Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow‐implementer community practices

Abstract

Objective: To evaluate the comparative effectiveness of external facilitation (EF) vs external + internal facilitation (EF/IF), on uptake of a collaborative chronic care model (CCM) in community practices that were slower to implement under low-level implementation support. Study Setting: Primary data were collected from 43 community practices in Michigan and Colorado at baseline and for 12 months following randomization. Study Design: Sites that failed to meet a pre-established implementation benchmark after six months of low-level implementation support were randomized to add either EF or EF/IF support for up to 12 months. Key outcomes were change in number of patients receiving the CCM and number of patients receiving a clinically significant dose of the CCM. Moderators' analyses further examined whether comparative effectiveness was dependent on prerandomization adoption, number of providers trained or practice size. Facilitation log data were used for exploratory follow-up analyses. Data Collection: Sites reported monthly on number of patients that had received the CCM. Facilitation logs were completed by study EF and site IFs and shared with the study team.

Multi-tiered external facilitation: the role of feedback loops and tailored interventions in supporting change in a stepped-wedge implementation trial

“…Given these wide ranging activities, previous work has illustrated the importance of models of external facilitation that go beyond a lone facilitator [5,11,[16][17][18]. Researchers have described the roles and impacts of facilitator dyads, such as in blended external and internal facilitation designs [19][20][21][22][23][24], and mixed discipline facilitator designs [16][17][18]. These models involve sharing and coordinating different functions of facilitation, though manuscripts rarely detail how they work together.…”

Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy to support CBT delivery at high schools in Michigan

“…For organizational barriers, Facilitation-based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) [39] frameworkprovides schools with ongoing consultation from an expert in strategic thinking and EBP implementation to garner administrative support, solve logistical challenges, and build community buy-in. In several communitybased cluster-randomized trials, Facilitation has been shown to improve mental health EBP uptake [30,34,[40][41][42][43][44][45] and to be highly cost-effective [46,47].…”

Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial

“…Multi-level implementation strategies targeting CCM determinants can improve implementation outcomes [ 51 , 52 ]. One promising approach is implementation facilitation, a type of interactive assistance designed to overcome barriers and leverage strengths to foster EBP implementation [ 52 , 53 ].…”

“…These strategies (e.g., mentoring managers to adapt workflows and support/reinforce EBP delivery) are designed to reduce organizational barriers and leverage resources to support EBP integration. Internal facilitation has augmented the impact of external facilitation on uptake in community settings, but not always [ 51 , 53 , 65 , 69 ]. Generally, research has shown benefits of internal facilitation on EBP competencies/fidelity with providers in adult primary care [ 66 , 70 ] and mental health agencies [ 58 , 71 , 72 ].…”