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McCreight MS, Rabin BA, Glasgow RE, Ayele RA, Leonard CA, Gilmartin HM, Frank JW, Hess PL, Burke RE, Battaglia CT. Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Transl Behav Med 2020; 9:1002-1011. [PMID: 31170296 DOI: 10.1093/tbm/ibz085] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
There is consensus in dissemination and implementation (D&I) science that addressing contextual factors is critically important for understanding translation of health care delivery interventions but little agreement on which contextual factors are key determinants of implementation outcomes. We describe the application of the Practical Robust Implementation and Sustainability Model (PRISM), which expands the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to identify contextual factors across four diverse programs. Multiple qualitative methods were used to collect multilevel, multistakeholder perspectives from the adopting organizations and staff. We identified measures for evaluating context through the various domains of PRISM to guide health services research across the phases of program implementation. The PRISM domains of Recipients, Implementation and Sustainability Infrastructure, and External Environment identified important multilevel contextual factors, including variability in operational processes and available resources. These domains helped to facilitate planning and implementation phases of the four interventions and guide purposeful adaptations. We found assessments of PRISM domains useful to systematically assess multilevel contextual factors across various content areas as well as phases of program implementation. Additionally, these contextual factors were found to be relevant to RE-AIM outcomes. Lessons learned can be applied to future research as there is a need to investigate the measurement properties of PRISM and continue to test which contextual factors are most important to successful implementation and for which outcomes.
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Affiliation(s)
- Marina S McCreight
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Research Service, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Borsika A Rabin
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Russell E Glasgow
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Roman A Ayele
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Research Service, VA Eastern Colorado Health Care System, Aurora, CO, USA
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Chelsea A Leonard
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Research Service, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Heather M Gilmartin
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Research Service, VA Eastern Colorado Health Care System, Aurora, CO, USA
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joseph W Frank
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Research Service, VA Eastern Colorado Health Care System, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paul L Hess
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Research Service, VA Eastern Colorado Health Care System, Aurora, CO, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert E Burke
- Center for Health Equity Research and Promotion (CHERP), Corporal Crescenz VA Medical Center, Philadelphia, PA, USA
- Section of Hospital Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Catherine T Battaglia
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Research Service, VA Eastern Colorado Health Care System, Aurora, CO, USA
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Vander Weg MW, Holman JE, Rahman H, Sarrazin MV, Hillis SL, Fu SS, Grant KM, Prochazka AV, Adams SL, Battaglia CT, Buchanan LM, Tinkelman D, Katz DA. Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial. J Subst Abuse Treat 2017; 77:79-88. [PMID: 28476277 DOI: 10.1016/j.jsat.2017.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers. DESIGN Pre-post quasi-experimental trial. SETTING General medical units of four US Department of Veterans Affairs hospitals. SUBJECTS 898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively). INTERVENTION The intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback. MEASURES The primary outcome was self-reported 7-day point prevalence abstinence at six months. ANALYSIS Tobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression. RESULTS Seven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio (AOR) and 95% confidence interval (CI95)=0.78 [0.51-1.18]) or six months (AOR=0.92; CI95=0.62-1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect (p=0.0004) and perceived likelihood of staying off cigarettes following discharge (p<0.0001). CONCLUSIONS Tobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.
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Affiliation(s)
- Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States; University of Iowa Department of Psychological and Brain Sciences, United States.
