Dissememination, Implementation and Sustainablility

Dissemination, Implementation and Sustainability research represents a rapidly expanding area of funding in healthcare for many federal and private granting organizations. With this support, researchers seek to understand and identify effective processes for spreading knowledge and information; explore implementation strategies that influence the integration of evidence-based interventions or methods into practice settings; and to examine organizational attributes influencing the capacity of health care providers to sustain changes once implemented in the organization.

CHSRA researchers are actively engaged in the development and implementation of dissemination, implementation and sustainability research projects. Our research in this field focuses on two areas:

Quality Improvement and Implementation Strategies

Our research in this are tests and evaluates innovative implementation strategies including approaches to coaching in a quality improvement collaborative to improve processes of care for patients and residents of long-term care, community and behavioral healthcare providers.

Sustainability of Organizational Change

CHSRA researchers have conducted extensive research in this area seeking to assess environmental, organizational and innovation attributes influencing the likelihood that organizations will sustain changes and develop models that allow organizations and researchers to explore the impact of implementation strategies on the sustainment of outcomes.

-+ Substance Abuse and HIV Care

The research project is a Type 2 Effectiveness-Implementation Hybrid Trial35 to simultaneously test: (a) the effectiveness of BI for substance use relative to usual care (UC; i.e., referral to treatment), and (b) the effectiveness of an organizational-level implementation intervention called “Implementation & Sustainment Facilitation” (ISF), relative to the standard implementation strategy used by SAMHSA-funded Addiction Technology Treatment Centers (ATTCs; i.e., staff workshop training and ongoing feedback/coaching provided by ATTC trainers). The primary aims of the proposed Type 2 Effectiveness-Implementation Hybrid Trial are:

Aim 1: Test the effectiveness of BI for substance use in community-based HIV/AIDS organizations.

Aim 2: Test the effectiveness of the ATTC+ISF implementation strategy.

Aim 3: Test the cost-effectiveness of the ATTC+ISF implementation strategy.

Project Duration: 07/01/14-06/30/19

Primary Personnel

Principal Investigator: Bryan Garner, RTI
Co-Investigator: James H. Ford II

Funding Source

National Institute on Drug Abuse

Links

National Institute on Drug Abuse

Presentations/Publications

  • Garner, B. R., Ball, L., Bradshaw, M., Chaple, M., Ford, J., Gotham, H., Kaiser, D., Martino, S., Rieckmann, T., Rockford, D., Speck, K., Tueller, S., Vandersloot, D., Wolfe, A., & Zehner, M. (2016, October). Integrating brief intervention for substance use within AIDS service organizations: Preliminary findings from the Substance Abuse Treatment to HIV Care (SAT2HIV) project. Presentation at Addiction Health Services Research (AHSR) Conference, Seattle, WA.
  • Garner, B. R., Chaple, M., Ford, J., Gotham, H., Kaiser, D. J., Martino, S., Rieckmann, T., Rockford, D., Speck, K., Vandersloot, D., & Zehner, M. (2015, September). Implementing brief intervention for substance use within HIV/AIDS settings: Preliminary findings from Substance Abuse Treatment to HIV care (SAT2HIV) project. Poster presented at SIRC: Society for Implementation Research Collaboration, Seattle, WA.
  • Garner, B. R., Bradshaw, M. R., Chaple, M., Ford, J., Gotham, H., Kaiser, D. J., Martino, S., Parrish, B. L., Rieckmann, T., Rockford, D., Speck, K., Vandersloot, D., & Zehner, M. (2015, October). Implementing a brief intervention for substance use within HIV/AIDS organizations: Factors associated with perceived urgency for change. Poster presented at Addiction Health Services Research (AHSR) Conference, Marina Del Rey, CA

-+ Using NIATx to Implement Integrated Services

The overarching goal of this research is to determine if NIATx strategies are effective in implementing integrated services for persons with co-occurring substance use and mental health disorders. Using a cluster randomized wait-list control group design, 46 community addiction treatment agencies will participate. The first cohort of 23 agencies will utilize NIATx strategies during an index 12 month period. The second (wait-list) cohort of 23 agencies activates NIATx strategies during a second index 12 month period. Primary outcomes are assessed at pre- and post-implementation, and at annual sustainment evaluations. The study aims are:

Specific Aim 1: Relative to wait-list, to determine if NIATx strategies improve implementation outcomes.

