Application of the FRAME-IS to a Multifaceted Implementation Strategy.

Area of Science:

• Implementation Science
• Health Services Research
• Clinical Practice Improvement

Background:

• Documenting adaptations to implementation strategies is crucial for integrating evidence-based interventions into practice.
• Existing frameworks like FRAME-IS have limitations in capturing adaptations for multifaceted strategies such as practice facilitation (PF).
• This study applied and modified FRAME-IS to evaluate PF's effectiveness on implementation fidelity for a technology-facilitated team care model in a federally qualified health center (FQHC).

Approach:

• Utilized three data sources: implementation committee minutes, practice facilitator reports, and root cause analysis/Plan-Do-Study-Act worksheets.
• Extracted text data according to FRAME-IS modules and analyzed using a master matrix.
• Involved content analysis by two authors and member checking/code validation by a third author.

Key Points:

• Modified FRAME-IS to include detailed tracking of strategy modifications and a numbering system for adaptations.
• Identified 27 adaptations, with 88.9% supporting patient identification and referral, and 52.9% modifying the PF strategy's context (e.g., group format, community health workers, shifting target to nurses).
• Most adaptations were widespread (83.9%), reactive (84.6%), but systematically documented, involving the FQHC in decision-making.

Conclusions:

• Demonstrated the applicability and value of the modified FRAME-IS for documenting adaptations across multifaceted implementation strategies.
• Recommended refining tracking systems for more practical documentation of iterative and ongoing adaptations.
• The study underscores the importance of systematic adaptation tracking for successful evidence-based intervention implementation.