3001 — Using the CFIR to guide analysis and dissemination of a national VHA Specialty Care Initiative

Stevenson LD, Louis Stokes Cleveland VAMC; Ball SL, Louis Stokes Cleveland VAMC; Haverhals LM, VA Eastern Colorado Health Care System; Szarka J, VA Puget Sound Health Care System; Aron DC, Louis Stokes Cleveland VAMC; Lowery J, VA Ann Arbor Healthcare System;

Objectives:
The Consolidated Framework for Implementation Research (CFIR) was used to evaluate implementation facilitators and barriers of Specialty Care Access Network- Extension for Community Healthcare Outcomes (SCAN-ECHO) within the Veterans Health Administration. SCAN-ECHO is a video teleconferencing-based program where centrally-located specialist teams train and mentor remotely-located primary care providers (PCPs) in providing routine specialty care for common chronic illnesses. The overall research goal was to provide guidance for and support the dissemination and spread of SCAN-ECHO.

Methods:
Sixty-four semi-structured telephone interviews with key informants (program participants, including clinical leads, PCPs, specialists, and support staff at nine programs) were conducted post-implementation and analyzed using CFIR constructs. Interview responses were coded deductively based on the CFIR and used to create ordinal ratings for each construct, for each program. Data were analyzed to distinguish high from low implementation sites (based on numbers of SCAN-ECHO sessions).

Results:
The CFIR constructs that distinguished between low and high implementation sites were: adaptability, design quality and packaging, compatibility, relative priority, knowledge and beliefs, engaging PCPs as key stakeholders, and reflecting and evaluating. Low implementation sites had less PCP buy-in and more concern about limited time to participate. Low implementation sites reported that PCPs had not seen the benefits and some were unsure of the appropriateness of PCP participation and treatment of complex cases. High implementation sites reported engaging in reflection and evaluation, some utilizing feedback to make improvements. High implementation sites also reported leadership placing high priority on SCAN-ECHO and allowing providers to dedicate time to participate, including time for some PCPs to start specialty mini-clinics.

Implications:
Identifying key constructs associated with SCAN-ECHO implementation success allowed us to focus recommendations for improving dissemination of the program. These recommendations included: 1) engage PCPs by providing dedicated time for participation; 2) obtain leadership involvement to establish relative priority; 3) develop an implementation guide based on successful strategies; and 4) establish a structured method to obtain feedback and disseminate findings.

Impacts:
This evaluation has identified key areas that increase implementation. Without this information, leaders are often left with a trial and error approach to prioritize intervention characteristics or organizational features.