Abstract

BackgroundMuch research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner.MethodsTo present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components.ResultsUsing the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts.ConclusionsThe CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad application and encourage others to use the CFIR, along with intervention-specific codes, to guide the efficient and rigorous analysis of rich qualitative data.Trial registrationNCT02318108

Highlights

  • Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes

  • We describe how we used Consolidated Framework for Implementation Research (CFIR) to guide data collection, analysis, and reporting of actionable findings related to the implementation of the Comprehensive Primary Care (CPC) initiative

  • Reporting the findings Drawing on the analytic matrices for each program component and CFIR domain combination, we described patterns of barriers and facilitators to implementation as they emerged across the 21 practices

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Summary

Introduction

Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. Numerous health care delivery interventions are being implemented across the USA with the aim of achieving better health outcomes for patients at lower costs. These health care delivery interventions are as complex as the issues in health care that they are designed to improve. Much research does not address the practical needs of the stakeholders responsible for introducing these interventions into the health care delivery organizations working to achieve better outcomes [4, 5]; these stakeholders can include payers and providers, and those helping providers alter care delivery. Rapid-cycle evaluation provides stakeholders with timely assessment of intervention effectiveness and ongoing feedback to support continuous improvement of an intervention during the implementation period to maximize its effectiveness [6]

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