Improving care quality through hybrid implementation/effectiveness studies: Best practices in design, methods, and measures

Abstract

Panel overview abstract Implementation research is the scientific study of methods that promote systematic uptake of research findings and other evidence-based practices into routine practice, thereby improving the quality and effectiveness of health services. As the field has progressed over the past decades , substantial advances continue in the development and application of implementation-related theories as well as innovative implementation strategies and methods. This session will provide three examples of implementation research studies that are designed to improve care through the use of evidence. The examples come from three health services areas: primary care, mental health, and HIV; from funded NIH and VA studies; and from community and hospital settings in rural and urban sites. Across the three examples, six different theories were used-providing ample examples of linking conceptual models and frameworks to study design, implementation strategies, and measurements. Each presentation will highlight the ways in which the conceptual theory was configured into the overall research design and evaluation , as well as common challenges and lessons learned while conducting implementation research. Blended facilitation to enhance PCMH program implementation: conceptual, design, and measurement considerations Integrated primary care mental health evidence-based programs improve care. The Department of Veterans Affairs mandated and provided limited national level implementation support for Primary Care-Mental Health Integration (PC-MHI) but VA facilities were slow to implement them. The Blended Facilitation study was funded by the VA to implement and evaluate an innovative implementation facilitation (IF) strategy that included a national external expert facilitator with expertise in implementation science and PC-MHI who mentored and worked with two internal regional facilita-tors to help clinics implement PC-MHI. According to the PARIHS framework, successful implementation is a function of the dynamic interaction between evidence, context and facilitation. This presentation will describe how PARIHS guided the application of the IF strategy and the study's design. For this quasi-experimental, Hybrid Type 3 study, we used mixed methods to test the effectiveness of the IF strategy and assess organizational context, perceptions of evidence, and facilitation activities. We used a consensus matching approach to select sixteen clinics that were unlikely to implement PC-MHI without assistance across four VA regions. The RE-AIM framework guided our test of IF's effectiveness using administrative data and program component interviews to measure RE-AIM dimensions. We conducted monthly debriefing interviews with and collected time data from facilitators and measured site level contextual and evidence factors through key informant interviews. We also conducted intensive case studies at four IF