Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: protocol for a quality improvement evaluation

Abstract

Background: Traditionally, system leaders, service line managers, researchers, and program evaluators hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can "go to scale." However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, are the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/design: In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to veterans and their trusted others of having an advance directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score-matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread.

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

“…The DoE program is guided by a 5-phase lifecycle designed to shepherd Gold Status Practices (GSPs) from early piloting to national diffusion [8,10,[14][15][16]21]. In phase 1, VHA employees develop and implement innovative practices in their local facility.…”

Adopting the RE-AIM analytic framework for rural program evaluation: experiences from the Advance Care Planning via Group Visits (ACP-GV) national evaluation

“…As noted earlier, the National ACP-GV Program adopted RE-AIM early, prior to the request from ORH. The adoption occurred as part of a grant award for additional intramural funding from the VA's Quality Enhancement Research Initiative (QUERI) ( 11 ). Given the focus on evidence-based practices, evaluation, and implementation strategies that is required for this type of funding, reviewers specifically requested the use of conceptual and analytic frameworks to support the selection of measured constructs.…”

Time–motion analysis of external facilitation for implementing the Collaborative Chronic Care Model in general mental health clinics: Use of an interval-based data collection approach

“…Time–motion methodology is beginning to be more widely used for implementation science. Especially as economic evaluation of implementation is receiving increased attention within the field (since implementation cost can influence whether and how to implement an evidence-based intervention) ( Eisman et al, 2020 ; Yoon, 2020 ), time–motion methodology is being embraced as an approach for collecting and analyzing data that inform implementation cost ( Matthieu et al, 2020 ; Lamper et al, 2020 ; Pittman et al, 2021 ). Notably, Ritchie et al (2020b) conducted a by-week time–motion study of implementation facilitation activities for the EFs, internal facilitators, and participating staff across all levels of the health care systems in which implementation of integrated mental health services within primary care settings was being carried out.…”