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A structured approach to modifying an implementation package while scaling up a complex evidence-based practice.

Kristina M Cordasco1,2,3, Sonya E Gabrielian1,4,5,6, Jenny Barnard1

  • 1VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.

Health Services Research
|May 16, 2024
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Summary
This summary is machine-generated.

Iterative modifications to implementation strategies, like the Critical Time Intervention (CTI), are key for successful nationwide scale-up of evidence-based practices in diverse settings. This approach enhances adoption and fidelity.

Keywords:
evidence‐based practicehealth services administrationhomelessnessimplementation scienceveterans

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Area of Science:

  • Implementation Science
  • Healthcare Management
  • Public Health

Background:

  • Nationwide scale-up of complex evidence-based practices presents challenges in diverse community settings.
  • The Critical Time Intervention (CTI) is an evidence-based case management model for homeless-experienced Veterans.
  • Adapting implementation strategies is crucial for successful adoption and fidelity.

Purpose of the Study:

  • To describe a structured, iterative, data-driven approach for modifying implementation strategies during a nationwide scale-up.
  • To assess the impact of modifications on the adoption and fidelity of the CTI model across diverse agencies.
  • To offer a pragmatic framework for midstream adjustments to implementation packages.

Main Methods:

  • A pragmatic randomized evaluation using a roll-out design across 32 Veterans Affairs (VA) Grant and Per Diem case management (GPD-CM) agencies.
  • Qualitative data collection through semi-structured interviews with Veterans, staff, and clinicians, and periodic reflections.
  • Rapid qualitative methods and content analysis to characterize modifications using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies.

Main Results:

  • Iterative modifications were made to the CTI implementation package after each scale-up wave in response to variations in agency characteristics.
  • Modifications included adding, deleting, integrating, and altering package components while preserving core elements.
  • These data-driven adjustments aimed to increase CTI adoption and fidelity across diverse contexts.

Conclusions:

  • Iterative, data-driven modifications to implementation packages are beneficial for optimizing the adoption and fidelity of complex evidence-based practices during scale-up.
  • The described structured approach can guide midstream adjustments for both VA and non-VA initiatives.
  • Simultaneous formative and summative evaluation requires careful consideration of trade-offs in scale-up projects.