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Sahay A, Gholami P, Heidenreich PA. Use of internal and external facilitators for the implementation the VA Hospital-To-Home (H2H) Initiative: Chronic Heart Failure (CHF) QUERI. Poster session presented at: National Institutes of Health Conference on the Science of Dissemination and Implementation: Research At The Crossroads; 2012 Mar 19; Bethesda, MD.
Abstract: Problem: Reducing readmission rates for heart failure (HF) patients is the primary goal of the Department of Veterans Affairs (VA) and its CHF QUERI. According to Rogers' Diffusion of Innovation Theory (2003) social networks significantly affect performance and innovation. Additionally, the Promoting Action on Research Implementation in Health Services (PARIHS, 2008) framework emphasizes the function of dynamic relationships among evidence, context and facilitation. In January 2010 the CHF QUERI through its HF Network launched the "VA H2H" QI initiative to implement the national H2H initiative at the VA facilities. External facilitators (HF Network's leadership) and internal facilitators (opinion leaders (OLs) at each facility) were used to implement the VA H2H initiative. Methods: A total of 122 VA facilities were identified with > 100 discharges during 2007-2008. Using the sociometric method OLs were identified to be "internal" facilitators. Members were to nominate up to 2 providers at own facility (physician/nurse/other/self) as the OL. Then OL teams were asked to participate in the VA H2H. External facilitators conducted web-based meetings, provided tool-kit and consultation to members at all 122 facilities. Periodic surveys were used to track projects recently initiated and/or planned based on VA H2H, or ongoing to reduce HF readmissions not based on VA H2H initiative. Findings: Members from 66% facilities (n = 81) responded with 1-2 nominations for OLs. Members from the remaining 34% facilities (n = 41) either responded with no nominations (n = 3) or were non-responders (n = 38). Overall, 47 facilities (39%) reported a total of 243 projects. Among them, 44 facilities had OLs (94%) with 234 projects (96%) and the remaining 3 facilities (6%) with no OL had only 9 projects (4%). Contributions: Facilities with OLs were very successful in implementing the VA H2H initiative. Use of OLs may be effective in implementing non-mandated QI initiatives to improve care for all VA HF patients. Funding: This research was supported by the US Department of Veterans Affairs QUERI program.

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