Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the veterans health administration

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Abstract

Background

While few countries and healthcare systems are on track to meet the World Health Organization’s hepatitis C virus (HCV) elimination goals, the US Veterans Health Administration (VHA) has been a leader in these efforts. We aimed to determine which implementation strategies were associated with successful national viral elimination implementation within the VHA.

Methods

We conducted a five-year, longitudinal cohort study of the VHA Hepatic Innovation Team (HIT) Collaborative between October 2015 and September 2019. Participants from 130 VHA medical centers treating HCV were sent annual electronic surveys about their use of 73 implementation strategies, organized into nine clusters as described by the Expert Recommendations for Implementing Change taxonomy. Descriptive and nonparametric analyses assessed strategy use over time, strategy attribution to the HIT, and strategy associations with site HCV treatment volume and rate of adoption, following the Theory of Diffusion of Innovations.

Results

Between 58 and 109 medical centers provided responses in each year, including 127 (98%) responding at least once, and 54 (42%) responding in all four implementation years. A median of 13–27 strategies were endorsed per year, and 8–36 individual strategies were significantly associated with treatment volume per year. Data warehousing, tailoring, and patient-facing strategies were most commonly endorsed. One strategy—“identify early adopters to learn from their experiences”—was significantly associated with HCV treatment volume in each year. Peak implementation year was associated with revising professional roles, providing local technical assistance, using data warehousing (i.e., dashboard population management), and identifying and preparing champions. Many of the strategies were driven by a national learning collaborative, which was instrumental in successful HCV elimination.

Conclusions

VHA’s tremendous success in rapidly treating nearly all Veterans with HCV can provide a roadmap for other HCV elimination initiatives.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07312-4.

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Most cited references 32

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A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project

Byron J. Powell, Thomas Waltz, Matthew J Chinman … (2015)

Background Identifying, developing, and testing implementation strategies are important goals of implementation science. However, these efforts have been complicated by the use of inconsistent language and inadequate descriptions of implementation strategies in the literature. The Expert Recommendations for Implementing Change (ERIC) study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice. Methods Purposive sampling was used to recruit a panel of experts in implementation and clinical practice who engaged in three rounds of a modified Delphi process to generate consensus on implementation strategies and definitions. The first and second rounds involved Web-based surveys soliciting comments on implementation strategy terms and definitions. After each round, iterative refinements were made based upon participant feedback. The third round involved a live polling and consensus process via a Web-based platform and conference call. Results Participants identified substantial concerns with 31% of the terms and/or definitions and suggested five additional strategies. Seventy-five percent of definitions from the originally published compilation of strategies were retained after voting. Ultimately, the expert panel reached consensus on a final compilation of 73 implementation strategies. Conclusions This research advances the field by improving the conceptual clarity, relevance, and comprehensiveness of implementation strategies that can be used in isolation or combination in implementation research and practice. Future phases of ERIC will focus on developing conceptually distinct categories of strategies as well as ratings for each strategy’s importance and feasibility. Next, the expert panel will recommend multifaceted strategies for hypothetical yet real-world scenarios that vary by sites’ endorsement of evidence-based programs and practices and the strength of contextual supports that surround the effort. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0209-1) contains supplementary material, which is available to authorized users.

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Implementation strategies: recommendations for specifying and reporting

Enola K. Proctor, Byron J. Powell, J. McMillen (2013)

Implementation strategies have unparalleled importance in implementation science, as they constitute the ‘how to’ component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of ‘packaged’ approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and ‘reproducibility.’ We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.

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An introduction to implementation science for the non-specialist

Mark S. Bauer, Laura Damschroder, Hildi Hagedorn … (2015)

Background The movement of evidence-based practices (EBPs) into routine clinical usage is not spontaneous, but requires focused efforts. The field of implementation science has developed to facilitate the spread of EBPs, including both psychosocial and medical interventions for mental and physical health concerns. Discussion The authors aim to introduce implementation science principles to non-specialist investigators, administrators, and policymakers seeking to become familiar with this emerging field. This introduction is based on published literature and the authors’ experience as researchers in the field, as well as extensive service as implementation science grant reviewers. Implementation science is “the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice, and, hence, to improve the quality and effectiveness of health services.” Implementation science is distinct from, but shares characteristics with, both quality improvement and dissemination methods. Implementation studies can be either assess naturalistic variability or measure change in response to planned intervention. Implementation studies typically employ mixed quantitative-qualitative designs, identifying factors that impact uptake across multiple levels, including patient, provider, clinic, facility, organization, and often the broader community and policy environment. Accordingly, implementation science requires a solid grounding in theory and the involvement of trans-disciplinary research teams. Summary The business case for implementation science is clear: As healthcare systems work under increasingly dynamic and resource-constrained conditions, evidence-based strategies are essential in order to ensure that research investments maximize healthcare value and improve public health. Implementation science plays a critical role in supporting these efforts.

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Author and article information

Contributors

Shari S. Rogal:

ORCID: http://orcid.org/0000-0001-8184-1546

Shari.Rogal@va.gov , rogalss@upmc.edu

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 18 December 2021

Publication date PMC-release: 18 December 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 1348

Affiliations

[1 ]Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA USA

[2 ]GRID grid.413720.3, ISNI 0000 0004 0419 2265, Gastroenterology Section, VA Long Beach Healthcare System, ; Long Beach, CA USA

[3 ]GRID grid.413935.9, ISNI 0000 0004 0420 3665, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, , University Drive (151C), ; Building 30, Pittsburgh, PA 15240 USA

[4 ]GRID grid.34474.30, ISNI 0000 0004 0370 7685, RAND Corporation, ; Pittsburgh, PA USA

[5 ]GRID grid.4367.6, ISNI 0000 0001 2355 7002, Brown School, , Washington University in St. Louis, ; St. Louis, MO USA

[6 ]Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA USA

[7 ]GRID grid.418356.d, ISNI 0000 0004 0478 7015, Department of Veterans Affairs, , Office of Healthcare Transformation, ; Washington, DC USA

[8 ]GRID grid.26009.3d, ISNI 0000 0004 1936 7961, Sanford School of Public Policy, , Duke University, ; Durham, NC USA

[9 ]GRID grid.239186.7, ISNI 0000 0004 0481 9574, HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, ; Washington, DC USA

[10 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, Division of Gastroenterology, Hepatology, and Nutrition, , University of Pittsburgh, ; Pittsburgh, PA USA

Author information

Shari S. Rogal http://orcid.org/0000-0001-8184-1546

Article

Publisher ID: 7312

DOI: 10.1186/s12913-021-07312-4

PMC ID: 8684191

PubMed ID: 34922538

SO-VID: 3a1f67a3-0d5b-4247-8e6a-8913ccaf988a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 17 February 2021

Date accepted : 19 November 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000738, U.S. Department of Veterans Affairs;

Funded by: Implementation Research Institute

Funded by: FundRef http://dx.doi.org/10.13039/100007181, Quality Enhancement Research Initiative;

Award ID: PEC 19-307

Funded by: FundRef http://dx.doi.org/10.13039/100000133, Agency for Healthcare Research and Quality;

Award ID: K12HS019461

Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;

Award ID: K23DA048182

Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;

Award ID: K01MH113806

Award Recipient : Byron J. Powell

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: implementation,veterans,diffusion of innovation,cirrhosis,liver

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: implementation, veterans, diffusion of innovation, cirrhosis, liver

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Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the veterans health administration

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Most cited references 32

A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project

Implementation strategies: recommendations for specifying and reporting

An introduction to implementation science for the non-specialist

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Cited by 8

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