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Measuring TRIP Implementation

Pearson ML, Parkerton PH, Takahashi NY, Smith NZY, Mittman BS. Measuring TRIP Implementation. Paper presented at: Agency for Healthcare Research and Quality Translating Research Into Practice and Policy Annual Meeting; 2004 Jul 12; Washington, DC.


Research Objective: TRIP evaluation research currently lacks well-defined methods for measuring the intensity and other dimensions of the implementation of complex interventions. This limits researchers' ability to account for differences in implementation in analyses of intervention impacts and outcomes. Our objective is to develop and test a framework for measuring TRIP implementation strategies across multiple quality enhancement projects.Study Design: The development of the intervention strategy paradigm has been undertaken as part of a multi-year program of research to synthesize finding from studies of TRIP strategies tested within the Veterans Health Administration (VHA). We are designing a formal approach (including data collection templates and analytical methods) for synthesizing research on TRIP processes and strategies. This approach is based on the chronic disease model, as well as extensive reviews of quality improvement literature in the social, behavioral, policy, and clinical sciences. We are testing and validating the templates and analytical methodology with data from current VA Quality Enhancement Research Initiative (QUERI) projects. A key element of our approach is a set of concepts and tools for characterizing the types of intervention strategies and the intensity of their implementation.Principal Findings: We hypothesize the existence of three major aspects of implementation influencing its success: a) what change strategies are selected for implementation, b) how they are chosen and implemented , and c) the context or setting in which they are implemented. For each of these, specific hypotheses and measures are needed. While the emerging typology of possible change strategies is broad and diverse, covering systems changes as well as individual behavior changes, parallel implementation measures can be developed by defining for each type of change strategy: who implements or delivers the change effort, in what dose, for what duration, the extent of exposure, and an indicator of institutionalization.Conclusions and Implications for TRIP: A fully specified framework for assessing TRIP implementation will help researchers to assess the effectiveness of translation interventions and to build the evidence base needed to inform policy makers, organizational leaders and clinicians of productive efforts.

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