Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients
Abstract Background The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptation...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-022-00297-z |
| _version_ | 1817988282542194688 |
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| author | Laura J. Damschroder Jeremy B. Sussman Paul N. Pfeiffer Jacob E. Kurlander Michelle B. Freitag Claire H. Robinson Patrick Spoutz Melissa L.D. Christopher Saraswathy Battar Kimberly Dickerson Christopher Sedgwick Ashleigh G. Wallace-Lacey Geoffrey D. Barnes Amy M. Linsky Christi S. Ulmer Julie C. Lowery |
| author_facet | Laura J. Damschroder Jeremy B. Sussman Paul N. Pfeiffer Jacob E. Kurlander Michelle B. Freitag Claire H. Robinson Patrick Spoutz Melissa L.D. Christopher Saraswathy Battar Kimberly Dickerson Christopher Sedgwick Ashleigh G. Wallace-Lacey Geoffrey D. Barnes Amy M. Linsky Christi S. Ulmer Julie C. Lowery |
| author_sort | Laura J. Damschroder |
| collection | DOAJ |
| description | Abstract Background The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies. Methods For each trial, we will recruit 8–12 clinics (24–36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently. Discussion MIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings. Trial registration ClinicalTrials.gov: NCT05065502 . Registered October 4, 2021—retrospectively registered. |
| first_indexed | 2024-04-14T00:32:25Z |
| format | Article |
| id | doaj.art-a2922b4309c3444f965bb9fdc1bd34e2 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-04-14T00:32:25Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-a2922b4309c3444f965bb9fdc1bd34e22022-12-22T02:22:30ZengBMCImplementation Science Communications2662-22112022-05-013111610.1186/s43058-022-00297-zMaintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patientsLaura J. Damschroder0Jeremy B. Sussman1Paul N. Pfeiffer2Jacob E. Kurlander3Michelle B. Freitag4Claire H. Robinson5Patrick Spoutz6Melissa L.D. Christopher7Saraswathy Battar8Kimberly Dickerson9Christopher Sedgwick10Ashleigh G. Wallace-Lacey11Geoffrey D. Barnes12Amy M. Linsky13Christi S. Ulmer14Julie C. Lowery15Center for Clinical Management Research, VA Ann Arbor Healthcare SystemCenter for Clinical Management Research, VA Ann Arbor Healthcare SystemCenter for Clinical Management Research, VA Ann Arbor Healthcare SystemCenter for Clinical Management Research, VA Ann Arbor Healthcare SystemCenter for Clinical Management Research, VA Ann Arbor Healthcare SystemCenter for Clinical Management Research, VA Ann Arbor Healthcare SystemVeterans Health Affairs VISN 20 Pharmacy Benefits ManagementPharmacy Benefits Management Services, Veterans Health AdministrationMichael E. DeBakey Veterans Affairs Medical CenterCentral Arkansas Veterans Healthcare SystemDepartment of Veterans Affairs, VA Heartland Network (VISN 15)VA St Louis Medical Center John Cochran DivisionDepartment of Internal Medicine, University of MichiganSection of General Medicine, VA Boston Healthcare SystemCenter of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care SystemCenter for Clinical Management Research, VA Ann Arbor Healthcare SystemAbstract Background The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies. Methods For each trial, we will recruit 8–12 clinics (24–36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently. Discussion MIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings. Trial registration ClinicalTrials.gov: NCT05065502 . Registered October 4, 2021—retrospectively registered.https://doi.org/10.1186/s43058-022-00297-zImplementation scienceMedication safetyDeprescribingPolypharmacyInsomniaAnti-coagulation |
| spellingShingle | Laura J. Damschroder Jeremy B. Sussman Paul N. Pfeiffer Jacob E. Kurlander Michelle B. Freitag Claire H. Robinson Patrick Spoutz Melissa L.D. Christopher Saraswathy Battar Kimberly Dickerson Christopher Sedgwick Ashleigh G. Wallace-Lacey Geoffrey D. Barnes Amy M. Linsky Christi S. Ulmer Julie C. Lowery Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients Implementation Science Communications Implementation science Medication safety Deprescribing Polypharmacy Insomnia Anti-coagulation |
| title | Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients |
| title_full | Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients |
| title_fullStr | Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients |
| title_full_unstemmed | Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients |
| title_short | Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients |
| title_sort | maintaining implementation through dynamic adaptations midas protocol for a cluster randomized trial of implementation strategies to optimize and sustain use of evidence based practices in veteran health administration vha patients |
| topic | Implementation science Medication safety Deprescribing Polypharmacy Insomnia Anti-coagulation |
| url | https://doi.org/10.1186/s43058-022-00297-z |
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