Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients

Laura J Damschroder, Jeremy B Sussman, Paul N Pfeiffer, Jacob E Kurlander, Michelle B Freitag, Claire H Robinson, Patrick Spoutz, Melissa L D Christopher, Saraswathy Battar, Kimberly Dickerson, Christopher Sedgwick, Ashleigh G Wallace-Lacey, Geoffrey D Barnes, Amy M Linsky, Christi S Ulmer, Julie C Lowery, Laura J Damschroder, Jeremy B Sussman, Paul N Pfeiffer, Jacob E Kurlander, Michelle B Freitag, Claire H Robinson, Patrick Spoutz, Melissa L D Christopher, Saraswathy Battar, Kimberly Dickerson, Christopher Sedgwick, Ashleigh G Wallace-Lacey, Geoffrey D Barnes, Amy M Linsky, Christi S Ulmer, Julie C Lowery

Abstract

Background: The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies.

Methods: For each trial, we will recruit 8-12 clinics (24-36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act.

Process: (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently.

Discussion: MIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings.

Trial registration: ClinicalTrials.gov: NCT05065502 . Registered October 4, 2021-retrospectively registered.

Keywords: Academic detailing; Anti-coagulation; Deprescribing; Implementation science; Implementation strategy; Insomnia; Medication safety; Polypharmacy; Quality improvement.

Conflict of interest statement

Dr. Geoffrey Barnes: Consulting fees - Pfizer/Bristol-Myers Squibb, Janssen, Acelis Connected Health, Boston Scientific. All other authors have none to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
LEAP program components
Fig. 2
Fig. 2
MIDAS conceptual framework

