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Adaptations and early adoption of a family caregiver intervention in the Veterans Affairs Health Care System: A multimethod pragmatic approach for national scaling.
Blok, Amanda C; Drake, Connor; Decosimo, Kasey; Zullig, Leah L; Hughes, Jaime M; Sperber, Nina R; Kota, Swetha; Franzosa, Emily; Coffman, Cynthia J; Shepherd-Banigan, Megan; Chadduck, Trisha; Allen, Kelli D; Hastings, Susan N; Van Houtven, Courtney H.
Afiliación
  • Blok AC; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
  • Drake C; Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
  • Decosimo K; Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.
  • Zullig LL; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
  • Hughes JM; Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.
  • Sperber NR; Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.
  • Kota S; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
  • Franzosa E; Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
  • Coffman CJ; Section on Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
  • Shepherd-Banigan M; Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.
  • Chadduck T; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
  • Allen KD; Durham VA Health Care System, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.
  • Hastings SN; James J. Peters VA Medical Center, Geriatric Research, Education and Clinical Center, Bronx, New York, USA.
  • Van Houtven CH; Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA.
Health Serv Res ; 2024 Aug 01.
Article en En | MEDLINE | ID: mdl-39090785
ABSTRACT

OBJECTIVE:

To examine the relationship between site-level adaptation and early adoption of Caregivers Finding Important Resources, Support, and Training (FIRST) training during national implementation across diverse Veteran Health Administration (VA) medical centers. DATA SOURCES AND STUDY

SETTING:

We enrolled and evaluated 25 VA medical centers (VAMCs). Along with administrative data on site characteristics, we examined site-reported data on adaptations and intervention adoption, defined as ≥4 training classes delivered to ≥5 caregivers at 6 months from April through October 2022. STUDY

DESIGN:

A type III hybrid implementation-effectiveness cluster randomized controlled trial, randomized VAMCs 11 to receive foundational (low-touch) implementation support (n = 12) or the addition of enhanced (high-touch) implementation support (n = 13). DATA COLLECTION/EXTRACTION

METHODS:

At key implementation phases, VAMCs were asked to report adaptations including content, contextual modifications (format, setting, personnel, and population), and training of providers. We describe site-level adaptations by arm and by organizational characteristics that included VAMC complexity level, staffing, rurality, and organizational readiness to change. We used qualitative comparative analysis to identify unique adaptations that contributed to intervention adoption at 6 months. PRINCIPAL

FINDINGS:

VAMCs randomized to receive enhanced support reported slightly more adaptations than those randomized to foundational support. At 6 months, VAMCs with two or more adaptations adopted Caregivers FIRST at a higher rate than those with fewer adaptations (90% vs. 44%). Staffing adaptations (e.g., who delivered the intervention), format and content (e.g., modified delivery pace), and referring provider training were unique adaptations to adopting sites.

CONCLUSIONS:

Site-level adaptations were diverse and occurred more frequently in sites with early adoption of Caregivers FIRST. Future research should identify best practices of supporting and monitoring intervention adaptation. Understanding the role of adaptation in early adoption success could assist other healthcare systems in implementing interventions for caregivers.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Health Serv Res Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Health Serv Res Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos