The priority research recommendations were to examine when successful, rapid, de-implementation occurs and has the greatest impact. For example, after negative effects or harm, de-implementation is often distinct and immediate. Similarly, clinicians may stop treatment immediately after a new evidence-based guideline is released, or there is the withdrawal of the drug from the market. However, the underlying mechanisms for stopping behaviors are different from those responsible for replacing behaviors. The science of behavior change relevant to the beliefs and incentives for de-implementation by providers and organizational systems are complex and understudied. Barriers and facilitators that influence implementation may differ than those for de-implementation, such as financial, organizational, provider characteristics, type of interventions, etc. Multilevel de-implementation strategies across individuals, organizations, and communities also require further research. Notably, innovative technologies using electronic health records demonstrate potential to facilitate data collection of health-care practices and strategies and serve as intervention tools for de-implementation. While de-implementation research remains a challenge, the forum participants endorsed the need for the advancement of de-implementation research to improve healthcare quality and implementation science.
Background: A Cochrane review indicated variable impact of tailored implementation methods over standardized approaches in healthcare settings1. Optimal methods to identify determinants and inform tailoring remain unknown. This study compared standardized versus tailored implementation of measurement based care (MBC) on clinician-level (fidelity) and client-level (depression severity) outcomes in community behavioral health settings. MBC is an evidence-based practice that involves the use of standardized assessment (i.e., PHQ-92) to guide psychotherapy practice3 and is used by fewer than 20% of providers in the United States.
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Background: Opioid use disorder (OUD) has reached epidemic proportions among pregnant women the United States. Northern New England is among the most severely impacted regions, with 5-8% of pregnancies across Maine, New Hampshire and Vermont affected. Untreated, maternal OUD is associated with poor maternal and neonatal outcomes, including risk for infectious disease, overdose, premature birth, and neonatal withdrawal. Concurrent tobacco use disorder is present in 95% of this population, contributing to adverse outcomes. Hepatitis C is also common with implications for both neonatal and maternal health. Although evidence-based guidelines for the care of substance-affected pregnancies exist, the quality of clinical care provided varies widely. This pilot (1) developed and implemented a checklist and toolkit to standardize practice in the care of pregnant women with OUD, and (2) explored contextual factors contributing to quality gaps at 8 diverse maternity care sites across the three states.
Methods: We administered organizational readiness to change and implementation climate surveys to VAGLA staff trained in MISSION (n=47). We also conducted semi-structured interviews with a purposive subset of staff (n=24). Our implementation team engaged VAGLA stakeholders in routine consultation meetings and tracked meeting minutes in a standardized template; we conducted semi-structured interviews with implementation team members (n=3) and reviewed facilitation tracking and team meeting notes. The Consolidated Framework for Implementation Research (CFIR) was used to guide the interview questions and data analyses, which facilitated dynamic adaptations to our implementation strategy and the intervention.
Background: Tobacco cessation services are not widely available in low middle-income countries (LMICs) where smoking rates remain high. In Vietnam 45% of males are current smokers. We recently completed a two-arm randomized control trial comparing the effectiveness of two strategies for implementing tobacco use treatment (TUT) guidelines in community health centers (CHCs) in Vietnam. All sites received training and patient education materials. Intervention sites received a system for referring smokers to a village health worker (VHW) for multisession counseling. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted a post-intervention qualitative analysis of factors that facilitate or challenge implementation and sustainability of screening and treatment of TU in CHCs in Vietnam.
Methods: The evaluation applied a mixed-methods, cross-sectional design that included surveys (n=69 from 43 states) and phone interviews (n=13 from 6 states) with state-level staff and phone and in-person interviews with district- and school-level staff (n=90 from 8 districts in 5 states). Descriptive analyses were applied to surveys and content analysis to interviews. Coding was guided by the Consolidated Framework for Implementation Research (CFIR). 2ff7e9595c
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