Using a longitudinal multi-method approach to document, assess, and understand adaptations in the Veterans Health...

Area of Science:

• Implementation Science
• Healthcare Program Management
• Health Services Research

Background:

• Systematic documentation of program adaptations is not routinely performed.
• Understanding adaptations is key for iterative refinement and program scale-out.
• Efficient capture of adaptations in real-world studies remains poorly understood.

Purpose of the Study:

• To systematically document adaptations during the pre-implementation, implementation, and sustainment phases of a healthcare program.
• To evaluate the characteristics and influences of identified adaptations.
• To assess the feasibility of a multi-method approach for capturing adaptation data.

Main Methods:

• A multi-method longitudinal approach was employed within the Veteran Health Administration (VA) Advanced Care Coordination program.
• Data sources included real-time tracking, process maps, Implementation and Evaluation (I&E) team meeting minutes, and adaptation interviews.
• The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and the FRAME model guided data collection and adaptation evaluation.

Main Results:

• A total of 144 adaptations were identified, resulting in 50 unique adaptations after consensus and member-checking.
• Most adaptations were planned, occurred during early to mid-implementation, and aimed to improve program delivery, fit local context, or address practical considerations.
• Implementation and Evaluation (I&E) team meeting minutes and process maps captured the most unique adaptations.

Conclusions:

• A longitudinal, multi-method approach is feasible for collecting adaptation data through I&E team engagement, providing a comprehensive understanding.
• Future research should pragmatically assess adaptation impact and optimize data collection to avoid overburdening staff.
• Effective documentation of adaptations supports program refinement and successful scale-out.