Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory

Cynthia K Perry, Laura J Damschroder, Jennifer R Hemler, Tanisha T Woodson, Sarah S Ono, Deborah J Cohen, Cynthia K Perry, Laura J Damschroder, Jennifer R Hemler, Tanisha T Woodson, Sarah S Ono, Deborah J Cohen

Abstract

Background: The use of implementation strategies is an active and purposive approach to translate research findings into routine clinical care. The Expert Recommendations for Implementing Change (ERIC) identified and defined discrete implementation strategies, and Proctor and colleagues have made recommendations for specifying operationalization of each strategy. We use empirical data to test how the ERIC taxonomy applies to a large dissemination and implementation initiative aimed at taking cardiac prevention to scale in primary care practice.

Methods: EvidenceNOW is an Agency for Healthcare Research and Quality initiative that funded seven cooperatives across seven regions in the USA. Cooperatives implemented multi-component interventions to improve heart health and build quality improvement capacity, and used a range of implementation strategies to foster practice change. We used ERIC to identify cooperatives' implementation strategies and specified the actor, action, target, dose, temporality, justification, and expected outcome for each. We mapped and compiled a matrix of the specified ERIC strategies across the cooperatives, and used consensus to resolve mapping differences. We then grouped implementation strategies by outcomes and justifications, which led to insights regarding the use of and linkages between ERIC strategies in real-world scale-up efforts.

Results: Thirty-three ERIC strategies were used by cooperatives. We identified a range of revisions to the ERIC taxonomy to improve the practical application of these strategies. These proposed changes include revisions to four strategy names and 12 definitions. We suggest adding three new strategies because they encapsulate distinct actions that were not described in the existing ERIC taxonomy. In addition, we organized ERIC implementation strategies into four functional groupings based on the way we observed them being applied in practice. These groupings show how ERIC strategies are, out of necessity, interconnected, to achieve the work involved in rapidly taking evidence to scale.

Conclusions: Findings of our work suggest revisions to the ERIC implementation strategies to reflect their utilization in real-work dissemination and implementation efforts. The functional groupings of the ERIC implementation strategies that emerged from on-the-ground implementers will help guide others in choosing among and linking multiple implementation strategies when planning small- and large-scale implementation efforts.

Trial registration: Registered as Observational Study at www.clinicaltrials.gov ( NCT02560428 ).

Keywords: Capacity building; Implementation facilitation; Implementation strategies; Implementation strategy mapping; Large-scale initiative.

