Adaptation for sustainability in an implementation trial of team-based collaborative care

Area of Science:

• Healthcare implementation science
• Public health practice
• Chronic disease management

Background:

• Sustaining healthcare interventions requires context-specific adaptations of evidence-based practices (EBPs) or implementation strategies.
• Clear documentation of adaptation logic and outcomes is crucial for replicability.
• This project focused on adapting implementation facilitation to improve uptake of the Collaborative Chronic Care Model (CCM).

Purpose of the Study:

• To describe the adaptation process for implementation facilitation to enhance the sustainability of CCM-consistent care.
• To identify and document specific adaptations to improve the uptake and long-term use of clinical care practices.

Main Methods:

• A multistep consensus process was used to identify adaptations based on prior trial data showing incomplete sustainability of CCM practices.
• Two frameworks, the iterative decision-making for evaluation of adaptations (IDEA) and the framework for reporting adaptations and modifications to evidence-based implementation strategies (FRAME-IS), were used for documentation.
• Quantitative and qualitative data from a previous implementation trial informed the adaptation process.

Main Results:

• Three key adaptations to implementation facilitation were identified and documented using FRAME-IS.
• Adaptations included increasing the scope of facilitation, empowering internal facilitators, and intensifying support over a shorter timeframe (8 months).
• These adaptations aimed to address challenges in sustaining CCM-consistent care practices.

Conclusions:

• Adapting EBPs or their implementation strategies is essential for achieving long-term sustainability in healthcare.
• Frameworks like IDEA and FRAME-IS can guide decision-making and documentation of adaptations.
• An ongoing study is evaluating the effectiveness of these adaptations in improving healthcare outcomes.