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Enhancing the Implementation of the Virtual Pediatric Trauma Center Using Practical, Robust, Implementation and
Jennifer L Rosenthal1, Sarah C Haynes1, Bethney Bonilla2
1Department of Pediatrics, University of California Davis, Sacramento, California, USA.
Insights
This telehealth intervention for pediatric trauma care faces implementation challenges, including provider workflow navigation and understanding. Addressing these issues early is crucial for optimizing the Virtual Pediatric Trauma Center
Area of Science:
- Pediatric Trauma Care
- Telehealth Interventions
- Implementation Science
Background:
- The Virtual Pediatric Trauma Center (VPTeC) intervention utilizes telehealth for expert consultations for critically injured children.
- This study evaluates factors influencing the adoption, implementation, and effectiveness of the VPTeC.
Purpose of the Study:
- To measure Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) outcomes of the VPTeC intervention.
- To identify Practical, Robust, Implementation, and Sustainability Model (PRISM) contextual factors impacting implementation.
Main Methods:
- A convergent mixed-methods design was employed for an interim implementation evaluation.
- Quantitative data from electronic health records and qualitative data from provider feedback and family advisory boards were analyzed.
- Data were synthesized using a joint display table organized by RE-AIM dimensions and categorized by PRISM domains.
Main Results:
- During the first 10 months, 246 subjects were randomized (69 to telehealth, 177 to standard care).
- Four sites transitioned to the intervention period.
- Key PRISM factors influencing RE-AIM outcomes included provider difficulties with intervention workflows, preconceived notions about the intervention, and its success in reducing parental anxiety.
Conclusions:
- Implementation challenges were identified that could affect the overall success of the telehealth trial.
- Early identification and addressing of these challenges are essential for optimizing intervention reach, adoption, and implementation.
- Proactive management of these factors will enhance trial success and the intervention's potential for broad impact.
Background:
This article describes factors related to adoption, implementation, and effectiveness of the Virtual Pediatric Trauma Center intervention, which uses telehealth for trauma specialist consultations for seriously injured children. We aimed at (1) measuring RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation outcomes and (2) identifying PRISM (Practical, Robust, Implementation, and Sustainability Model) contextual factors that influenced the implementation outcomes.
Methods:
This interim implementation evaluation of our telehealth trial used a convergent mixed-methods design. The quantitative component was a cross-sectional analysis of pediatric trauma encounters using electronic health records. The qualitative component was a thematic analysis of written and verbal feedback from providers and family advisory board meetings. We compared the quantitative and qualitative data by synthesizing them in a joint display table, organized by RE-AIM dimensions. We categorized these key findings into the PRISM domains.
Results:
During the first 10 months of this trial, 246 subjects were randomized, with 177 assigned to standard care and 69 assigned to telehealth. Four referring sites transitioned from standard care into their intervention period. PRISM contextual factors that influenced RE-AIM implementation outcomes included the following findings: Providers struggle to remember, interpret, and navigate intervention workflows; providers have preconceived ideas about the intervention purpose; the intervention mitigates parents' anxieties about the transfer process.
Discussion:
This study revealed implementation challenges that influence the overall success of this telehealth trial. Early identification of these challenges allows our team the opportunity to address them now to optimize the intervention reach, adoption, and implementation. This early action will ultimately enhance the success of our trial and the ability of our intervention to achieve broad impact.
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