| | - John E Holman
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States
| | - Hafizur Rahman
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States
| | - Mary Vaughan Sarrazin
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States
| | - Stephen L Hillis
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Biostatistics, United States; University of Iowa Department of Radiology, United States
| | - Steven S Fu
- Center for Chronic Disease and Outcomes Research (CCDOR), Minneapolis VA Health Care System, United States
| | - Kathleen M Grant
- Mental Health and Behavioral Sciences Department, VA Nebraska-Western Iowa Health Care System, United States; The Department of Internal Medicine, University of Nebraska Medical Center, United States
| | - Allan V Prochazka
- Department of Medicine, VA Eastern Colorado Health Care System, United States; The Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States
| | - Susan L Adams
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States
| | - Catherine T Battaglia
- Department of Medicine, VA Eastern Colorado Health Care System, United States; The Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States
| | | | | | - David A Katz
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States; University of Iowa Department of Epidemiology, United States
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Katz DA, Stewart K, Paez M, Holman J, Adams SL, Vander Weg MW, Battaglia CT, Joseph AM, Titler MG, Ono S. "Let Me Get You a Nicotine Patch": Nurses' Perceptions of Implementing Smoking Cessation Guidelines for Hospitalized Veterans. Mil Med 2017; 181:373-82. [PMID: 27046185 DOI: 10.7205/milmed-d-15-00101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Many hospitalized smokers do not receive guideline-recommended tobacco treatment, but little is known about the perceptions of inpatient nurses with regard to tobacco treatment. We used a sequential explanatory mixed methods design to help explain the findings of an academic detailing intervention trial on the inpatient medicine units of four Veterans Affairs (VA) hospitals. We surveyed 164 nurses and conducted semistructured interviews in a purposeful sample of 33 nurses with different attitudes toward cessation counseling. Content analysis was used to inductively characterize the issues raised by participants. Emerging themes were categorized using the knowledge-attitudes-behavior framework of guideline adherence. Knowledge-related and attitudinal barriers included perceived lack of skills in cessation counseling and skepticism about the effectiveness of cessation guidelines in hospitalized veterans. Nurses also reported multiple behavioral and organizational barriers to guideline adherence: resistance from patients, insufficient time and resources, the presence of smoking areas on VA premises, and lack of coordination with primary care. VA hospitals should train inpatient staff how to negotiate behavior change, integrate cessation counseling into nurses' workflow, develop alternative referral mechanisms for post-discharge cessation counseling, and adopt hospital policies to promote inpatient abstinence.
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Affiliation(s)
- David A Katz
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
| | - Kenda Stewart
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
| | - Monica Paez
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
| | - John Holman
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
| | - Susan L Adams
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
| | - Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
| | - Catherine T Battaglia
- Department of Medicine, VA Eastern Colorado Health Care System and the Denver Seattle Center for Veteran-Centric Value-Based Research (DiSCoVVR), Denver, CO
| | - Anne M Joseph
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | | | - Sarah Ono
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
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Morrato EH, Rabin B, Proctor J, Cicutto LC, Battaglia CT, Lambert-Kerzner A, Leeman-Castillo B, Prahl-Wretling M, Nuechterlein B, Glasgow RE, Kempe A. Bringing it home: expanding the local reach of dissemination and implementation training via a university-based workshop. Implement Sci 2015; 10:94. [PMID: 26141909 PMCID: PMC4490605 DOI: 10.1186/s13012-015-0281-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 06/15/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Currently, national training programs do not have the capacity to meet the growing demand for dissemination and implementation (D&I) workforce education and development. The Colorado Research in Implementation Science Program (CRISP) developed and delivered an introductory D&I workshop adapted from national programs to extend training reach and foster a local learning community for D&I. METHODS To gauge interest and assess learning needs, a pre-registration survey was administered. Based on feedback, a 1.5-day workshop was designed. Day 1 introduced D&I frameworks, strategies, and evaluation principles. Local and national D&I experts provided ignite-style talks on key lessons followed by panel discussion. Breakout sessions discussed community engagement and applying for D&I grants. A workbook was developed to enhance the training and provided exercises for application to an individual's projects. Day 2 offered expert-led mentoring sessions with selected participants who desired advanced instruction. Two follow-up surveys (immediate post-workshop, 6 months) assessed knowledge gained from participation and utilization of workshop content. RESULTS Ninety-three workshop registrants completed an assessment survey to inform workshop objectives and curriculum design; 43 % were new and 54 % reported a basic understanding of the D&I field. Pre-registrants intended to use the training to "apply for a D&I grant" (73 %); "incorporate D&I into existing projects" (76 %), and for quality improvement (51 %). Sixty-eight individuals attended Day 1; 11 also attended Day 2 mentoring sessions. In the 1-week post-workshop survey (n = 34), 100 % strongly agreed they were satisfied with the training; 97 % strongly agreed the workshop workbook was a valuable resource. All Day 2 participants strongly agreed that working closely with faculty and experts increased their overall confidence. In the 6-month follow-up evaluation (n = 23), evidence of new D&I-related manuscripts and grant proposals was found. Training materials were published online ( www.ucdenver.edu/implementation/workshops ) and disseminated via the National Institutes of Health (NIH) Clinical and Translational Science Awards Consortium. To sustain reach, CRISP adapted the materials into an interactive e-book ( www.CRISPebooks.org ) and launched a new graduate course. CONCLUSIONS Local D&I training workshops can extend the reach of national training programs.
