Supporting teams to optimize function and independence in Veterans: a multi-study program and mixed methods protocol

Virginia Wang, Kelli Allen, Courtney H Van Houtven, Cynthia Coffman, Nina Sperber, Elizabeth P Mahanna, Cathleen Colón-Emeric, Helen Hoenig, George L Jackson, Teresa M Damush, Erika Price, Susan N Hastings, Virginia Wang, Kelli Allen, Courtney H Van Houtven, Cynthia Coffman, Nina Sperber, Elizabeth P Mahanna, Cathleen Colón-Emeric, Helen Hoenig, George L Jackson, Teresa M Damush, Erika Price, Susan N Hastings

Abstract

Background: Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. However, a one-size-fits-all approach is rarely effective. In partnership with VA national clinical leaders and local clinical champions, the Optimizing Function and Independence VA Quality Enhancement Research Initiative program (Function QUERI) will evaluate efforts to implement team-based clinical programs for Veterans at risk for functional decline and disability.

Methods: Function QUERI will implement and evaluate three innovative, evidence-based clinical programs in VA medical centers: (1) a group physical therapy program for knee osteoarthritis (Group PT); (2) assisted early mobility for hospitalized older veterans (STRIDE), a supervised walking program for hospitalized older veterans; and (3) implementation of helping invested family members improve veteran experiences study (iHI-FIVES), a skills training program for caregivers of disabled Veterans. A common reason for clinical care gaps in these populations is poor communication and coordination among the many interdisciplinary providers involved in their care. To facilitate the implementation of the clinical programs, Function QUERI will evaluate the impact of complexity science-based implementation intervention to promote team readiness (CONNECT), an implementation intervention designed as a bundle of interaction-oriented activities to promote team function and readiness for change, on the implementation of clinical programs across multiple sites. The evaluation will use a mixed methods design. Group PT is a local, single-site quality improvement project where a modified CONNECT intervention will be tested to inform the remaining program implementation projects. For STRIDE and iHI-FIVES projects, we will randomize participating sites to implement the clinical program, with the CONNECT intervention or not, and will use a stepped-wedge cluster randomized trial design.

Discussion: Function QUERI will translate its findings across its projects to identify the contextual factors and components from CONNECT that improve team processes and function to optimize effective implementation for future rollout of VA clinical programs. Synthesizing findings within and across projects, we will specify dimensions of team characteristics and function that enhance capacity for clinical innovation and uptake of evidence-based programs.

Trial registration: NCT03300336 Registered September 28, 2017, NCT03474380 Registered March 15, 2018.

Keywords: Function; Healthcare team; Implementation; VA; Veterans.

Conflict of interest statement

Ethics approval and consent to participate

This program was funded through the VA Quality Enhancement Research Initiative (QUERI) program. VA QUERI funds are operational funds in the Veterans Health Administration, and much of the work funded through QUERI is conducted as quality improvement. The Department of Veterans Affairs has specific guidance for the approval of work done as QI, as outlined in VHA Handbook 1058.05. The authors provided supporting documentation that attest to meeting the requirements under this guidance, which is available from the authors upon request.

Competing interests

Courtney Van Houtven received payment for consultation for Truven Analytics. All other authors (VW, CVH, KDA, CC, NS, EM, CCE, HH, GLJ, TMD, EP, SNH) declare no competing interests.

Publisher’s Note

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

Figures

Fig. 1
Fig. 1
Nested model of team function and performance in implementation. Notes: (1) Team characteristics and processes, their environmental context, and the prescribed work characteristics of Function QUERI’s clinical programs both affect and are affected by one another in a nonlinear fashion. Collectively, these factors are critical to successful implementation of new clinical programs and improvements in patient care. (2) Replicating Effective Programs (REP) is a framework of processes for implementing new clinical programs into VA practice. Function QUERI REP processes, by project, are described in Additional file 1. (3) CONNECT is a novel implementation intervention to facilitate and enhance team function and readiness to implement Function QUERI’s new clinical programs
Fig. 2
Fig. 2
Stepped-wedge design for the eight participating sites for STRIDE and iHI-FIVES implementation projects. Site sample sizes: n = 4 per stratified block, n = 2 per wave. Phases of activity (where all phases involve data collection and length of time periods will vary by project*): ■pre-implementation, ■implementation, ■ post-implementation,.and ■ administrative data collection only. *The iHI-FIVES project will combine implementation and post-implementation periods

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