References

    1. Meaney M, Pung C. McKinsey global results: Creating organizational transformations. McKinsey Q. 2008;7:1–7.
    1. Rafferty AE, Jimmieson NL, Armenakis AA. Change readiness: A multilevel review. J Manag. 2013;39:110–135.
    1. Kilbourne AM, Elwy AR, Sales AE, Atkins D. Accelerating Research Impact in a Learning Health Care System: VA’s Quality Enhancement Research Initiative in the Choice Act Era. Med Care. 2017;55(Suppl 7):S4–12. doi: 10.1097/MLR.0000000000000683.
    1. Miake-Lye I, Mak S, Lam CA, Lambert-Kerzner AC, Delevan D, Olmos-Ochoa T, et al. Scaling Beyond Early Adopters: a Content Analysis of Literature and Key Informant Perspectives. J Gen Intern Med. 2021;36:383–395. doi: 10.1007/s11606-020-06142-0.
    1. Rogers E. Diffusion of Innovations. 5. New York: Free Press; 2003.
    1. Lennox L, Linwood-Amor A, Maher L, Reed J. Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review. Health Res Policy Sys. 2020;18:120. doi: 10.1186/s12961-020-00601-0.
    1. Lennox L, Maher L, Reed J. Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare. Implement Sci. 2018;13:27. doi: 10.1186/s13012-017-0707-4.
    1. Lennox L, Doyle C, Reed JE, Bell D. What makes a sustainability tool valuable, practical and useful in real-world healthcare practice? A mixed-methods study on the development of the Long Term Success Tool in Northwest London. BMJ Open. 2017;7:e014417. doi: 10.1136/bmjopen-2016-014417.
    1. Rostata-Pesola H, Olender L, Leon N, Aytaman A, Hoffman R, Pesola GR. Hepatitis C virus screening at a Veterans Administration Hospital in New York City. J Am Assoc Nurse Pract. 2020. 10.1097/JXX.0000000000000393.
    1. Rozenberg-Ben-Dror K, Taylor JM, Chia L, Ruiz D, Himsel AS, Jacob DA, et al. Hepatocellular carcinoma surveillance utilizing a population management dashboard in the veterans affairs healthcare system. Hepatology. 2018;68:313A–314A. doi: 10.1002/hep.30257.
    1. Peterson JF, Kripalani S, Danciu I, Harrell D, Marvanova M, Mixon AS, et al. Electronic Surveillance and Pharmacist Intervention for Vulnerable Older Inpatients on High-Risk Medication Regimens. J Am Geriatr Soc. 2014;62:2148–2152. doi: 10.1111/jgs.13057.
    1. Bertsimas D, Kallus N, Weinstein AM, Zhuo YD. Personalized Diabetes Management Using Electronic Medical Records. Diabetes Care. 2017;40:210–217. doi: 10.2337/dc16-0826.
    1. Carmichael JM, Meier J, Robinson A, Taylor J, Higgins DT, Patel S. Leveraging electronic medical record data for population health management in the Veterans Health Administration: Successes and lessons learned. Am J Health Syst Pharm. 2017;74:1447–1459. doi: 10.2146/ajhp161048.
    1. Burningham Z, Jackson GL, Kelleher J, Stevens M, Morris I, Cohen J, et al. The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED? Clin Ther. 2020;42:573–582. doi: 10.1016/j.clinthera.2020.02.013.
    1. Fischer MJ, Kourany WM, Sovern K, Forrester K, Griffin C, Lightner N, et al. Development, implementation and user experience of the Veterans Health Administration (VHA) dialysis dashboard. BMC Nephrol. 2020;21:136. doi: 10.1186/s12882-020-01798-6.
    1. Lau MK, Bounthavong M, Kay CL, Harvey MA, Christopher MLD. Clinical dashboard development and use for academic detailing in the U.S. Department of Veterans Affairs. J Am Pharm Assoc. 2019;59:S96-S103.e3. doi: 10.1016/j.japh.2018.12.006.
    1. Oliva EM, Bowe T, Tavakoli S, Martins S, Lewis ET, Paik M, et al. Development and applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide. Psychol Serv. 2017;14:34–49. doi: 10.1037/ser0000099.
    1. Twohig PA, Rivington JR, Gunzler D, Daprano J, Margolius D. Clinician dashboard views and improvement in preventative health outcome measures: a retrospective analysis. BMC Health Serv Res. 2019;19:475. doi: 10.1186/s12913-019-4327-3.
    1. Agency for Healthcare Research and Quality (AHRQ). Adapting to a Changing Evidence Environment: The EvidenceNOW Key Driver Diagram. Agency for Healthcare Research and Quality n.d. (Accessed 12 May 2021).
    1. Pan American Health Organization (PATH) Immunization Data: Evidence for Action. A Realist Review of What Works to Improve Data Use for Immunization, Evidence from Low- and MiddleIncome Countries. Seattle: PATH; 2019.
    1. Dowding D, Randell R, Gardner P, Fitzpatrick G, Dykes P, Favela J, et al. Dashboards for improving patient care: review of the literature. Int J Med Inform. 2015;84:87–100. doi: 10.1016/j.ijmedinf.2014.10.001.