Specific Aim 2: Relative to wait-list, to determine if NIATx strategies improve patient care outcomes.

Specific Aim 3: Across entire sample, to evaluate variation in the extent of and fidelity to NIATx strategies.

Project Duration: 09/30/15-05/31/20

Primary Personnel

Principal Investigator: James H. Ford II
Principal Investigator: Mark McGovern

Funding Source

National Institute on Drug Abuse

Links

National Institute on Drug Abuse
Materials from the DDCAT/NIATx meeting on October 5th, 2016 in Yakima, Washington (login required)
Materials from the DDCAT/NIATx webinar on February 9th 2017 (login required)

Presentations/Publications

  • McGovern MP, Ghosh A, Ford II JH, Osborne EL, Moriarity S and Sanders E. Operationalizing a Framework of Barriers and Facilitators to Implementation: The CFIR Index. Addictions Health Services Research Conferenece (Poster Presentation). October 13-15, 2016. Seattle Washington
  • Ford II JH Saldana L, Schaper H, Campbell M, Zehner M and McGovern MP. Adaptation of the Stages of Implementation Completion for NIATx Implementation Strategies. Addictions Health Services Research Conference (Poster Presentation). October 13-15, 2016. Seattle Washington

-+ Medication Research Partnership

The Medication Research Partnership (Partnership) is a collaboration between a national commercial health plan and treatment centers contracting with the health plan. The Partnership extended the Advancing Recovery model, developed in publicly funded systems of care to facilitate organizational change and promote the adoption of evidence-based practices for the treatment of alcohol and drug use disorders, to a commercial health plan and tested the model’s generalizability to increase use of medications for members covered by a commercial health plan. The study had four aims:

Specific Aim 1: Apply the Advancing Recovery model of system change to accelerate the implementation of buprenorphine-assisted treatment and integration with medical care within Aetna Behavioral Health and 12 intensive outpatient addiction treatment centers compared to 12 untreated comparison sites.

Specific Aim 2: Assess the impact of buprenorphine on the utilization and cost of behavioral health and medical care using Aetna’s utilization and payment data.

Specific Aim 3: Spread medication-assisted treatment to include alcohol medications in the 12 study sites.

Specific Aim 4: Conduct qualitative interviews to document implementation barriers and effective implementation strategies for medication assisted treatment.

Project Duration: 07/01/11–06/30/16

Primary Personnel

Principal Investigator: Dennis McCarty, Oregon Health and Sciences University
Co-Investigator: James H. Ford II
Co-Investigator: Mady Chalk, Treatment Research Institute
Co-Investigator: Amanda Abraham, University of Georgia
Co-Investigator: Laura Schmidt, University of California San Francisco

