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Implementation Science
Published in: Implementation Science 1/2020

01-12-2020 | Care | Study protocol

Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans

Authors: Shari S. Rogal, Vera Yakovchenko, Timothy Morgan, Jasmohan S. Bajaj, Rachel Gonzalez, Angela Park, Lauren Beste, Edward J. Miech, Carolyn Lamorte, Brittney Neely, Sandra Gibson, Patrick S. Malone, Maggie Chartier, Tamar Taddei, Guadalupe Garcia-Tsao, Byron J. Powell, Jason A. Dominitz, David Ross, Matthew J. Chinman

Published in: Implementation Science | Issue 1/2020

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Abstract

Background

Cirrhosis is a rapidly increasing cause of global mortality. To improve cirrhosis care, the Veterans Health Administration (VHA) developed the Hepatic Innovation Team (HIT) Collaborative to support VA Medical Centers (VAMCs) to deliver evidence-based cirrhosis care. This randomized HIT program evaluation aims to develop and assess a novel approach for choosing and applying implementation strategies to improve the quality of cirrhosis care.

Methods

Evaluation aims are to (1) empirically determine which combinations of implementation strategies are associated with successful implementation of evidence-based practices (EBPs) for Veterans with cirrhosis, (2) manualize these “data-driven” implementation strategies, and (3) assess the effectiveness of data-driven implementation strategies in increasing cirrhosis EBP uptake. Aim 1 will include an online survey of all VAMCs’ use of 73 implementations strategies to improve cirrhosis care, as defined by the Expert Recommendations for Implementing Change taxonomy. Traditional statistical as well as configurational comparative methods will both be employed to determine which combinations of implementation strategies are associated with site-level adherence to EBPs for cirrhosis. In aim 2, semi-structured interviews with high-performing VAMCs will be conducted to operationalize successful implementation strategies for cirrhosis care. These data will be used to inform the creation of a step-by-step guide to tailoring and applying the implementation strategies identified in aim 1. In aim 3, this manualized implementation intervention will be assessed using a hybrid type III stepped-wedge cluster randomized design. This evaluation will be conducted in 12 VAMCs, with four VAMCs crossing from control to intervention every 6 months, in order to assess the effectiveness of using data-driven implementation strategies to improve guideline-concordant cirrhosis care.

Discussion

Successful completion of this innovative evaluation will establish the feasibility of using early evaluation data to inform a manualized, user-friendly implementation intervention for VAMCs with opportunities to improve care. This evaluation will provide implementation support tools that can be applied to enhance the implementation of other evidence-based practices.

Trial registration

This project was registered at ClinicalTrials.Gov (NCT04178096) on 4/29/20.
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Metadata
Title
Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans
Authors
Shari S. Rogal
Vera Yakovchenko
Timothy Morgan
Jasmohan S. Bajaj
Rachel Gonzalez
Angela Park
Lauren Beste
Edward J. Miech
Carolyn Lamorte
Brittney Neely
Sandra Gibson
Patrick S. Malone
Maggie Chartier
Tamar Taddei
Guadalupe Garcia-Tsao
Byron J. Powell
Jason A. Dominitz
David Ross
Matthew J. Chinman
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2020
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-020-01050-7

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