2015 National Conference

3147 — Do Practice Based Research Networks add value to VA implementation research?

Goldstein KM, Durham VAMC; Duke University; Vogt D, National Center for PTSD; Boston University; Frayne S, VA Palo Alto; Stanford University; Gierisch J, Durham VAMC; Duke University; Blakeney J, Durham VAMC; Sadler A, Iowa City VAMC; University of Iowa; Bean-Mayberry B, Greater LA VAMC; Carney D, VA Palo Alto; DiLeone B, Philadelphia VAMC; National Center for PTSD; Yano E, Greater LA VAMC; UCLA

Objectives:
VA's Blueprint for Excellence highlights the need to accelerate implementation of research evidence into routine clinical care. Evidence-Based Quality Improvement (EBQI) is a systematic approach to fostering the multilevel research-clinical partnerships necessary for effective implementation, integrating evidence through existing structures and tailoring of evidence to local contexts. As one of many implementation strategies pioneered in the VA, EBQI has demonstrated impacts on implementing evidence-based practice, but has not been systematically deployed in Practice-Based Research Networks (PBRNs) in the VA. We examined whether implementation in a PBRN added value to VA's investment in efforts to deliver evidence-based care.

Methods:
We conducted a multi-site cluster randomized trial of an EBQI approach to tailoring an evidence-based gender awareness training, "Caring for Women Veterans" (CWV), in the four inaugural sites within the VA Women's Health PBRN. The EBQI approach used local interdisciplinary expert panels to agree on strategies for tailoring the training to fit local contexts (e.g., selected local implementation leaders and clinical settings, group vs. individual modalities). Each PBRN site was asked to identify EBQI-related barriers and facilitators in each of the four phases of the Replicating Effective Programs (REP) implementation conceptual framework (i.e., pre-conditions, pre-implementation, implementation, and maintenance/evolution).

Results:
Across the PBRN, 442 employees were trained. Marked facility leadership support and common institutional values reinforced and supported by PBRN site leads was a key pre-condition facilitator. Opportunities to capitalize on common resources and efforts across PBRN sites were considered a pre-implementation strength. Implementation benefited from PBRN Coordinating Center support for managing EBQI complexities raised by differences in site timelines and variable local project resources. Use of PBRN communication channels to share dissemination materials amplified local site efforts during maintenance.

Implications:
The Women's Health PBRN offered advantages across all phases of implementation in a multi-site EBQI project. Now that the PBRN has expanded almost 10-fold, lessons learned from this EBQI trial will be used to examine the PBRN's contribution to spread of evidence-based VA initiatives.

Impacts:
PBRNs represent a promising pathway for speeding the translation of research into everyday practice, and may serve as an important component of future VA implementation initiatives.