Lead/Presenter: Vera Yakovchenko, COIN - Bedford/Boston
All Authors: Yakovchenko V (CHOIR, BridgeQUERI, Bedford), Gonzalez R (National Hepatic Consortium for Redesigning Care, Long Beach), Park A (Office of Healthcare Transformation) Morgan T (National Hepatic Consortium for Redesigning Care, Long Beach) Chartier M (HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services) Ross D (HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services, Washington) Chinman M (Center for Health Equity Research and Promotion, Pittsburgh) Rogal S (Center for Health Equity Research and Promotion, Pittsburgh)
To increase access to evidence-based treatments for hepatitis C (HCV), the Department of Veterans Affairs (VA) established regional Hepatitis Innovation Teams tasked with identifying local needs and selecting implementation strategies to increase treatment initiations. The aim of this longitudinal evaluation was to assess how site-level implementation strategies were associated with HCV treatment initiation.
An HCV provider at each VA site (N = 130) was asked in four consecutive fiscal years (FYs) to complete an online survey examining use of 73 implementation strategies organized into nine clusters as described by the Expert Recommendations for Implementing Change (ERIC) study. The number of Veterans initiating treatment for HCV, or "treatment starts", at each site was captured using administrative data for each FY. Descriptive, nonparametric, multivariate analyses and configurational comparative methods were conducted on the respondents in FY15 (N = 80), FY16 (N = 105), FY17 (N = 109), and FY18 (N = 88).
Of 130 sites, 127 (98%) responded at least once and 54 (42%) responded across all four years. A mean of 25Â±14 strategies were endorsed in Year 1, 28Â±14, 26Â±15, and 35Â±26 in Years 2, 3, and 4, respectively. The most commonly endorsed strategies were: data warehousing techniques, tailoring strategies to deliver HCV care, and intervening with patients to promote uptake and adherence to HCV treatment. The least commonly endorsed strategies were in the financial efforts cluster. One strategy ("make efforts to identify early adopters to learn from their experiences") was significantly associated with treatment starts in all four years, 7 strategies were significant in three years, 13 in two, 24 in one, and 28 in no years.
We have demonstrated the feasibility of assessing ERIC strategies over time in a national sample to assess associations between strategies and clinical outcomes. We have shown that changes in strategy use over time can be measured and that strategies are not consistently associated with outcomes across multi-year implementation.
This evaluation represents the first large-scale longitudinal assessment of implementation strategies nationwide. These results add to our understanding of the process and uptake of implementation strategies over time and across stages of planning, implementation, and sustainability.