Intensification of Implementation Strategies: Developing a Model of Foundational and Enhanced Implementation Approaches to Support National Adoption and Scale-up

Overview

Journal Gerontologist

Publisher Oxford University Press

Specialty Geriatrics

Date 2022 Aug 27

PMID 36029028

Authors

Jaime M Hughes

Leah L Zullig

Ashley L Choate

Kasey P Decosimo

Virginia Wang

Courtney H Van Houtven

Kelli D Allen

S Nicole Hastings

Affiliations

Soon will be listed here.

Abstract

Implementation strategies are activities to support integration of evidence-based programs (EBPs) into routine care. Comprised of 170+ facilities, the Veterans Affairs Healthcare System is conducive to evaluating feasibility and scalability of implementation strategies on a national level. In previous work evaluating implementation of three EBPs for older Veterans (hospital-based walking, caregiver skills training, group physical therapy), we found facilities varied in their need for implementation support, with some needing minimal guidance and others requiring intensive support. Committed to national scalability, our team developed an implementation intensification model consisting of foundational (low-touch) and enhanced (high-touch) implementation support. This Forum article describes our multilevel and multistep process to develop and evaluate implementation intensification. Steps included (a) review completed trial data; (b) conduct listening sessions; (c) review literature; (d) draft foundational and enhanced implementation support packages; (e) iteratively refine packages; and (7) devise an evaluation plan. Our model of implementation intensification may be relevant to other health care systems seeking strategies that can adapt to diverse delivery settings, optimize resources, help build capacity, and ultimately enhance implementation outcomes. As more health care systems focus on spread of EBPs into routine care, identifying scalable and effective implementation strategies will be critical.

Citing Articles

Development and Delivery of Enhanced Implementation Support to Disseminate a National Caregiver Skills Training Program.

Hughes J, Makaroun L, Decosimo K, Tucker M, Dadolf J, Drake C Innov Aging. 2025; 9(1):igae107.

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Implementation outcomes from a multi-site stepped wedge cluster randomized family caregiver skills training trial.

Van Houtven C, Decosimo K, Drake C, Bruening R, Sperber N, Dadolf J Health Serv Res. 2024; 59(6):e14361.

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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 A, Drake C, Decosimo K, Zullig L, Hughes J, Sperber N Health Serv Res. 2024; 59 Suppl 2:e14360.

PMID: 39090785 PMC: 11540588. DOI: 10.1111/1475-6773.14360.

The business case for hospital mobility programs in the veterans health care system: Results from multi-hospital implementation of the STRIDE program.

Kaufman B, Hastings S, Meyer C, Stechuchak K, Choate A, Decosimo K Health Serv Res. 2024; 59 Suppl 2:e14307.

PMID: 38632179 PMC: 11540580. DOI: 10.1111/1475-6773.14307.

Group physical therapy for knee osteoarthritis: protocol for a hybrid type III effectiveness-implementation trial.

Webb S, Drake C, Coffman C, Sullivan C, Sperber N, Tucker M Implement Sci Commun. 2023; 4(1):125.

PMID: 37828564 PMC: 10571277. DOI: 10.1186/s43058-023-00502-7.

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