Pittman James O E, Rabin Borsika, Almklov Erin, Afari Niloofar, Floto Elizabeth, Rodriguez Eusebio, Lindamer Laurie
VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, USA.
Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, USA.
Implement Sci Commun. 2021 Apr 7;2(1):37. doi: 10.1186/s43058-021-00132-x.
The Veterans Health Administration (VHA) developed a comprehensive mobile screening technology (eScreening) that provides customized and automated self-report health screening via mobile tablet for veterans seen in VHA settings. There is agreement about the value of health technology, but limited knowledge of how best to broadly implement and scale up health technologies. Quality improvement (QI) methods may offer solutions to overcome barriers related to broad scale implementation of technology in health systems. We aimed to develop a process guide for eScreening implementation in VHA clinics to automate self-report screening of mental health symptoms and psychosocial challenges.
This was a two-phase, mixed methods implementation project building on an adapted quality improvement method. In phase one, we adapted and conducted an RPIW to develop a generalizable process guide for eScreening implementation (eScreening Playbook). In phase two, we integrated the eScreening Playbook and RPIW with additional strategies of training and facilitation to create a multicomponent implementation strategy (MCIS) for eScreening. We then piloted the MCIS in two VHA sites. Quantitative eScreening pre-implementation survey data and qualitative implementation process "mini interviews" were collected from individuals at each of the two sites who participated in the implementation process. Survey data were characterized using descriptive statistics, and interview data were independently coded using a rapid qualitative analytic approach.
Pilot data showed overall satisfaction and usefulness of our MCIS approach and identified some challenges, solutions, and potential adaptations across sites. Both sites used the components of the MCIS, but site 2 elected not to include the RPIW. Survey data revealed positive responses related to eScreening from staff at both sites. Interview data exposed implementation challenges related to the technology, support, and education at both sites. Workflow and staffing resource challenges were only reported by site 2.
Our use of RPIW and other QI methods to both develop a playbook and an implementation strategy for eScreening has created a testable implementation process to employ automated, patient-facing assessment. The efficient collection and communication of patient information have the potential to greatly improve access to and quality of healthcare.
退伍军人健康管理局（VHA）开发了一种全面的移动筛查技术（电子筛查），通过移动平板电脑为在VHA机构就诊的退伍军人提供定制化和自动化的自我报告健康筛查。人们对健康技术的价值已达成共识，但对于如何最好地广泛实施和扩大健康技术的了解有限。质量改进（QI）方法可能提供解决方案，以克服与在卫生系统中广泛实施技术相关的障碍。我们旨在制定一份在VHA诊所实施电子筛查的流程指南，以实现心理健康症状和心理社会挑战的自我报告筛查自动化。
这是一个基于改进的质量改进方法的两阶段混合方法实施项目。在第一阶段，我们调整并进行了RPIW，以制定一份可推广的电子筛查实施流程指南（电子筛查手册）。在第二阶段，我们将电子筛查手册和RPIW与培训和促进等其他策略相结合，为电子筛查创建了一个多组件实施策略（MCIS）。然后，我们在两个VHA站点对MCIS进行了试点。从参与实施过程的两个站点的个人那里收集了电子筛查实施前的定量调查数据和定性实施过程“小型访谈”。使用描述性统计对调查数据进行特征分析，并使用快速定性分析方法对访谈数据进行独立编码。
试点数据显示了我们的MCIS方法的总体满意度和实用性，并确定了各站点的一些挑战、解决方案和潜在调整。两个站点都使用了MCIS的组件，但站点2选择不包括RPIW。调查数据显示两个站点的工作人员对电子筛查都有积极回应。访谈数据揭示了两个站点在技术、支持和教育方面的实施挑战。只有站点2报告了工作流程和人员资源方面的挑战。
我们使用RPIW和其他QI方法来制定电子筛查的手册和实施策略，创建了一个可测试的实施过程，以采用面向患者的自动化评估。患者信息的有效收集和沟通有可能极大地改善医疗保健的可及性和质量。