    1. Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Therapeut Adv Drug Saf. 2020;11:204209862093374. doi: 10.1177/2042098620933741.
    1. Peel N, Runganga M, Hubbard R. Multiple medication use in older patients in post-acute transitional care: a prospective cohort study. CIA. 2014;1453. 10.2147/CIA.S64105.
    1. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230. doi: 10.1186/s12877-017-0621-2.
    1. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:57–65. doi: 10.1517/14740338.2013.827660.
    1. Salazar JA, Poon I, Nair M. Clinical consequences of polypharmacy in elderly: expect the unexpected, think the unthinkable. Expert Opin Drug Saf. 2007;6:695–704. doi: 10.1517/14740338.6.6.695.
    1. Rankin A, Cadogan CA, Patterson SM, Kerse N, Cardwell CR, Bradley MC, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2018. 10.1002/14651858.CD008165.pub4.
    1. By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults: 2019 AGS BEERS CRITERIA® UPDATE EXPERT PANEL. J Am Geriatr Soc. 2019;67:674–694. doi: 10.1111/jgs.15767.
    1. Nelson MW, Downs TN, Puglisi GM, Simpkins BA, Collier AS. Use of a Deprescribing Tool in an Interdisciplinary Primary-Care Patient-Aligned Care Team. Sr Care Pharm. 2022;37:34–43. doi: 10.4140/TCP.n.2022.34.
    1. VAntage Point Contributor. New best practices are being implemented across VA following “Shark Tank” competition. VAntage Point 2018. (Accessed 14 Apr 2021).
    1. Battar S, Watson Dickerson KR, Sedgwick C, Cmelik T. Understanding Principles of High Reliability Organizations Through the Eyes of VIONE: A Clinical Program to Improve Patient Safety by Deprescribing Potentially Inappropriate Medications and Reducing Polypharmacy. Fed Pract. 2019;36:564–568.
    1. Bloomfield H, Linsky A, Bolduc J, Greer N, Naidl T, Vardeny O, et al. Deprescribing for Older Veterans: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs; 2019.
    1. Veterans Health Administration (VHA). VHA Directive 1108.16(1): Anticoagulation Therapy Management (2021).
    1. Dawwas GK, Dietrich E, Cuker A, Barnes GD, Leonard CE, Lewis JD. Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation: A Population-Based Cohort Study. Ann Intern Med. 2021:M20–6194. 10.7326/M20-6194.
    1. Kurlander JE, Gu X, Scheiman JM, Haymart B, Kline-Rogers E, Saini SD, et al. Missed opportunities to prevent upper GI hemorrhage: The experience of the Michigan Anticoagulation Quality Improvement Initiative. Vasc Med. 2019;24:153–155. doi: 10.1177/1358863X18815971.
    1. Rossier C, Spoutz P, Schaefer M, Allen A, Patterson ME. Working smarter, not harder: evaluating a population health approach to anticoagulation therapy management. J Thromb Thrombolysis. 2020. 10.1007/s11239-020-02341-y.
    1. Barnes GD, Sippola E, Dorsch M, Errickson J, Lanham M, Allen A, et al. Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol. Implement Sci. 2020;15:83. doi: 10.1186/s13012-020-01044-5.
    1. Valencia D, Spoutz P, Stoppi J, Kibert JL, Allen A, Parra D, et al. Impact of a Direct Oral Anticoagulant Population Management Tool on Anticoagulation Therapy Monitoring in Clinical Practice. Ann Pharmacother. 2019;53:806–811. doi: 10.1177/1060028019835843.
    1. The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea Work Group . VA/DoD Clinical Practice Guidelines for the Management of Chronic Insomnia Disorder and Obstructive Aleep Apnea. 2019.
    1. Kim HM, Gerlach LB, Van T, Yosef M, Conroy DA, Zivin K. Predictors of Long-Term and High-Dose Use of Zolpidem in Veterans. J Clin Psychiatry. 2019;80. 10.4088/JCP.18m12149.
    1. Tom SE, Wickwire EM, Park Y, Albrecht JS. Nonbenzodiazepine Sedative Hypnotics and Risk of Fall-Related Injury. Sleep. 2016;39:1009–1014. doi: 10.5665/sleep.5742.
    1. Chen P-L, Lee W-J, Sun W-Z, Oyang Y-J, Fuh J-L. Risk of Dementia in Patients with Insomnia and Long-term Use of Hypnotics: A Population-based Retrospective Cohort Study. PLoS One. 2012;7:e49113. doi: 10.1371/journal.pone.0049113.
    1. Hansen RN, Boudreau DM, Ebel BE, Grossman DC, Sullivan SD. Sedative Hypnotic Medication Use and the Risk of Motor Vehicle Crash. Am J Public Health. 2015;105:e64–e69. doi: 10.2105/AJPH.2015.302723.
