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2023 HSR&D/QUERI National Conference Abstract

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1150 — Distilling qualitative data for real-time implementation planning and rollout: The Rapid Implementation Feedback (RIF) report

Lead/Presenter: Erin Finley,  COIN - Los Angeles
All Authors: Finley EP (Center for the Study of Healthcare Innovation, Implementation, and Policy [CSHIIP], VA Greater Los Angeles; UT Health San Antonio), Chrystal JG (CSHIIP) Gable AR (CSHIIP) Oishi A (CSHIIP) Dyer KE (CSHIIP) Oberman RS (CSHIIP) Lesser R (CSHIIP) Canelo I (CSHIIP) Jackson LS (CSHIIP) Olmos-Ochoa TT (CSHIIP) Moin T (CSHIIP; David Geffen School of Medicine, University of California Los Angeles [UCLA]) Bean-Mayberry B (CSHIIP; UCLA) Farmer MM (CSHIIP) Hamilton A (CSHIIP; UCLA)

Objectives:
The VA EMPOWER 2.0 QUERI is conducting a hybrid type 3 effectiveness-implementation trial comparing the impact of Replicating Effective Programs and Evidence-Based Quality Improvement as strategies for implementing three evidence-based practices (EBPs) for women Veterans: Virtual Diabetes Prevention Program; Telephone Lifestyle Coaching to reduce cardiovascular risk; and Reach Out, Stay Strong Essentials to prevent postpartum depression. We describe an innovative, pragmatic, team-based approach for the rapid synthesis of qualitative data to aid implementation planning, tailoring, and rollout across strategies, interventions, and sites.

Methods:
Trained qualitative staff conducted pre-implementation interviews with site- and VISN-level partners to assess content domains reflecting the Consolidated Framework for Implementation Research and behavior design (e.g., motivation). The EMPOWER 2.0 implementation teams, which are composed of investigators and site liaisons for each EBP and provide external implementation support for each site, met with the qualitative team to agree upon high-priority domains related to implementation planning (e.g., critical roles for implementation planning and launch; questions and concerns related to the EBP; existing use of and wished-for data to track women Veterans’ population health needs). Following each interview, the qualitative team reviewed interview notes and summarized key points for each domain, producing a structured Rapid Implementation Feedback (RIF) report organized by site, region, and EBP. Information was added cumulatively to the RIF, with emergent findings highlighted in weekly emails and meetings with the implementation teams.

Results:
82 semi-structured interviews were completed with frontline staff, providers, and leadership across 11 sites in three VISNs, November 2021-June 2022. The qualitative team’s weekly additions to and verbal updates on the RIF provided continuous updates on key findings, particularly questions and concerns raised by participants related to the three EBPs (e.g., whether referrals could be made for men as well as women) and their expected impact for sites (e.g., on workflow). The implementation teams drew upon findings in real time to inform and refine implementation planning, tailoring, and messaging, including by: developing a frequently asked questions (FAQ) document to support clear and consistent communication with sites; tailoring site rollout activities to address local needs, resources, and concerns; and informing design and tailoring of a quality dashboard to support sites in understanding the population health needs of their women Veterans and tracking implementation milestones (e.g., referrals to EBPs). Findings have been used to tailor implementation planning and rollout at six sites to date.

Implications:
Amid the challenge of needing to characterize the context and needs of diverse sites in preparing for launch of multiple EBPs simultaneously, the RIF report provided a pragmatic, real-time method for distillation of multi-level data with relevance for implementation planning, while also offering a structured format for continuous communication between qualitative and implementation teams.

Impacts:
Rapid qualitative methods are a critical tool for enhancing pre- and early implementation planning, communication, and tailoring. The RIF report provides a structured strategy for distillation of early findings, allowing continuous communication between qualitative and implementation teams, and supporting effective tailoring of implementation rollout in real time.