1106 — Applying the CFIR Constructs Directly to Qualitative Data: The Power of Implementation Science in Action

Miech EJ, Stroke QUERI & COIN-Indy; Damush TM, Stroke QUERI & COIN-Indy;

Objectives:
An innovative new analytic strategy for implementation-related projects is the direct application of constructs from the Consolidated Framework for Implementation Research (CFIR) to qualitative data.

Methods:
An eight-person study team based in Indianapolis led by PI Miech undertook the task of systematically rating more than 300 interview transcripts generated over 33 site visits with 20 CFIR constructs in 2014-15. Individual members of the project team rated interview transcripts first for construct and valence (i.e., positive, neutral or negative). When all the interviews in a site visit had been rated, the entire team met to review ratings and then score each VA medical center for each site visit with a facility-level valence (i.e., positive, neutral, negative, polarized, or minimally referenced) and magnitude (i.e., weak or strong). By the time the scoring process was complete, the project team had assigned valence and magnitude to CFIR constructs over 600 times.

Results:
The direct application of CFIR constructs to qualitative data yielded original, key findings in the RE-INSPIRE project into how interventions, implementation strategies, and local contexts influenced implementation success. In completing this work the RE-INSPIRE team developed new rubrics, devised technical methods for on-demand access to CFIR-related information and pioneered the use of an Audience Response System to harness the expertise and autonomy of individual team members yet adhere to a standard of team consensus when applying CFIR constructs to RE-INSPIRE data.

Implications:
The same longitudinal RE-INSPIRE dataset was tagged with qualitative descriptive codes, quantitative CFIR scores, and categorical variables, yielding qualitative, quantitative, and CFIR-driven findings directly relevant to acute stroke care within the VA as well as to implementation science.

Impacts:
The quantification of CFIR constructs provides an important new analytic strategy for understanding how interventions, implementation strategies, and local contexts influence implementation success, and represents a major contribution to the VA and implementation science.