    1. Leatherman S, Berwick D, Iles D, Lewin LS, Davidoff F, Nolan T, et al. The business case for quality: case studies and an analysis. Health Aff (Millwood) 2003;22:17–30. doi: 10.1377/hlthaff.22.2.17.
    1. Scheirer MA, Dearing JW. An agenda for research on the sustainability of public health programs. Am J Public Health. 2011;101:2059–2067. doi: 10.2105/AJPH.2011.300193.
    1. Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, et al. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21:S1–S8. doi: 10.1007/s11606-006-0267-9.
    1. Curry LA, Krumholz HM, O’Cathain A, Clark VLP, Cherlin E, Bradley EH. Mixed Methods in Biomedical and Health Services Research. Circ Cardiovasc Qual Outcomes. 2013;6:119–123. doi: 10.1161/CIRCOUTCOMES.112.967885.
    1. Bush PL, Pluye P, Loignon C, Granikov V, Wright MT, Pelletier JF, et al. Organizational participatory research: a systematic mixed studies review exposing its extra benefits and the key factors associated with them. Implement Sci. 2017;12:119. doi: 10.1186/s13012-017-0648-y.
    1. Buttigieg SC, Pace A, Rathert C. Hospital performance dashboards: a literature review. J Health Organ Manag. 2017;31:385–406. doi: 10.1108/JHOM-04-2017-0088.
    1. Helminski D, Kurlander JE, Renji AD, Sussman JB, Pfeiffer PN, Conte ML, et al. Dashboards in Health Care Settings: Protocol for a Scoping Review. JMIR Res Protoc. 2022;11:e34894. doi: 10.2196/34894.
    1. Smart MH, Mandava MR, Lee TA, Pickard AS. Feasibility and acceptability of virtual academic detailing on opioid prescribing. Int J Med Inform. 2021;147:104365. doi: 10.1016/j.ijmedinf.2020.104365.
    1. Baldwin L-M, Fischer MA, Powell J, Holden E, Tuzzio L, Fagnan LJ, et al. Virtual Educational Outreach Intervention in Primary Care Based on the Principles of Academic Detailing. J Contin Educ Health Prof. 2018;38:269–275. doi: 10.1097/CEH.0000000000000224.
    1. Kennedy AG, Regier L, Fischer MA. Educating community clinicians using principles of academic detailing in an evolving landscape. Am J Health Syst Pharm. 2021;78:80–86. doi: 10.1093/ajhp/zxaa351.
    1. Chan WV, Pearson TA, Bennett GC, Cushman WC, Gaziano TA, Gorman PN, et al. ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;69:1076–1092. doi: 10.1016/j.jacc.2016.11.004.
    1. Kamarudin G, Penm J, Chaar B, Moles R. Educational interventions to improve prescribing competency: a systematic review. BMJ Open. 2013;3:e003291. doi: 10.1136/bmjopen-2013-003291.
    1. Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, et al. Systematic review of interventions to improve prescribing. Ann Pharmacother. 2009;43:502–513. doi: 10.1345/aph.1L488.
    1. O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007:CD000409. 10.1002/14651858.CD000409.pub2.
    1. Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance. Wiley; 2009.
    1. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Liang L, Bernhardsson S, Vernooij RWM, Armstrong MJ, Bussières A, Brouwers MC, et al. Use of theory to plan or evaluate guideline implementation among physicians: a scoping review. Implement Sci. 2017;12:26. doi: 10.1186/s13012-017-0557-0.
    1. Miller WR, Moyers TB. Motivational interviewing and the clinical science of Carl Rogers. J Consult Clin Psychol. 2017;85:757–766. doi: 10.1037/ccp0000179.
    1. Fischer F, Lange K, Klose K, Greiner W, Kraemer A. Barriers and Strategies in Guideline Implementation-A Scoping Review. Healthcare (Basel). 2016;4. 10.3390/healthcare4030036.
    1. Damschroder LJ, Lowery JC. Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR) Implement Sci. 2013;8:51. doi: 10.1186/1748-5908-8-51.
    1. Damschroder LJ, Reardon CM, Sperber N, Robinson CH, Fickel JJ, Oddone EZ. Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation. Transl Behav Med. 2017;7:233–241. doi: 10.1007/s13142-016-0424-6.
    1. Damschroder LJ, Reardon CM, AuYoung M, Moin T, Datta SK, Sparks JB, et al. Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA) Implement Sci. 2017;12:94. doi: 10.1186/s13012-017-0619-3.
    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;69:123–157. 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, Fernández ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci. 2019;14:42. doi: 10.1186/s13012-019-0892-4.
    1. Practical Improvement Science in Health Care: A Roadmap for Getting Results n.d. . Accessed 27 Apr 2022.
