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. 2023 Mar 21;63(3):604-613.
doi: 10.1093/geront/gnac130.

Intensification of Implementation Strategies: Developing a Model of Foundational and Enhanced Implementation Approaches to Support National Adoption and Scale-up

Jaime M Hughes  1   2 , Leah L Zullig  2   3 , Ashley L Choate  2 , Kasey P Decosimo  2 , Virginia Wang  2   3 , Courtney H Van Houtven  2   3 , Kelli D Allen  2   4 , S Nicole Hastings  2   5
Affiliations

Intensification of Implementation Strategies: Developing a Model of Foundational and Enhanced Implementation Approaches to Support National Adoption and Scale-up

Jaime M Hughes et al. Gerontologist. .

Abstract

Implementation strategies are activities to support integration of evidence-based programs (EBPs) into routine care. Comprised of 170+ facilities, the Veterans Affairs Healthcare System is conducive to evaluating feasibility and scalability of implementation strategies on a national level. In previous work evaluating implementation of three EBPs for older Veterans (hospital-based walking, caregiver skills training, group physical therapy), we found facilities varied in their need for implementation support, with some needing minimal guidance and others requiring intensive support. Committed to national scalability, our team developed an implementation intensification model consisting of foundational (low-touch) and enhanced (high-touch) implementation support. This Forum article describes our multilevel and multistep process to develop and evaluate implementation intensification. Steps included (a) review completed trial data; (b) conduct listening sessions; (c) review literature; (d) draft foundational and enhanced implementation support packages; (e) iteratively refine packages; and (7) devise an evaluation plan. Our model of implementation intensification may be relevant to other health care systems seeking strategies that can adapt to diverse delivery settings, optimize resources, help build capacity, and ultimately enhance implementation outcomes. As more health care systems focus on spread of EBPs into routine care, identifying scalable and effective implementation strategies will be critical.

Trial registration: ClinicalTrials.gov NCT04868656 NCT05319535 NCT05282927.

Keywords: Facilitation; Function; Implementation strategies; Scalability; Veterans.

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Conflict of interest statement

Conflict of Interest

None declared.

Figures

Figure 1.
Figure 1.
Function QUERI study design overview. EBP = evidence-based program; EHR = electronic health record; QUERI = Quality Enhancement Research Initiative; R = randomization. All caregivers FIRST sites retain access to foundational support materials for the duration of the study period.
Figure 2.
Figure 2.
Implementation intensification development process.
See this image and copyright information in PMC

References

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