3139 — Using a Common Framework to Implement Clinical Practice Change: Experiences in the Spinal Cord Injury System of Care
Hill JN, Guihan M, Hogan TP, Evans CT, Smith BM, and Weaver FM, Center for Management of Complex Chronic Care (CMC3), Spinal Cord Injury Quality Enhancement Research Initiative (SCI-QUERI), Hines, IL;
The goal of the Quality Enhancement Research Initiative (QUERI) is to use evidence-based (EB) strategies to implement EB care into clinical practice. The VA Spinal Cord Injury (SCI) QUERI has used the Promoting Action on Research Implementation in Health Services (PARiHS) framework to begin to develop an approach to implementation of evidence into practice and inform studies within the SCI System of Care. This abstract describes our experiences using PARiHS to improve preventive care and patient self-management in two studies. Development and Testing of MRSA Educational Materials for Veterans with SCI (MRSA) focused on developing patient educational materials to promote MRSA prevention. Promoting Implementation of My HealtheVet (MHV) Among Veterans with SCI/D (MHV) focused on improving patient and provider awareness of MHV.
The MRSA study was a randomized-controlled trial while the MHV study was a pre/post test design. Relevant elements of PARiHS Organizational Readiness to Change (ORCA) were used to develop data collection tools. The MRSA study implemented an educational intervention based on a review of existing materials, feedback from patient and provider focus groups and expert panel consensus. The MHV study implemented a promotional intervention based on provider interviews and Veteran surveys. Following interventions, post-measures were collected, and clinical facilitators evaluated the intervention.
Common factors were critical to the success of implementation in both studies including: obtaining clinician buy-in and leadership support, addressing resource deficiencies, and choosing the “right” clinical champion. Both studies examined SCI-specific functional deficits (e.g., mobility, hand function), patient and provider awareness of the innovation, organizational culture, and clinical workflow. The MRSA study significantly increased aspects of knowledge about MRSA and patient intent to clean their hands more frequently. The MHV study nearly doubled MHV in-person authentication (IPA) rates at the two participating facilities.
Our experiences demonstrate value in using data from multiple sources to examine evidence and context within and across settings to develop and implement targeted interventions and their respective implementation.
Use of the PARHIS framework to refine methods and measures, develop interventions, and inform facilitation represents a shared knowledge/experience base that can inform future research in improving uptake of evidence into clinical practice.