Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
J Am Geriatr Soc. 2024 Oct;72(10):3210-3218. doi: 10.1111/jgs.19044. Epub 2024 Jul 29.
There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site-initiated adaptations to STRIDE, a hospital-based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States.
STRIDE was implemented at eight hospitals in a stepped-wedge cluster randomized trial. During the pre-implementation phase, sites were encouraged to adapt program characteristics to optimize implementation and align with their hospital's resources, needs, and culture. Recommended adaptations included those related to staffing models, marketing, and documentation. To assess the number and types of adaptations, multiple data sources were reviewed, including implementation support notes from site-level support calls and group-based learning collaborative sessions. Adaptations were classified based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), including attention to what was adapted, when, why, and by whom. We reviewed the number and types of adaptations across sites that did and did not sustain STRIDE, defined as continued program delivery during the post-implementation period.
A total of 25 adaptations were reported and classified across seven of the eight sites. Adaptations were reported across five areas: program documentation (n = 13), patient eligibility criteria (n = 5), program enhancements (n = 3), staffing model (n = 2), and marketing and recruitment (n = 2). More than one-half of adaptations were planned. Adaptations were common in both sustaining and non-sustaining sites.
Adaptations were common within a program designed with flexible implementation in mind. Identifying common areas of planned and unplanned adaptations within a flexible program such as STRIDE may contribute to more efficient and effective national scaling. Future research should evaluate the relationship between adaptations and program implementation.
越来越多的人认识到，在扩大和推广有效的项目时，最大限度地使方案设置与实际情况相匹配非常重要。然而，在基于医院的流动性项目的背景下，关于如何使环境考虑当地情况并修改方案特征或实施活动以增强匹配程度的信息有限。为了填补这一空白，我们研究了 STRIDE 在 8 家美国退伍军人事务部设施中的适应性，STRIDE 是一项针对老年退伍军人的基于医院的流动性项目。
STRIDE 在一个逐步楔形集群随机试验中的 8 家医院实施。在实施前阶段，鼓励各机构调整方案特征，以优化实施并与医院的资源、需求和文化保持一致。建议的调整包括与人员配备模式、营销和文件编制有关的调整。为了评估调整的数量和类型，我们审查了多个数据来源，包括来自现场支持电话和基于小组的学习协作会议的实施支持记录。调整基于框架报告调整和修改增强版（FRAME）进行分类，包括注意调整的内容、时间、原因和人员。我们审查了在继续实施阶段继续提供 STRIDE 项目的和没有继续提供 STRIDE 项目的机构之间的调整数量和类型。
共报告并分类了七个地点中的 25 项调整。调整涉及五个方面：方案文件编制（n = 13）、患者资格标准（n = 5）、方案增强（n = 3）、人员配备模式（n = 2）和营销和招募（n = 2）。超过一半的调整是计划内的。调整在维持和不维持的机构中都很常见。
在一个考虑到灵活实施的方案中，调整是常见的。在 STRIDE 等具有灵活性的方案中确定计划内和计划外的常见调整领域可能有助于更有效地进行全国范围的推广。未来的研究应评估调整与方案实施之间的关系。
