2019 HSR&D/QUERI National Conference
4121 — Measuring the Fidelity of Implementation Facilitation in a Primary Care Integrated Pain Support (PIPS) Program
Lead/Presenter: Steve Martino, COIN - West Haven
All Authors: Martino S ((VA Connecticut Healthcare System, Yale University School of Medicine)), Midboe AM (Palo Alto VA Hospital), Heapy A (VA Connecticut Healthcare System, Yale University School of Medicine) Krein S (VA Ann Arbor Healthcare System, University of Michigan) Fenton B (VA Connecticut Healthcare System) Kerns R (VA Connecticut Healthcare System, Yale University School of Medicine) Becker WC (VA Connecticut Healthcare System, Yale University School of Medicine)
Implementation of Primary Care Integrated Pain Support (PIPS) - a pharmacist-primary care provider collaborative care program to support reduction of high-risk medication regimens and use of non-pharmacological pain treatment - entails an implementation facilitation approach that includes an external facilitator, internal facilitators and champions. We developed an implementation facilitation fidelity measure for use in a PIPS hybrid effectiveness-implementation trial being conducted at three VAs.
Members of the research team compiled and operationalized a list of implementation strategies planned for use in PIPS from the Expert Recommendations for Implementing Change project (Powell et al., 2015). Internal facilitators and champions reviewed and revised the list with the research team until consensus was reached. Internal facilitators and champions were trained on the measure and then independently rated eight vignettes prepared by the research team, varying in the presence or absence of 14 implementation items. We calculated the proportion of correct item identification per rater within and across vignettes and the sensitivity and specificity of the raters' judgment for each item. We also tracked the use of implementation facilitation strategies over the course of PIPS implementation.
The final consensus-based measure consisted of 5 items that capture interactions among the external facilitator, internal facilitators, and champions (e.g., team calls, engaging the external facilitator) and 9 items that detail specific implementation strategies, which might be used to implement PIPS (e.g., problem-solving, providing technical assistance). Three internal facilitators and four champions across three sites rated the vignettes. The proportion of items correctly identified across all vignettes was good to excellent per rater (73-93%) and consistent between raters within each vignette. Sensitivity and specificity was good for most items ( > 75%). Problem-solving dominated implementation facilitation in the PIPS trial.
Our fidelity measure is a promising tool for tracking the use of implementation strategies within an implementation facilitation approach over time.
A broad-based implementation facilitation approach is widely-used in the VA. Reliable and valid measurement of implementation strategies during a trial is critical to ascertain what occurred within an implementation facilitation approach and how the strategies relate to implementation outcomes.