Funding Source

National Institute on Drug Abuse

Links

National Institute on Drug Abuse

Presentations/Publications

  • Ford II JH, Abraham A, Lupulescu-Mann N, Croff R, Hoffman KA, Alanis-Hirsch K, Chalk M, Schmidt L and McCarty D. Promoting Adoption of Medication for Opioid and Alcohol Use Disorders through System Change. Journal of Studies on Alcohol and Drugs. Accepted for Publication (3/17/17)
  • Alanis-Hirsch K, Croff R, Ford JH, Johnson K, Chalk M, Schmidt L and McCarty D. (2016) Extended-release naltrexone: A qualitative analysis of barriers to routine use. Journal of Substance Abuse Treatment, 62:68-73
  • K. Alanis-Hirsch, R. Croff, J. Ford, L. Schmidt, D. McCarty, M. Chalk Strategies to influence attitudes towards pharmacotherapies for alcohol and opioid use disorders (Poster Presentation). College on Problem Drug Dependence, June 15-19, 2014. San Juan, PR
  • R. Croff, K. Alanis-Hirsch, J. Ford, L. Schmidt, M. Chalk, D. McCarty. Strategies to increase family influence on patient decisions about medication-assisted treatment  (Poster Presentation). College on Problem Drug Dependence, June 15-19, 2014. San Juan, PR
  • Ford JH 2nd, Croff R, Chalk M, Alanis-Hirsch K, Johnson K, Schmidt L and McCarty D. Strategies to Implement and Sustain Medication Use for Alcohol and Opioid Disorders. (Poster Presentation). Addiction Health Services Research, October 15-17, 2014. Boston, MA.
  • Ford JH 2nd, Croff R, Chalk M, Alanis-Hirsch K, Johnson K, Schmidt L and McCarty D Strategies to Increase the Sustainability of Medication Assisted Treatment. AMERSA. November 6-8, 2014. San Francisco, CA
  • Ford II JH, Abraham A, Lupulescu-Mann N, Croff R, Chalk M, Johnson K, Schmidt L and McCarty D. Medication Research Partnership: Implementing Change to Increase Medication Use for Alcohol and Opioid Disorders Addiction Health Services Research Conference (Oral Presentation) October 14 to 16, 2015

-+ Patient-Centered Outcomes in Addiction

The overall aim of this project was to utilize the Maintenance of Certification (MOC) process to motivate addiction psychiatrists to learn skills taught by traditional and/or social media routes that will enable them to employ patient centered outcomes research (PCOR) in the care of their patients. The project specifically focused on the MOC Part 4 process (MOC4) of Performance in Practice (PIP), and peer and patient review. The study included three stages: (1) development and tailoring of patient-centered processes and materials needed to support MOC; (2) delivery of skills and content education regarding PCOR informed care, the MOC4, performance improvement principles, and social media, as well as measurement of outcomes of projects/care through a AAAP Annual Meeting Learning Collaborative, follow-up webinars and social media; and (3) dissemination of educational process to full AAAP membership and preparation for sustained support by AAAP of PCOR informed care via the MOC/social media mechanisms.

Project Duration: 04/01/13-07/31/16

Primary Personnel

Principal Investigator: Frances Levin, Columbia University
Co-Investigator: James H. Ford II
Co-Investigator: Dean Krahn, VA
Co-Investigator: Karen Oliver, VA
Co-Investigator: Kathryn-Cates Wessel, AAAP

Funding Source

Agency for Healthcare Research and Quality

Links

Agency for Healthcare Research and Quality

Presentations/Publications

  • Ford II JH, Oliver KA, Giles M, Cates-Wessel K, Krahn D and Levin F. (2017) Maintenance of Certification: Improving Addiction Psychiatrists Practice of Care. The American Journal on Addictions. 26(1): 34-41
  • Ford II JH, Oliver KA, Cates-Wessel K, Giles M, Krahn D and Levin F. The Impact of Performance in Practice on Physician Practice Improvements and Person Centered Care. 2015 AHRQ Research Conference. October 4 to 6, 2015
  • Ford II JH, Oliver KA, Cates-Wessel K, Giles M, Krahn D and Levin F. Performance in Practice: Impact on Physician Practice and Person Centered Care. Addiction Health Services Research Conference (Oral Presentation). October 14 to 16, 2015
  • Ford II JH, Oliver KA, Cates-Wessel K, Giles M, Krahn D and Levin F. Performance in Practice Completion: Its Impact on Physician Practice Improvements and Perceptions of Person-Centered Care. AMERSA Annual Conference (Poster Presentation). November 5 to 7, 2015

-+ QI Learning & Coaching

Coaching is a key component of quality improvement collaboratives. Understanding coach effectiveness and how the “teacher-student” relationship supports knowledge acquisition is a missing element in quality improvement research. In this study, we adapted scales developed and validated in educational settings and used the revised scales to individual learning and teaching styles in a quality improvement collaborative. The mixed methods study has three specific aims:

Specific Aim 1: What is the learning and teaching styles typology in a quality improvement collaborative?

