Context:

Improving quality in children’s mental health and social service settings.

 

Objective:

This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city.

A mixed methods multiple case study of seven children’s social service organizations in one Midwestern city in the United States (the control group of a larger randomized controlled trial). Qualitative data included semi-structured interviews with organizational leaders and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) to understand implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Focus groups with clinicians explore their perceptions of a range of implementation strategies.

This qualitative work informs the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders.

The Organizational Social Context measure will be used to assess organizational culture and climate.

Context:

Understanding patient-centered health behavior and psychosocial issues in primary care.

 

Objective:

Our goal is to design a scientifically rigorous and valid pragmatic trial to test whether primary care practices can systematically implement the collection of patient-reported information and provide patients needed advice, goal setting, and counseling in response.

Evaluation Design:

A cluster randomized delayed intervention trial, of the My Own Health Report (MOHR) study. Nine pairs of diverse primary care practices are randomized to early or delayed intervention four months later. The intervention consists of fielding the MOHR assessment and subsequent provision of needed counseling and support for patients presenting for wellness or chronic care.

Stakeholder groups are engaged throughout the study design to account for local resources and characteristics.

Study outcomes include the intervention reach (percent of patients offered and completing the MOHR assessment), effectiveness (patients reporting being asked about topics, setting change goals, and receiving assistance in early versus delayed intervention practices), contextual factors influencing outcomes, and intervention costs.

Context:

Heart failure is the primary reason for discharge from the VA medical service. Furthermore, the readmission rate is high.

The Hospital to Home (H2H) Excellence in Transitions Initiative is a new national campaign to reduce preventable readmissions for patients recently hospitalized with a cardiovascular condition (www.H2Hquality.org).

 

Objective:

1. To determine if VA facility enrollment in H2H results in improved care for VA patients with heart failure.
2. To determine barriers and facilitators to a) enrolling facilities in H2H, and for those facilities enrolled, b) adopting the H2H interventions.
3. To evaluate the use of the VA Heart Failure Network to aid in implementing the H2H initiative in a randomized trial. (HF Network

A 122 VA facilities with <100 discharges were randomized into intervention and control groups. From Month 1 through month 6 the implementation of the VA H2H initiative was facilitated for all the intervention facilities.

All the intervention facilities were asked to participate by (1) enrolling their facility at the H2H website as commitment to, and (2) initiating projects based on the VA H2H initiative. In Month 6 surveys were sent to both the intervention and control facilities to assess participation in the VA H2H initiative. From Month 7 to Month 12 the VA H2H initiative is being facilitated at all remaining 61 control facilities.

Context:

Implementing and disseminating an evidence-based model of well-child care (WCC) that includes developmental and preventive services recommended by the American Academy of Pediatrics. 

Implementation Design:

Twenty-first Century WCC is a parent-centered, team-based, primary care model that combines online pre-visit assessments—completed by parents and caregivers—with vaccinations and anticipatory guidance.
Nurses, nurse practitioners, developmental specialists, and pediatricians all play roles in the WCC model.
Patient and clinician interaction, health records, and resources are all facilitated through a Web-based diagnostic, management, tracking, and resource information tool.
Unlike innovations that are embedded only in technical systems, validated models of team-based health care have multiple components that must be made compatible with complex sociotechnical systems. Interpersonal communication, work, coordination, and judgment are key processes that affect implementation quality.  Implementation can involve tailoring to a particular site and customizing either the model or the organizational context to accommodate it.