Development and application of a menu-based choice framework to structure expert recommendations for implementing complex practice changes in the VA.

Matthieu MM, Waltz TJ, Kirchner JE, Damschroder LJ, Chinman MJ, Smith JL, Powell BJ, Proctor EK. Development and application of a menu-based choice framework to structure expert recommendations for implementing complex practice changes in the VA. Paper presented at: National Institutes of Health / AcademyHealth Conference on the Science of Dissemination and Implementation; 2014 Dec 9; Bethesda, MD.

Abstract: The Expert Recommendations for Implementing Change (ERIC) project sought to utilize methods to support a highly structured and transparent recommendation process that actively engaged key stakeholders throughout the project's execution. The ERIC project's penultimate activity involves a menu based choice (MBC) task. MBC methods are used in consumer marketing research for product development and these tasks are useful for providing a context rich structure for making decisions that involve multiple elements. In ERIC's MBC tasks, panelists were presented with 73 implementation strategies structured into nine categories. They were tasked with building multi-strategy implementation approaches for particular clinical practice changes being implemented across three settings, each with specific relative strengths and weaknesses (i.e., varying contextual characteristics). The clinical practice changes were identified by national VA leadership as high priority areas for clinical quality improvement efforts (e.g., improving safety for patients taking antipsychotic medications, depression outcome monitoring in primary care mental health, prolonged exposure therapy for treating post-traumatic stress disorder). Scenarios describing these practice changes were developed using key informant interviews with front line providers, clinical managers, health service researchers, and implementation scientists. These experts all practice in the respective area and were able to provide common and realistic challenges they face in routine service delivery in VA settings. ERIC project staff then expanded the scenarios to address varying organizational contexts (e.g., organizational culture, leadership, evaluation infrastructure) and across levels of evidence (e.g., strength and quality, relative advantage, compatibility, adaptability). Stakeholders were repeatedly engaged in an iterative process of evaluating the scenarios for reliability, credibility, and transferability. This presentation will highlight the critical role partnering with key stakeholders plays in executing this structured recommendation method.