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Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake

Evaluations of clinical decision support (CDS) implementation often struggle to measure and explain heterogeneity in uptake over time and across settings, and to account for the impact of context and adaptation on implementation success. In 2017–2020, the EMPOWER QUERI implemented a cardiovascular t...

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Autores principales: Brunner, Julian, Farmer, Melissa M., Bean-Mayberry, Bevanne, Chanfreau-Coffinier, Catherine, Than, Claire T., Hamilton, Alison B., Finley, Erin P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012802/
https://www.ncbi.nlm.nih.gov/pubmed/36925876
http://dx.doi.org/10.3389/frhs.2022.946802
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author Brunner, Julian
Farmer, Melissa M.
Bean-Mayberry, Bevanne
Chanfreau-Coffinier, Catherine
Than, Claire T.
Hamilton, Alison B.
Finley, Erin P.
author_facet Brunner, Julian
Farmer, Melissa M.
Bean-Mayberry, Bevanne
Chanfreau-Coffinier, Catherine
Than, Claire T.
Hamilton, Alison B.
Finley, Erin P.
author_sort Brunner, Julian
collection PubMed
description Evaluations of clinical decision support (CDS) implementation often struggle to measure and explain heterogeneity in uptake over time and across settings, and to account for the impact of context and adaptation on implementation success. In 2017–2020, the EMPOWER QUERI implemented a cardiovascular toolkit using a computerized template aimed at reducing women Veterans' cardiovascular risk across five Veterans Healthcare Administration (VA) sites, using an enhanced Replicating Effective Programs (REP) implementation approach. In this study, we used longitudinal joint displays of qualitative and quantitative findings to explore (1) how contextual factors emerged across sites, (2) how the template and implementation strategies were adapted in response to contextual factors, and (3) how contextual factors and adaptations coincided with template uptake across sites and over time. We identified site structure, staffing changes, relational authority of champions, and external leadership as important contextual factors. These factors gave rise to adaptations such as splitting the template into multiple parts, pairing the template with a computerized reminder, conducting academic detailing, creating cheat sheets, and using small-scale pilot testing. All five sites exhibited variability in utilization over the months of implementation, though later sites exhibited higher template utilization immediately post-launch, possibly reflecting a “preloading” of adaptations from previous sites. These findings underscore the importance of adaptive approaches to implementation, with intentional shifts in intervention and strategy to meet the needs of individual sites, as well as the value of integrating mixed-method data sources in conducting longitudinal evaluation of implementation efforts.
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spelling pubmed-100128022023-03-15 Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake Brunner, Julian Farmer, Melissa M. Bean-Mayberry, Bevanne Chanfreau-Coffinier, Catherine Than, Claire T. Hamilton, Alison B. Finley, Erin P. Front Health Serv Health Services Evaluations of clinical decision support (CDS) implementation often struggle to measure and explain heterogeneity in uptake over time and across settings, and to account for the impact of context and adaptation on implementation success. In 2017–2020, the EMPOWER QUERI implemented a cardiovascular toolkit using a computerized template aimed at reducing women Veterans' cardiovascular risk across five Veterans Healthcare Administration (VA) sites, using an enhanced Replicating Effective Programs (REP) implementation approach. In this study, we used longitudinal joint displays of qualitative and quantitative findings to explore (1) how contextual factors emerged across sites, (2) how the template and implementation strategies were adapted in response to contextual factors, and (3) how contextual factors and adaptations coincided with template uptake across sites and over time. We identified site structure, staffing changes, relational authority of champions, and external leadership as important contextual factors. These factors gave rise to adaptations such as splitting the template into multiple parts, pairing the template with a computerized reminder, conducting academic detailing, creating cheat sheets, and using small-scale pilot testing. All five sites exhibited variability in utilization over the months of implementation, though later sites exhibited higher template utilization immediately post-launch, possibly reflecting a “preloading” of adaptations from previous sites. These findings underscore the importance of adaptive approaches to implementation, with intentional shifts in intervention and strategy to meet the needs of individual sites, as well as the value of integrating mixed-method data sources in conducting longitudinal evaluation of implementation efforts. Frontiers Media S.A. 2022-09-29 /pmc/articles/PMC10012802/ /pubmed/36925876 http://dx.doi.org/10.3389/frhs.2022.946802 Text en Copyright © 2022 Brunner, Farmer, Bean-Mayberry, Chanfreau-Coffinier, Than, Hamilton and Finley. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Services
Brunner, Julian
Farmer, Melissa M.
Bean-Mayberry, Bevanne
Chanfreau-Coffinier, Catherine
Than, Claire T.
Hamilton, Alison B.
Finley, Erin P.
Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake
title Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake
title_full Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake
title_fullStr Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake
title_full_unstemmed Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake
title_short Implementing clinical decision support for reducing women Veterans' cardiovascular risk in VA: A mixed-method, longitudinal study of context, adaptation, and uptake
title_sort implementing clinical decision support for reducing women veterans' cardiovascular risk in va: a mixed-method, longitudinal study of context, adaptation, and uptake
topic Health Services
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012802/
https://www.ncbi.nlm.nih.gov/pubmed/36925876
http://dx.doi.org/10.3389/frhs.2022.946802
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