Evidence map›Paper›PMID 35568903›Full record

ArticleImplementation science communications2022

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.

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 and 6 more

Registry-linked trialAbstract read
In one paragraph

Article in Implementation science communications, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05065502 (Maintaining Implementation Through Dynamic Adaptations), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05065502 nacompletednot on this map

Maintaining Implementation Through Dynamic Adaptations (MIDAS) (QUE 20-025)

TypeinterventionalSponsorVA Office of Research and DevelopmentRan2021 to 2024Enrolled24ConditionsPolypharmacy, Insomnia, AnticoagulantsArmsAcademic Detailing (AD), LEAP
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Laura J DamschroderCenter for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA. Laura.Damschroder@va.gov.ORCID http://orcid.org/0000-0002-3657-8459
Jeremy B SussmanCenter for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Paul N PfeifferCenter for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Jacob E KurlanderCenter for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Michelle B FreitagCenter for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Claire H RobinsonCenter for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Patrick SpoutzVeterans Health Affairs VISN 20 Pharmacy Benefits Management, Vancouver, WA, USA.
Melissa L D ChristopherPharmacy Benefits Management Services, Veterans Health Administration, 810 Vermont Ave NW, Washington DC, 20420, USA.
Saraswathy BattarMichael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
Kimberly DickersonCentral Arkansas Veterans Healthcare System, Little Rock, AR, USA.
Christopher SedgwickDepartment of Veterans Affairs, VA Heartland Network (VISN 15), Kansas City, MO, USA.
Ashleigh G Wallace-LaceyVA St Louis Medical Center John Cochran Division, St. Louis, MO, USA.
Geoffrey D BarnesDepartment of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Amy M LinskySection of General Medicine, VA Boston Healthcare System, Boston, MA, USA.
Christi S UlmerCenter of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, NC, USA.
Julie C LoweryCenter for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.

Funding

Quality Enhancement Research Initiative QUE 20-025
6 · The paper itself

Abstract

backgroundThe 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.

methodsFor 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 registrationClinicalTrials.gov: NCT05065502 . Registered October 4, 2021-retrospectively registered.

Indexed as

Academic detailingAnti-coagulationDeprescribingImplementation scienceImplementation strategyInsomniaMedication safetyPolypharmacyQuality improvement

Identifiers

PMID35568903
PMCPMC9107220

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.