Implementation Success

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Neil Porter
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1 Challenges in Measuring Implementation Success Carol VanDeusen Lukas, EdD VA Center for Organizational, Oga ato a, Leadership & Management age e (COLMR) Carmen Hall, RN, PhD VA Center for Chronic Disease Outcomes Research (CCDOR) Mariana Gerena Melia, Mli PhD VA Center for Organizational, Leadership & Management (COLMR) 3 rd Annual lnih Conference on Science of Dissemination and Implementation Methods and Measurement March 15, 2010 Bethesda, MD

(CCDOR) Mariana Gerena Melia, Mli PhD VA Center for Organizational, Leadership & Management (COLMR) 3 rd Annual

2 Think tank objectives: Stimulate discussion about terminology and a shared framework How do we define implementation success? Against what shared standards should implementation success be judged? Explore issues in measuring implementation success How do we set the standards for a specific study? How do we df define a complex intervention in operational terms to measure it? What are appropriate p measurement approaches? 2

Explore issues in measuring implementation success How do we set the standards for a specific study?

3 Implementing a clinical innovation: Implementation strategies Intervention ti Clinical innovation Process outcomes Health outcomes Other factors affecting progress and success

4 Why do we care? Essential to judging effectiveness of strategies for implementing innovative programs Implementation success as dependent variable Understanding factors affecting implementation Implementation success as independent d variable 4

5 How do we define dfi implementation ti success? Implementation success is the presence of the innovation as intended in the delivery context Measuring implementation success is formally determining that presence 5

6 What is implementation strategy v. innovation i v. outcomes? Examples: Study Implementation strategy Innovation Process outcome Bipolar CCM Replicating effective Collaborative chronic Guideline concordant programs (REP) care model (CCM) anti-manic treatment Organizational collaboration for hand-hygiene External facilitation Organizational model for strengthening g implementation of evidence-based practices Hand-hygiene compliance Does this work with your projects?

chronic Guideline concordant programs (REP) care model (CCM) anti-manic treatment Organizational collaboration for

7 Does the concept of implementation success apply to implementation processes as well as to the innovation? Measures es of implementation e success? Implementation strategies Intervention Clinical innovation Process outcomes Health outcomes Other factors affecting progress and success

Measures es of implementation e success?

8 Against what shared standards should implementation success be judged? Fidelity Adherence, Scope/reliability, Intensity/dose, Quality of program, Participant responsiveness, Sustainability RE AIM Reach, Effectiveness, Adoption, Implementation, Maintenance Are these standards appropriate in all situations? Are there other standards again which implementation should be judged? 8

responsiveness, Sustainability RE AIM Reach, Effectiveness, Adoption, Implementation,

9 How do we set the standards for a specific study? Example: Treating tobacco use and dependence Ask Advise Assess Assist Arrange What have you done? How did you decide which to use?

10 How do we operationalize a complex intervention to measure it? Key elements Important for implementation as well as measurement Replication v tailoring/ customization/ adaptation Which features are core to the intervention? Which features es have aeo to be present pese for the intervention to maintain its effectiveness? Which can vary without compromising effectiveness? 10

customization/ adaptation Which features are core to the intervention?

11 How do we operationalize? Example: Testing an organizational model to improve hand hygiene compliance Concept of key elements built into theoretical framework Implementation plan by recipients Ratings by research team How have you done it?

12 What are appropriate measurement approaches? Secondary v primary data? Availability of existing data Resource & logistical constraints of collecting new data Qualitative, ti quantitative Who collects? Scale of intervention ti & role of researcher Expectations/burden of implementation staff collection 12

collecting new data Qualitative, ti quantitative Who collects?

13 What measurement approaches are appropriate in what settings? Example: ASK Data sources: electronic records new practice survey chart review coded qualitative data from interviews or documents

14 What measurement approaches are appropriate in what settings? Example: ASK Levels of analysis: how often an individual patient is asked about tobacco use? number of clinics which implemented a system for universal identification of tobacco use How have you measured implementation success?

15 Recap

Use advanced techniques for summary and visualization of complex data for exploratory analysis and presentation.

Use advanced techniques for summary and visualization of complex data for exploratory analysis and presentation. MS Biostatistics MS Biostatistics Competencies Study Development: Work collaboratively with biomedical or public health researchers and PhD biostatisticians, as necessary, to provide biostatistical expertise