Abstract
BackgroundFew implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. This study compared the effectiveness of an immediate versus delayed enhanced implementation strategy (Enhanced Replicating Effective Programs (REP)) for providers at Veterans Health Administration (VA) outpatient facilities (sites) on improved uptake of an outreach program (Re-Engage) among sites not initially responding to a standard implementation strategy.MethodsOne mental health provider from each U.S. VA site (N = 158) was initially given a REP-based package and training program in Re-Engage. The Re-Engage program involved giving each site provider a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assessing patient clinical status, and where appropriate, facilitating appointments to VA health services. At month 6, sites considered non-responsive (N = 89, total of 3,075 patients), defined as providers updating documentation for less than <80% of patients on their list, were randomized to two adaptive implementation interventions: Enhanced REP (provider coaching; N = 40 sites) for 6 months followed by Standard REP for 6 months; versus continued Standard REP (N = 49 sites) for 6 months followed by 6 months of Enhanced REP for sites still not responding. Outcomes included patient-level Re-Engage implementation and utilization.ResultsPatients from sites that were randomized to receive Enhanced REP immediately compared to Standard REP were more likely to have a completed contact (adjusted OR = 2.13; 95% CI: 1.09–4.19, P = 0.02). There were no differences in patient-level utilization between Enhanced and Standard REP sites.ConclusionsEnhanced REP was associated with greater Re-Engage program uptake (completed contacts) among sites not responding to a standard implementation strategy. Further research is needed to determine whether national implementation of Facilitation results in tangible changes in patient-level outcomes.Trial registrationISRCTN: ISRCTN21059161Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0163-3) contains supplementary material, which is available to authorized users.
Highlights
Few implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs
This study did not address key questions that would inform a larger rollout of Enhanced Replicating Effective Programs (REP), notably, whether adding Facilitation to sites that are initially nonresponsive to Standard REP and whether more immediate versus delayed implementation of Facilitation lead to improved program uptake. This current study reports 12-month findings from a national cluster randomized intervention study comparing two adaptive implementation strategies among sites that are initially non-responsive to Standard REP: one providing Enhanced REP immediately versus another delaying the provision of Enhanced REP only for sites that remain non-responsive 6 months later
Among sites randomized to Enhanced versus Standard REP, there were no significant differences in patient-level characteristics with the exception that patients from Enhanced REP sites were less likely Black and less likely to have a diagnosis of schizophrenia or related disorder (Table 1)
Summary
Few implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. Derived from Social Learning Theory [20] and Rogers’ diffusion model [21], REP consists of three central operational components: program “packaging” (i.e., translation and dissemination of treatment materials into user-friendly language), structured training for providers, and brief technical assistance for providers focused on the technical aspects of program implementation. These three components in combination compared to package dissemination alone resulted in improved uptake of HIV prevention intervention programs in AIDS service organizations [19,22]
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