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2023 HSR&D/QUERI National Conference Abstract

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4029 — Engaging Operational Partners is Critical for Successful Implementation: A Coincidence Analysis of Access-Related Projects in the VA Healthcare System

Lead/Presenter: Jessica Dodge,  COIN - Ann Arbor
All Authors: Dodge JR (Center for Clinical Management Research, Ann Arbor, MI), Youles B (Center for Clinical Management Research, Ann Arbor, MI) Caldararo J (Center for Clinical Management Research, Ann Arbor, MI) Sears ED (Center for Clinical Management Research, Ann Arbor, MI) Caverly TJ (Center for Clinical Management Research, Ann Arbor, MI) Ho PM (Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO) Shimada S (Center for Healthcare Organization and Implementation Research, Bedford, MA) Kaboli P (Center for Access and Delivery Research and Evaluation, Iowa City, IA) Albright K (Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO) Robinson S (Center for Healthcare Organization and Implementation Research, Bedford, MA) McNeal D (Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO) Damschroder L (Center for Clinical Management Research, Ann Arbor, MI) Saini SD (Center for Clinical Management Research, Ann Arbor, MI) Adams MA (Center for Clinical Management Research, Ann Arbor, MI)

Objectives:
The Veterans Health Administration (VHA) has prioritized timely access to care and made substantial investments in research aimed at optimizing access for Veterans. The aim of this study was to assess the implementation status of recent VHA access-related research projects and to explore factors associated with successful implementation using novel Coincidence Analysis (CNA) methods.

Methods:
We conducted a portfolio review of recent VHA research and operational projects focused on access to care (“Access Portfolio”). Specifically, we systematically searched VHA and National Library of Medicine websites and conducted structured interviews with VHA operational partners and researchers. Project inclusion criteria were: (1) funded or supported by VHA (e.g., Health Services Research and Development, Quality Enhancement Research Initiative, or a program office) between 1/2015 and 7/2020; (2) directly or indirectly related to access to care; (3) resulted in an implementable deliverable (e.g., effective intervention, usable tool). Next, a 24-item electronic adapted implementation survey assessed the implementation status for each Access Portfolio project and identified barriers and facilitators to implementation of deliverables. Results were analyzed using CNA.

Results:
From 286 access-related projects, 36 with implementable deliverables from 32 investigators across 20 VHA facilities met inclusion criteria. Twenty-nine respondents completed the survey for 32 projects. Twenty-eight percent of projects reported fully implementing their project deliverables, 34% of projects reported partially implementing their project deliverables, and 37% of projects reported not implementing any deliverables (i.e., the resulting tool/intervention was not implemented into practice). Out of 13 possible facilitators, only two were identified in CNA analysis to be associated with either partial or full implementation of project deliverables: (1) engagement with national VHA leadership; (2) support and commitment from local site leadership. These two environmental conditions explained 91% of projects with full or partial implementation with 100% accuracy.

Implications:
These findings empirically highlight the importance of an engagement strategy for successful implementation of research deliverables.

Impacts:
HSRD, QUERI, and ORD should continue to expand efforts to strengthen communication and engagement between the research community and VHA leaders to ensure that VHA’s investment in research leads to meaningful improvements in care delivery for Veterans.