1165 — When an implementation strategy is a "game-changer": Stakeholders' perspectives on the value of evidence-based quality improvement

Lead/Presenter: Alison Hamilton,  COIN - Los Angeles
All Authors: Hamilton AB (Center for the Study of Healthcare Innovation, Implementation & Policy), Brunner J (Center for the Study of Healthcare Innovation, Implementation & Policy), Hovsepian S (Center for the Study of Healthcare Innovation, Implementation & Policy) Canelo I (Center for the Study of Healthcare Innovation, Implementation & Policy) Oishi K (Center for the Study of Healthcare Innovation, Implementation & Policy) Rubenstein L (Center for the Study of Healthcare Innovation, Implementation & Policy) Yano E (Center for the Study of Healthcare Innovation, Implementation & Policy)

Objectives:
Evidence-based quality improvement (EBQI) is a multicomponent implementation strategy comprised of a multilevel research-clinical partnership approach to engaging organizational leaders and local QI teams in developing new care models in the context of prior evidence, local practice context, and provider behavior change methods, with researchers providing training, technical support, formative data feedback, and practice facilitation. In a cluster randomized trial, we tested EBQI for gender-tailoring primary care. To advance our understanding of the ways in which an implementation strategy impacts the target audience, the objective of this longitudinal qualitative analysis was to examine stakeholders' perspectives on the value of EBQI components over time.

Methods:
We conducted individual and/or group telephone interviews with multilevel key stakeholders at pre- (n = 88), mid- (n = 13 EBQI champions only), and post- (24 months; n = 114) EBQI implementation across 12 sites. An immersion-crystallization analytic framework was used to examine attitudes toward EBQI and identify salient EBQI components.

Results:
The EBQI national training provided teams with knowledge and tools for engaging in organizational improvement, enabling them to move beyond "taking stabs in the dark" when trying to address local problems. Stakeholders appreciated the validation and visibility fostered by multilevel stakeholder planning meetings. External facilitation via site-specific calls was the most consistently identified important component of EBQI; these calls helped teams maintain momentum and accountability, especially in the context of competing priorities. Cross-site calls, meant to foster spread of QI innovations, were less consistently noted as valuable. Formative feedback reports and evidence reviews were favorably received particularly by those who considered themselves to be data-oriented. While stakeholders were able to speak to specific EBQI components, they were not always able to attribute changes to any particular component: they described the overall effort as a "game changer," providing "renewed hope," "encouragement," and "tools, inspiration, and support to come up with ideas to improve our own practice environments."

Implications:
According to multilevel key stakeholders, this implementation strategy had notable value in empowering staff to make locally-driven, spreadable practice improvements

Impacts:
EBQI has the flexibility to be variably deployed across sites, and has been adopted by VA Women's Health Services to help sites improve women's health performance metrics.