Health Services Research & Development

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Yakovchenko V, Miech EJ, Gonzalez R, Park A, Chartier M, Ross D, Chinman M, Morgan T, Rogal S. Pinpointing the Specific Implementation Strategies that Matter Most For Increasing HCV Treatment: An Applied Use of Comparative Configurational Methods. [Abstract]. Implementation science : IS. 2019 Mar 25; 14(Suppl 1):878.
Abstract: Background: The Veterans Health Administration (VHA) cares for more patients with hepatitis C virus (HCV) than any other healthcare system in the US. In anticipation of interferon-free HCV treatments, VHA developed the HCV Innovation Team (HIT) Collaborative in 2015. Within the HIT Collaborative providers joined regional teams and conducted HCV quality improvement activities. We applied comparative configurational methods (CCMs) to identify specific implementation strategies associated with higher HCV treatment rates. Methods: We operationalized quality improvement activities as implementation strategies per the Expert Recommendations for Implementing Change (ERIC) project, which defined 73 different strategies meant to promote the uptake of evidence-based practices. We conducted an electronic survey of HCV providers at 130 different sites to assess each facility's use of each of the 73 implementation strategies to promote HCV treatment starts. We used configurational comparative methods (CCMs), a mathematical approach based on Boolean algebra and set theory, to identify the specific combinations of implementation strategies associated with higher HCV treatment starts. These analyses were conducted using the "cna" package for R. Findings: Eighty (62%) of 130 sites responded to the survey and reported using a mean of 25 implementation strategies per site in 2015. The CCMs analyses identified three distinct "high-uptake paths" involving 6 implementation strategies that collectively accounted for 65% of the sites with higher HCV treatment starts with 100% consistency. One path featured a single strategy ("local technical assistance"); another, a combination of two strategies ("foster collaborative learning environment" AND "recruit, designate, train leaders"); and the third, a combination of three strategies ("activate patients" AND "create new clinical teams" AND "share the knowledge gained from quality improvement efforts with other sites"). The presence of any one of these three paths was sufficient for higher HCV treatment starts. Implications for D&I Research: Through applying CCMs to a national sample of VHA sites, we pinpointed specific combinations of implementation strategies associated with increased HCV treatment. Starting with an initial set of 73 different implementation strategies, we identified 3 high-uptake paths that involved only 6 implementation strategies. CCMs provide a mathematical method for identifying specific combinations of implementation strategies that matter to implementation outcomes.