Specific Aim 2: How do coaches and staff with a range of teaching and learning styles assess their teaching/learning experience within a quality improvement initiative?

Specific Aim 3: How do levels of convergence and divergence between staff learning style and coach teaching style influence the outcomes in a quality improvement collaborative?

Project Duration: 06/01/13 – 05/31/16

Primary Personnel

Principal Investigator: James H. Ford II
Co-Investigator: Jim Robinson
Co-Investigator: Meg Wise

Funding Source

National Institute on Drug Abuse

Links

National Institute on Drug Abuse

Presentations/Publications

  • Ford II JH, Robinson JM and Wise ME. Adaptation of the Grasha Riechman Student Learning Style Survey and Teaching Style Inventory to Assess Individual Teaching and Learning Styles in a Quality Improvement Collaborative. BMC Medical Education. BMC Medical Education.2016, 16:252 DOI: 10.1186/s12909-016-0772-4 URL: http://www.biomedcentral.com/1472-6920/16/252 PMCID: PMC5041280
  • Ford JH 2nd and Robinson J. Teaching and Learning Styles in Quality Improvement: Identification and Impact on Process Outcomes. Addiction Health Services Research, October 15-17, 2014. Boston, MA.

-+ Sustaining Change After NIATx200

Multi-organizational quality improvement collaboratives (QICs) are effective strategies for implementing evidence-based practices and improving patient care.6-13 Research on the effectiveness of quality improvement collaboratives to promote long-term sustainment of change is lacking, however. Moreover, we do not yet understand what attributes--organizational, innovation or environmental–are the most important contributors to the ability of organizations to successfully sustain change following participation in quality improvement collaboratives. This research study uses mixed-effects regression modeling and qualitative interviews to achieve our specific aims:

Specific Aim 1: Assess the level of sustainment of NIATx200 individual level outcomes--wait time, retention and number of admissions—during the 36 months following termination of NIATx200 supports.

Specific Aim 2: Identify attributes in the environment, in the organization and of the implemented innovation, that influence whether process improvements experienced during the NIATx200 intervention were sustained.

Project Duration: 07/01/14-06/30/17

Primary Personnel

Principal Investigator: James H. Ford II
Co-Investigator: Jim Robinson
Kaiser Permanente, Scott Stumbo Subcontract PI

Funding Source

National Institute on Drug Abuse

Links

National Institute on Drug Abuse

Presentations/Publications

  • Ford II JH, Robinson J and Stumbo S. Assessing Long-Term Sustainability of Wait Time Improvements from Participation in the NIATx200 Quality Improvement Collaborative. Addictions Health Services Research Conference (Oral Presentation). October 13-15, 2016. Seattle Washington

Stumbo S, Green CA, Scheirer MA and Ford II JH. Factors Influencing the Long-Term Sustainability of Quality Improvements Made in Addiction Treatment Facilities. Addictions Health Services Research Conference (Oral Presentation). October 13-15, 2016. Seattle Washington

Ford II JH, Alagoz E, Dinauer S, Johnson KA, Pe-Romashko K, Gustafson DH Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders J Med Internet Res 2015;17(8):e201 DOI: 10.2196/jmir.3965 PubMed PMID: 26286257. PMCID: PMC4642385.

  • Ford II JH; Robinson J; Krahn D; McCarty D and Gustafson D. Role of Staff Perceptions about Sustainability on Sustained Improvements (Poster Presentation). Addiction Health Services Research, October 23-25, 2013. Portland, OR.

-+ Veterans Health Administration

Three studies in the Veterans Health Administration (VHA) used the British National Health Service Sustainability Index to explore staff sustainability perceptions. Study 1: Examined staff perceptions about the likelihood that changes from a national rollout of a mental health system redesign would be sustained. Study 2: Explored how staff sustainability perceptions and their commitment to an integration of primary care and mental health services in VA hospitals in two Veteran Integrated Services Network. Study 3: involved Polytrauma Rehabilitation Centers (PRC) staff and studied perceptions that the Family Care Map (FCM) would be sustained. These manuscripts summarize the results from these three studies.

Presentations/Publications