    1. Damschroder LJ, Yankey NR, Robinson CH, Freitag MB, Burns JA, Raffa SD, et al. The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings. J Gen Intern Med. 2021;36:288-95.
    1. Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8:117. doi: 10.1186/1748-5908-8-117.
    1. Wandersman A, Chien VH, Katz J. Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement. Am J Community Psychol. 2012;50:445–459. doi: 10.1007/s10464-012-9509-7.
    1. Wandersman A, Duffy J, Flaspohler P, Noonan R, Lubell K, Stillman L, et al. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Am J Community Psychol. 2008;41:171–181. doi: 10.1007/s10464-008-9174-z.
    1. Rotenstein LS, Johnson AK. Taking Back Control—Can Quality Improvement Enhance The Physician Experience? 2020. .
    1. Edwards ST, Marino M, Solberg LI, Damschroder L, Stange KC, Kottke TE, et al. Cultural And Structural Features Of Zero-Burnout Primary Care Practices: Study examines features of primary care practices where physician burnout was reported to be zero. Health Aff. 2021;40:928–936. doi: 10.1377/hlthaff.2020.02391.
    1. Goldberg DG, Soylu TG, Kitsantas P, Grady VM, Elward K, Nichols LM. Burnout among Primary Care Providers and Staff: Evaluating the Association with Practice Adaptive Reserve and Individual Behaviors. J Gen Intern Med. 2021. 10.1007/s11606-020-06367-z.
    1. Edmondson AC. Teaming . How organizations learn, innovate, and compete in the knowledge economy. San Francisco; Chichester: Jossey-Bass Pfeiffer; 2014.
    1. Perla RJ, Provost LP, Parry GJ. Seven propositions of the science of improvement: exploring foundations. Qual Manage Healthc. 2013;22:170–186. doi: 10.1097/QMH.0b013e31829a6a15.
    1. Hayes RJ, Moulton LH. Cluster randomised trials. 2009.
    1. Campbell MJ, Walters SJ. How to design, analyse and report cluster randomised trials in medicine and health related research. Chichester: Wiley; 2014.
    1. Creswell JW, Plano Clark VL, Gutmann ML, Hanson WE. An Expanded Typology for Classifying Mixed Methods Research Into Designs: The Mixed Methods Reader. Chichester: Sage Publishing; n.d.
    1. Averill JB. Matrix Analysis as a Complementary Analytic Strategy in Qualitative Inquiry. Qual Health Res. 2002;12:855–866. doi: 10.1177/104973230201200611.
    1. McMullen CK, Ash JS, Sittig DF, Bunce A, Guappone K, Dykstra R, et al. Rapid Assessment of Clinical Information Systems in the Healthcare Setting: An Efficient Method for Time-pressed Evaluation. Methods Inf Med. 2011;50:299–307. doi: 10.3414/ME10-01-0042.
    1. Gehlert E, Jacobs J, Barnett P. Costing Methods Used in VA Research, 1980-2012: Technical Report 32. 2016.
    1. Gold HT, McDermott C, Hoomans T, Wagner TH. Cost data in implementation science: categories and approaches to costing. Implement Sci. 2022;17:11. doi: 10.1186/s13012-021-01172-6.
    1. Azevedo KJ, Gray CP, Gale RC, Urech TH, Ramirez JC, Wong EP, et al. Facilitators and barriers to the Lean Enterprise Transformation program at the Veterans Health Administration. Health Care Manage Rev. 2020; Publish Ahead of Print. 10.1097/HMR.0000000000000270.
    1. Bradley EH, Brewster AL, McNatt Z, Linnander EL, Cherlin E, Fosburgh H, et al. How guiding coalitions promote positive culture change in hospitals: a longitudinal mixed methods interventional study. BMJ Qual Saf. 2018;27:218–225. doi: 10.1136/bmjqs-2017-006574.
    1. Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, Shwartz M, et al. Transformational change in health care systems: An organizational model. Health Care Manage Rev. 2007;32:309–320. doi: 10.1097/01.HMR.0000296785.29718.5d.
    1. Stephens TJ, Peden CJ, Pearse RM, Shaw SE, Abbott TEF, Jones EL, et al. Improving care at scale: process evaluation of a multi-component quality improvement intervention to reduce mortality after emergency abdominal surgery (EPOCH trial) Implement Sci. 2018;13:142. doi: 10.1186/s13012-018-0823-9.
    1. Damschroder LJ, Knighton AJ, Griese E, Greene SM, Lozano P, Kilbourne AM, et al. Recommendations for Strengthening the Role of Embedded Researchers to Accelerate Implementation in Health Systems: Findings from a State-of-the-Art (SOTA) Conference. Healthcare: J Deliv Sci Innov. 2021;8:100455.
    1. Frenk J. Balancing relevance and excellence: Organizational responses to link research with decision making. Soc Sci Med. 1992;35:1397–1404. doi: 10.1016/0277-9536(92)90043-P.

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