ArticleHepatology (Baltimore, Md.)2022
Core implementation strategies for improving cirrhosis care in the Veterans Health Administration.
Article in Hepatology (Baltimore, Md.), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Getting to Implementation: applying data-driven implementation strategies to improve guideline concordant surveillance for hepatocellular carcinoma.Implementation science : IS · 2025Trial
- Scaling up point-of-care hepatitis C testing in Canada: protocol for a multilevel implementation science study of clinical processes, barriers, facilitators and implementation strategies (SCALE-POCT study).Implementation science communications · 2025Article
- Explaining site-level fidelity within a national initiative to implement a VA patient safety guidebook: the difference-making role of networks & communications.Implementation science communications · 2025Article
- Difference-Making Factors Linked to Higher Reach of Specialist Palliative Care Among People With Heart Failure Across a National Sample of VA Medical Centers.The American journal of hospice & palliative care · 2025Article
- Comparing the effectiveness of implementation strategies to improve liver and colon cancer screening for Veterans: protocol for a large cluster-randomized implementation study.Implementation science : IS · 2025Article
- Development, Implementation, and Evaluation Methods for Dashboards in Health Care: Scoping Review.JMIR medical informatics · 2024Article
- Albumin for Spontaneous Bacterial Peritonitis: Care Variation, Disparities, and Outcomes.The American journal of gastroenterology · 2024Article
- Understanding Whether and How a Digital Health Intervention Improves Transition Care for Emerging Adults Living With Type 1 Diabetes: Protocol for a Mixed Methods Realist Evaluation.JMIR research protocols · 2023Article
- Actionable Solutions to Achieve Health Equity in Chronic Liver Disease.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023Review
- Refining Expert Recommendations for Implementing Change (ERIC) strategy surveys using cognitive interviews with frontline providers.Implementation science communications · 2023Article
- Getting to implementation: Adaptation of an implementation playbook.Frontiers in public health · 2022Article
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18 authors.
Funding
Abstract
BACKGROUND AND
aimsThe Veterans Health Administration (VHA) provides care for more than 80,000 veterans with cirrhosis. This longitudinal, multimethod evaluation of a cirrhosis care quality improvement program aimed to (1) identify implementation strategies associated with evidence-based, guideline-concordant cirrhosis care over time, and (2) use qualitative interviews to operationalize strategies for a manualized intervention. APPROACH AND
resultsVHA providers were surveyed annually about the use of 73 implementation strategies to improve cirrhosis care in fiscal years 2018 (FY18) and 2019 (FY19). Implementation strategies linked to guideline-concordant cirrhosis care were identified using bivariate statistics and comparative configurational methods. Semistructured interviews were conducted with 12 facilities in the highest quartile of cirrhosis care to specify the successful implementation strategies and their mechanisms of change. A total of 106 VHA facilities (82%) responded at least once over the 2-year period (FY18, n = 63; FY19, n = 100). Facilities reported using a median of 12 (interquartile range [IQR] 20) implementation strategies in FY18 and 10 (IQR 19) in FY19. Of the 73 strategies, 35 (48%) were positively correlated with provision of evidence-based cirrhosis care. Configurational analysis identified multiple strategy pathways directly linked to more guideline-concordant cirrhosis care. Across both methods, a subset of eight strategies was determined to be core to cirrhosis care improvement and specified using qualitative interviews.
conclusionsIn a national cirrhosis care improvement initiative, a multimethod approach identified a core subset of successful implementation strategy combinations. This process of empirically identifying and specifying implementation strategies may be applicable to other implementation challenges in hepatology.
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