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2023 HSR&D/QUERI National Conference Abstract

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1144 — Site implementation profiles: a rapid qualitative approach to support formative evaluation and tailoring in the Housing Transitions QUERI

Lead/Presenter: Erica Fletcher,  COIN - Los Angeles
All Authors: Palma AE (CSHIIP), Hoffmann LC (HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy [CSHIIP], VA Greater Los Angeles Healthcare System, North Hills, CA) Skaperdas E (HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy [CSHIIP], VA Greater Los Angeles Healthcare System, North Hills, CA) McCoy M (HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy [CSHIIP], VA Greater Los Angeles Healthcare System, North Hills, CA) Fletcher E (HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy [CSHIIP], VA Greater Los Angeles Healthcare System, North Hills, CA) Barnard JM (HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy [CSHIIP], VA Greater Los Angeles Healthcare System, North Hills, CA) Harris T (Desert Pacific Mental Illness Research, Education, and Clinical Center [MIRECC], VA Greater Los Angeles, Los Angeles, CA) Calderon R (Desert Pacific Mental Illness Research, Education, and Clinical Center [MIRECC], VA Greater Los Angeles, Los Angeles, CA) Olmos-Ochoa T (HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy [CSHIIP], VA Greater Los Angeles Healthcare System, North Hills, CA) Gabrielian S (Desert Pacific Mental Illness Research, Education, and Clinical Center [MIRECC], VA Greater Los Angeles, Los Angeles, CA) Cordasco KM (Department of Medicine, VA Greater Los Angeles Healthcare System) Finley EP (Departments of Medicine and Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX)

Objectives:
Qualitative data collection can be a critical early step in the implementation of evidence-based interventions, providing valuable knowledge on site-level context and guiding tailoring of the intervention/implementation plan to increase likelihood of adoption and sustainment. Rapid turnaround of this information is critical in guiding interventions that are important for improving Veteran health and well-being, including practices that address Veteran homelessness. Housing Transitions (HT) QUERI is a VA-funded initiative to implement Critical Time Intervention (CTI), an evidence-based case management practice supporting housing transitions for homeless-experienced Veterans, across 32 community-based agencies nationwide who partner with VA. This hybrid type 3 implementation-effectiveness trial compares the impacts of two implementation strategies: Replicating Effective Programs [REP] and REP enhanced with external facilitation. We describe rapid distillation of pre-implementation qualitative findings in CTI formative evaluation, implementation planning, and tailoring.

Methods:
Semi-structured qualitative interviews were conducted with 38 case managers, supervisors, VA liaisons to the agencies, and Veterans across 11 agencies; interview guides reflected key domains of the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted by trained qualitative research staff and recorded, with structured summaries completed immediately following. Content related to priority CFIR domains was further distilled into site implementation profiles, bringing together key information from roles/individuals associated with each site. The format, content, and length of site implementation profiles were iteratively refined in consultation with the HT QUERI implementation team, ensuring relevance and utility.

Results:
Interviews were conducted from January-March 2022 and site implementation profiles were completed by April 2022, allowing for real-time feedback of site-level findings to the implementation team. Early findings indicated that while GPD case managers, supervisors, and liaisons responded positively to the six-session CTI training, additional tailoring of the content of training sessions and Community of Practice calls was needed. Insights were also gleaned into how staff, community, and local VA contextual factors (e.g., staff turnover, site rurality, role of the VA liaison) are interacting with implementation efforts. Resulting improvements included further clarifying what components of CTI were unique compared to traditional case management and added emphasis on strategies for linking Veterans experiencing homelessness with VA resources for medical and mental health care. Site profiles also provided critical information on site-specific challenges such as staff turnover, transportation, resource availability, and housing safety. In addition, site profiles synthesized key information for facilitators during the early months of working with sites, providing insight into, for example, concerns expressed about the compatibility of CTI with the needs of Veterans.

Implications:
Despite the challenges of large-scale implementation initiatives, including compressed timelines for baseline data collection and analysis, a rapid qualitative approach to developing site implementation profiles allowed for effective assessments of context and practice tailoring during early implementation of CTI across 11 GPD sites.

Impacts:
Creation of site implementation profiles provides a pragmatic method for rapid assessment and distillation of site context, needs, and resources, thus increasing the speed and efficiency of incorporating critical early improvements into large-scale implementation initiatives.