Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.
Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
Front Public Health. 2023 Jan 6;10:980958. doi: 10.3389/fpubh.2022.980958. eCollection 2022.
Implementation strategies supporting the translation of evidence into practice need to be tailored and adapted for maximum effectiveness, yet the field of adapting implementation strategies remains nascent. We aimed to adapt "Getting To Outcomes" (GTO), a 10-step implementation playbook designed to help community-based organizations plan and evaluate behavioral health programs, into "Getting To Implementation" (GTI) to support the selection, tailoring, and use of implementation strategies in health care settings.
Our embedded evaluation team partnered with operations, external facilitators, and site implementers to employ participatory methods to co-design and adapt GTO for Veterans Health Administration (VA) outpatient cirrhosis care improvement. The Framework for Reporting Adaptations and Modifications to Evidenced-based Implementation Strategies (FRAME-IS) guided documentation and analysis of changes made pre- and post-implementation of GTI at 12 VA medical centers. Data from multiple sources (interviews, observation, content analysis, and fidelity tracking) were triangulated and analyzed using rapid techniques over a 3-year period.
Adaptations during pre-implementation were planned, proactive, and focused on context and content to improve acceptability, appropriateness, and feasibility of the GTI playbook. Modifications during and after implementation were unplanned and reactive, concentrating on adoption, fidelity, and sustainability. All changes were collaboratively developed, fidelity consistent at the level of the facilitator and/or implementer.
GTO was initially adapted to GTI to support health care teams' selection and use of implementation strategies for improving guideline-concordant medical care. GTI required ongoing modification, particularly in steps regarding team building, context assessment, strategy selection, and sustainability due to difficulties with step clarity and progression. This work also highlights the challenges in pragmatic approaches to collecting and synthesizing implementation, fidelity, and adaptation data.
This study was registered on ClinicalTrials.gov (Identifier: NCT04178096).
为了实现最大效果，支持证据转化实践的实施策略需要进行调整和适配，但实施策略的调整领域仍处于起步阶段。我们的目的是调整“实现目标”（GTO），这是一个 10 步实施手册，旨在帮助基于社区的组织规划和评估行为健康计划，将其调整为“实现实施”（GTI），以支持在医疗保健环境中选择、定制和使用实施策略。
我们的嵌入式评估团队与运营、外部促进者和现场实施者合作，采用参与式方法共同设计和调整 GTO，以改善退伍军人事务部（VA）门诊肝硬化护理改进。报告对基于证据的实施策略的改编和调整的框架（FRAME-IS）指导了在 12 个 VA 医疗中心进行 GTI 实施前后的变化记录和分析。来自多个来源（访谈、观察、内容分析和保真度跟踪）的数据经过三年的时间使用快速技术进行了三角分析和综合分析。
在实施前进行的调整是计划的、主动的，并且侧重于背景和内容，以提高 GTI 手册的可接受性、适当性和可行性。在实施中和实施后的修改是无计划的和被动的，集中在采用、保真度和可持续性上。所有的变化都是共同制定的，促进者和/或实施者层面的保真度一致。
GTO 最初被调整为 GTI，以支持医疗保健团队选择和使用实施策略来改善符合指南的医疗护理。GTI 需要不断修改，特别是在团队建设、背景评估、策略选择和可持续性方面，因为步骤的清晰度和进展存在困难。这项工作还突出了在实用方法中收集和综合实施、保真度和适应数据的挑战。
本研究在 ClinicalTrials.gov 上注册（标识符：NCT04178096）。
