Engaging stakeholders to retrospectively discern implementation strategies to support program evaluation: Proposed...

Area of Science:

• Healthcare Management
• Implementation Science
• Health Services Research

Background:

• Availability of evidence-based practices (EBPs) is crucial for healthcare improvement but faces diffusion challenges.
• Implementation activities are key to EBP adoption and sustainability.
• Evaluating costs of implementation activities within quality improvement is complex due to classification needs.

Purpose of the Study:

• To develop and evaluate a stakeholder-engaged process for identifying implementation activities and estimating associated costs.
• To assess the budget impact of implementing Advance Care Planning via Group Visits (ACP-GV) in the Veterans Health Administration (VHA).

Main Methods:

• An observational study utilized a four-stage, stakeholder-engaged process.
• 49 potential implementation activities were identified and reduced to 14 strategies with input from implementation actors.
• Data were collected to determine total implementation effort and applied cost estimates.

Main Results:

• The process successfully identified and classified implementation activities for the ACP-GV initiative.
• The total implementation effort and applied cost estimates were determined.
• The budget impact of ACP-GV implementation for the VHA was estimated.

Conclusions:

• A four-stage, stakeholder-engaged methodology can pragmatically evaluate implementation efforts.
• This process enhanced understanding of implementation effort and budget impact.
• Recall bias may affect the identification of implementation activities.