Conflict of interest statement

Ethics approval and consent to participate

Study was approved by the Oregon Health & Science University Institutional Review Board. Participants provided informed consent prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8:139. doi: 10.1186/1748-5908-8-139.
    1. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53. doi: 10.1186/s13012-015-0242-0.
    1. Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337–350. doi: 10.1016/j.amepre.2012.05.024.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi: 10.1186/1748-5908-4-50.
    1. Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2016;11:33. doi: 10.1186/s13012-016-0398-2.
    1. May CR, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, et al. Development of a theory of implementation and integration: normalization process theory. Implement Sci. 2009;4:29. doi: 10.1186/1748-5908-4-29.
    1. Davidoff F, Dixon-Woods M, Leviton L, Michie S. Demystifying theory and its use in improvement. BMJ Qual Saf. 2015;24(3):228–238. doi: 10.1136/bmjqs-2014-003627.
    1. Foy R, Ovretveit J, Shekelle PG, Pronovost PJ, Taylor SL, Dy S, et al. The role of theory in research to develop and evaluate the implementation of patient safety practices. BMJ Qual Saf. 2011;20(5):453–459. doi: 10.1136/bmjqs.2010.047993.
    1. Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, et al. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. 2012;69(2):123–157. doi: 10.1177/1077558711430690.
    1. Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:21. doi: 10.1186/s13012-015-0209-1.
    1. Waltz TJ, Powell BJ, Matthieu MM, Damschroder LJ, Chinman MJ, Smith JL, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implement Sci. 2015;10:109. doi: 10.1186/s13012-015-0295-0.
    1. Boyd M, Powell B, Endicott D, Lewis C. A method for tracking implementation strategies: an exemplar implementing measurement-based care in community behavioral health clinics. Behav Ther. 2018;49(4):525–537. doi: 10.1016/j.beth.2017.11.012.
    1. Bunger AC, Powell BJ, Robertson HA, MacDowell H, Birken SA, Shea C. Tracking implementation strategies: a description of a practical approach and early findings. Health Res Policy Syst. 2017;15(1):15. doi: 10.1186/s12961-017-0175-y.
    1. Gold R, Bunce AE, Cohen DJ, Hollombe C, Nelson CA, Proctor EK, et al. Reporting on the strategies needed to implement proven interventions: an example from a “real-world” cross-setting implementation study. Mayo Clin Proc. 2016;91(8):1074–1083. doi: 10.1016/j.mayocp.2016.03.014.
    1. Huynh AK, Hamilton AB, Farmer MM, Bean-Mayberry B, Stirman SW, Moin T, et al. A pragmatic approach to guide implementation evaluation research: strategy mapping for complex interventions. Front Public Health. 2018;6:134. doi: 10.3389/fpubh.2018.00134.
    1. Rogal SS, Yakovchenko V, Waltz TJ, Powell BJ, Kirchner JE, Proctor EK, et al. The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample. Implement Sci. 2017;12(1):60. doi: 10.1186/s13012-017-0588-6.
    1. Agency for Healthcare Research and Quality: EvidenceNOW: Advancing Hearth Health in Primary Care. . Accessed 4 Jan 2019.
    1. Accelerating the Dissemination and Implementation of PCOR Findings into Primary Care Practice (R18). Rockville: Agency for Healthcare Research and Quality. . Updated December 2014. Accessed 4 Jan 2019.
    1. Cohen DJ, Balasubramanian BA, Gordon L, Marino M, Ono S, Solberg LI, et al. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol. Implement Sci. 2016;11(1):86. doi: 10.1186/s13012-016-0449-8.
    1. Ono SS, Crabtree BF, Hemler JR, Balasubramanian BA, Edwards ST, Green LA, et al. Taking innovation to scale in primary care practices: the functions of health care extension. Health Aff (Millwood) 2018;37(2):222–230. doi: 10.1377/hlthaff.2017.1100.
    1. Cohen D, Leviton L, Isaacson N, Tallia A, Crabtree B. Online diaries for qualitative evaluation gaining real-time insights. Am J Eval. 2006;27:163–184. doi: 10.1177/1098214006288448.
    1. Miller W, Crabtree B. The dance of interpretation. In: CBaM WL, editor. Doing qualitative research. 2. Thousand Oaks: Sage Publications; 1999. pp. 127–143.
    1. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;13(6):CD000259.
    1. Ivers NM, Grimshaw JM, Jamtvedt G, Flottorp S, O'Brien MA, French SD, et al. Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care. J Gen Intern Med. 2014;29(11):1534–1541. doi: 10.1007/s11606-014-2913-y.
    1. Ivers NM, Sales A, Colquhoun H, Michie S, Foy R, Francis JJ, et al. No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci. 2014;9:14. doi: 10.1186/1748-5908-9-14.
    1. Brehaut JC, Colquhoun HL, Eva KW, Carroll K, Sales A, Michie S, et al. Practice feedback interventions: 15 suggestions for optimizing effectiveness. Ann Intern Med. 2016;164(6):435–441. doi: 10.7326/M15-2248.
    1. Berta W, Cranley L, Dearing JW, Dogherty EJ, Squires JE, Estabrooks CA. Why (we think) facilitation works: insights from organizational learning theory. Implement Sci. 2015;10:141. doi: 10.1186/s13012-015-0323-0.
    1. Dogherty EJ, Harrison MB, Graham ID. Facilitation as a role and process in achieving evidence-based practice in nursing: a focused review of concept and meaning. Worldviews Evid-Based Nurs. 2010;7(2):76–89.
    1. Lessard S, Bareil C, Lalonde L, Duhamel F, Hudon E, Goudreau J, et al. External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change. Implement Sci. 2016;11:97. doi: 10.1186/s13012-016-0458-7.
    1. Nagykaldi Z, Mold JW, Aspy CB. Practice facilitators: a review of the literature. Fam Med. 2005;37(8):581–588.
    1. Taylor EF, Machta RM, Meyers DS, Genevro J, Peikes DN. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers. Ann Fam Med. 2013;11(1):80–83. doi: 10.1370/afm.1462.
    1. Grumbach K, Bainbridge E, Bodenheimer T. Facilitating improvement in primary care: the promise of practice coaching. Issue Brief Commonwealth Fund. 2012;15:1-14.
    1. Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, et al. Getting evidence into practice: the role and function of facilitation. J Adv Nurs. 2002;37(6):577–588. doi: 10.1046/j.1365-2648.2002.02126.x.
    1. Leeman J, Birken SA, Powell BJ, Rohweder C, Shea CM. Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice. Implement Sci. 2017;12(1):125. doi: 10.1186/s13012-017-0657-x.

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