Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
Health Serv Res. 2024 Dec;59 Suppl 2(Suppl 2):e14360. doi: 10.1111/1475-6773.14360. Epub 2024 Aug 1.
To examine the relationship between site-level adaptation and early adoption of Caregivers Finding Important Resources, Support, and Training (FIRST) training during national implementation across diverse Veteran Health Administration (VA) medical centers.
We enrolled and evaluated 25 VA medical centers (VAMCs). Along with administrative data on site characteristics, we examined site-reported data on adaptations and intervention adoption, defined as ≥4 training classes delivered to ≥5 caregivers at 6 months from April through October 2022.
A type III hybrid implementation-effectiveness cluster randomized controlled trial, randomized VAMCs 1:1 to receive foundational (low-touch) implementation support (n = 12) or the addition of enhanced (high-touch) implementation support (n = 13).
DATA COLLECTION/EXTRACTION METHODS: At key implementation phases, VAMCs were asked to report adaptations including content, contextual modifications (format, setting, personnel, and population), and training of providers. We describe site-level adaptations by arm and by organizational characteristics that included VAMC complexity level, staffing, rurality, and organizational readiness to change. We used qualitative comparative analysis to identify unique adaptations that contributed to intervention adoption at 6 months.
VAMCs randomized to receive enhanced support reported slightly more adaptations than those randomized to foundational support. At 6 months, VAMCs with two or more adaptations adopted Caregivers FIRST at a higher rate than those with fewer adaptations (90% vs. 44%). Staffing adaptations (e.g., who delivered the intervention), format and content (e.g., modified delivery pace), and referring provider training were unique adaptations to adopting sites.
Site-level adaptations were diverse and occurred more frequently in sites with early adoption of Caregivers FIRST. Future research should identify best practices of supporting and monitoring intervention adaptation. Understanding the role of adaptation in early adoption success could assist other healthcare systems in implementing interventions for caregivers.
在全国范围内不同的退伍军人健康管理局 (VA) 医疗中心实施过程中，研究站点层面的适应性与 Caregivers Finding Important Resources, Support, and Training (FIRST) 培训的早期采用之间的关系。
我们招募并评估了 25 个 VA 医疗中心 (VAMC)。除了有关站点特征的管理数据外，我们还检查了站点报告的适应性和干预措施采用的数据，定义为从 2022 年 4 月至 10 月的 6 个月内向至少 5 名护理人员提供了≥4 次培训课程。
这是一项 III 型混合实施效果的集群随机对照试验，将 VAMC 随机分为 1:1 接受基础（低接触）实施支持（n=12）或增强（高接触）实施支持（n=13）。
数据收集/提取方法：在关键实施阶段，要求 VAMC 报告适应性，包括内容、环境修改（格式、设置、人员和人群）和提供者培训。我们按手臂和组织特征描述站点层面的适应性，包括 VAMC 复杂性水平、人员配备、农村性和组织变革准备就绪程度。我们使用定性比较分析来确定有助于 6 个月时干预措施采用的独特适应性。
接受增强支持的 VAMC 报告的适应性略多于接受基础支持的 VAMC。在 6 个月时，有两个或更多适应性的 VAMC 采用 Caregivers FIRST 的比例高于适应性较少的 VAMC（90%比 44%）。工作人员适应性（例如，谁提供了干预措施）、格式和内容（例如，修改交付速度）以及推荐医生培训是采用站点的独特适应性。
站点层面的适应性多种多样，并且在 Caregivers FIRST 早期采用的站点中更为常见。未来的研究应确定支持和监测干预措施适应性的最佳实践。了解适应性在早期采用成功中的作用可以帮助其他医疗保健系统实施护理人员干预措施。
