conclusions. This study is designed to address important knowledge gaps in implementation science, with the potential for widespread impact on dissemination of proven interventions into CHCs. Making Visible the Invisible: Reporting Implementation Strategies to Improve Intervention Uptake Across Care Settings
The Complex Role of Data Feedback in Intervention Uptake
Protocol for the “Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)??? Pragmatic Cluster-Randomized Trial