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Affiliation(s)
- Elaine H Morrato
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA.
- Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Borsika Rabin
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
- Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Health Care System, Denver, CO, USA
- Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), Denver, CO, USA
| | - Jeff Proctor
- The Evaluation Center, School of Education and Human Development, University of Colorado Denver, Denver, CO, USA
| | - Lisa C Cicutto
- Clinical Science Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- National Jewish Health, Denver, CO, USA
| | - Catherine T Battaglia
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
- VA Eastern Colorado Health Care System, Denver, CO, USA
- Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), Denver, CO, USA
- Clinical Science Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne Lambert-Kerzner
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
- VA Eastern Colorado Health Care System, Denver, CO, USA
- Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), Denver, CO, USA
| | | | - Michelle Prahl-Wretling
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
| | - Bridget Nuechterlein
- The Evaluation Center, School of Education and Human Development, University of Colorado Denver, Denver, CO, USA
| | - Russell E Glasgow
- Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison Kempe
- Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Fu SS, Roth C, Battaglia CT, Nelson DB, Farmer MM, Do T, Goldstein MG, Widome R, Hagedorn H, Zillich AJ. Training primary care clinicians in motivational interviewing: a comparison of two models. Patient Educ Couns 2015; 98:61-8. [PMID: 25455795 DOI: 10.1016/j.pec.2014.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 09/12/2014] [Accepted: 10/04/2014] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To evaluate implementing two training models for motivational interviewing (MI) to address tobacco use with primary care clinicians. METHODS Clinicians were randomized to moderate or high intensity. Both training modalities included a single ½ day workshop facilitated by MI expert trainers. The high intensity (HI) training provided six booster sessions including telephone interactions with simulated patients and peer coaching by MI champions over 3 months. To assess performance of clinicians to deliver MI, an objective structured clinical evaluation (OSCE) was conducted before and 12 weeks after the workshop training. RESULTS Thirty-four clinicians were enrolled; 18 were randomly assigned to HI. Compared to the moderate intensity group, the HI group scored significantly higher during the OSCE for three of six global Motivational Interviewing Treatment Integrity scale scores. There was also significant improvement for three of the four measures of MI counseling knowledge, skills and confidence. CONCLUSIONS Using champions and telephone interactions with simulated patients as enhancement strategies for MI training programs is feasible in the primary care setting and results in greater gains in MI proficiency. PRACTICE IMPLICATIONS Results confirm and expand evidence for use of booster sessions to improve the proficiency of MI training programs for primary care clinicians.
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Affiliation(s)
- Steven S Fu
- Center for Chronic Disease Outcomes Research and Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, USA; University of Minnesota, Minneapolis, USA.
| | - Craig Roth
- Center for Chronic Disease Outcomes Research and Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, USA; University of Minnesota, Minneapolis, USA
| | - Catherine T Battaglia
- Denver Seattle Center for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, USA; Colorado School of Public Health, University of Colorado, Denver, USA
| | - David B Nelson
- Center for Chronic Disease Outcomes Research and Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, USA; University of Minnesota, Minneapolis, USA
| | - Melissa M Farmer
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, Los Angeles, USA
| | - Tam Do
- Center for Chronic Disease Outcomes Research and Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, USA
| | - Michael G Goldstein
- VHA National Center for Health Promotion and Disease Prevention, Durham, USA
| | - Rachel Widome
- Center for Chronic Disease Outcomes Research and Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, USA; University of Minnesota, Minneapolis, USA
| | - Hildi Hagedorn
- Center for Chronic Disease Outcomes Research and Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, USA
| | - Alan J Zillich
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA; College of Pharmacy, Purdue University, West Lafayette, USA
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Katz DA, Holman JE, Johnson SR, Hillis SL, Adams SL, Fu SS, Grant KM, Buchanan LM, Prochazka A, Battaglia CT, Titler MG, Joseph AM, Vander Weg MW. Implementing Best Evidence in Smoking Cessation Treatment for Hospitalized Veterans: Results from the VA-BEST Trial. Jt Comm J Qual Patient Saf 2014; 40:493-1. [DOI: 10.1016/s1553-7250(14)40064-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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