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2019 HSR&D/QUERI National Conference Abstract

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4016 — A National Evaluation of the Veterans Health Administration Diffusion of Excellence Initiative: Learning from Local Team Implementation Experiences

Lead/Presenter: Andrea Nevedal,  COIN - Palo Alto
All Authors: Nevedal AL (Center for Innovation to Implementation, VA Palo Alto Healthcare System), Reardon CM (Center for Clinical Management Research, VA Ann Arbor Healthcare System), Jackson GL (Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine) Cutrona S (Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers;Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School) White B (Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System) Gifford AL (Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers; Section of General Internal Medicine & Department of Health Law, Policy & Management, Boston University) Orvek E (Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School) DeLaughter K (Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School) White L (Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers) King HA (Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine) Vega R (VHA Office of Discovery, Education and Affiliate Networks) Henderson B (VHA Innovation eco-system) Damschroder L (Center for Clinical Management Research, VA Ann Arbor Healthcare System) Brandolyn White, MPH3 Allen L. Gifford, MD5,7, Elizabeth Orvek, MS, Kathryn DeLaughter, MA5,6 Lindsay White, MPH5 Heather A. King, PhD3,4 Ryan Vega, MD, MHSA8 Blake Henderson, BA9 Laura Damschroder, MS, MPH2

Objectives:
The Veterans Health Administration (VHA) is evolving as a learning health system, in which best practices are identified and diffused across facilities. VHA Diffusion of Excellence (DoE) is developing structures and processes to support this effort through an annual "Shark Tank" competition, in which leaders bid on the opportunity to implement a Gold Status Practice with 6 months of external facilitation support. Leaders with winning bids designate an Implementing Facility Fellow to lead implementation locally. Over 1000 diverse practices were submitted in the first three rounds of Shark Tanks; 36 were designated Gold Status Practices and were implemented in 48 facilities. An aim of this national evaluation of DoE is to identify factors contributing to implementation success.

Methods:
Semi-structured telephone interviews (N = 88/115 invited) with External Facilitators, Implementing Facility Fellows, and key-stakeholders were completed for 32 of the 36 Gold Status Practices. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis to understand the factors influencing implementation success.

Results:
Although each team received extensive external facilitation throughout implementation, inadequate implementation readiness hindered implementation success. Approximately half of the teams successfully implemented their Gold Status Practice; these teams had the necessary infrastructure, staff, and/or resources ahead of implementation. However, the other half failed to complete implementation within 6 months due to inadequate implementation readiness. Unsuccessful teams could not develop infrastructure, hire staff, and/or obtain necessary resources during the rapid timeline. Additionally, some teams felt implementation readiness was hindered because Gold Status Practice description and selection criteria were not sufficiently explained during the "Shark Tank."

Implications:
DoE is an innovative large-scale model for health systems seeking to identify and diffuse best practices. The initiative was designed to increase implementation success by providing external facilitation, but inadequate implementation readiness is a significant barrier to implementation success.

Impacts:
Understanding this process will further strengthen strategic alignment among DoE, VHA research, and QUERI as VHA seeks to strengthen the pipeline for promising practices in VHA. Clear criteria for implementation readiness are crucial for Gold Status Practice selection and implementation, and the success of the Diffusion of Excellence Initiative on a large scale.