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VA » Health Care » Seattle-Denver Center of Innovation (COIN) » Implementation and Adaptation Guide

Seattle-Denver Center of Innovation (COIN)

Implementation and Adaptation Guide

Glossary

The Dissemination and Implementation (D&I) field is still growing, and below are the current working definitions of the D&I concepts, taken from the published literature. These definitions are not meant to be taken as a gold standard - instead, they are helpful to provide insights into the current understanding of the D&I concepts. The field is still working to standardize the definitions and identify/validate measures to evaluate these.

Adaptations: “any changes to the program (intervention, practice change, or implementation strategy), context that have a potential impact on: 1) implementation, service, and/or clinical outcomes; 2) how the program is being implemented in the current setting (i.e., iterative improvements); 3) the likelihood that the program will: a) continue to be offered at the current setting; b) have sustained impact on outcomes of interest; and/or c) be adopted by other settings”; McCreight, Marina, et al. "Using a Longitudinal Multi-Method Approach to Document, Assess, and Understand Adaptations in the Veterans Administration Advanced Care Coordination Program." Frontiers in Health Services: 69. DOI 10.3389/frhs.2022.970409; Read the full article on the publisher's website
Brain Writing Premortem: “the silent sharing of written ideas about why an intervention failed. The method can engage stakeholders and identify barriers more efficiently than traditional brainstorming focus groups”; Gilmartin H, Lawrence E, Leonard C, McCreight M, Kelley L, Lippmann B, Coy A, Burke RE. Brainwriting Premortem: A Novel Focus Group Method to Engage Stakeholders and Identify Preimplementation Barriers. J Nurs Care Qual. 2019 Apr/Jun;34(2):94-100. doi: 10.1097/NCQ.0000000000000360. PMID: 30148746; PMCID: PMC6493673.; Read full article for free at PubMed Central
Dissemination and Implementation Science: “emerging scientific field with a focus on ensuring that evidence-based interventions are developed in ways that match well with users’ needs, resources, and time frames”; Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015 Sep 16;3(1):32. doi: 10.1186/s40359-015-0089-9. PMID: 26376626; PMCID: PMC4573926.; Read full article for free at PubMed Central; “the scientific study of methods to promote the uptake of research findings into routine healthcare in clinical, organizational, or policy contexts”; von Thiele Schwarz U, Aarons GA, Hasson H. The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation. BMC Health Serv Res. 2019 Nov 21;19(1):868. doi: 10.1186/s12913-019-4668-y. PMID: 31752846; PMCID: PMC6873662.; Read full article for free at PubMed Central
Evidence-Based Intervention/Practice: “practices by which the provider’s decision is backed by the most appropriate information. EBIs originated from the evidence-based medicine movement. In recent years, additional fields that involve routine intervention and clinical decision making have embraced this movement . This includes a range of EBIs in treatment research, prevention, policy, medicine, community-based public health, and overall healthcare”; Barnes C, Yoong SL, Nathan N, Wolfenden L, Wedesweiler T, Kerr J, Ward DS, Grady A. Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial. J Med Internet Res. 2021 Dec 15;23(12):e25902. doi: 10.2196/25902. PMID: 34914617; PMCID: PMC8717135.; Read full article for free at PubMed Central
Fidelity: “…also denoted as adherence or treatment integrity, …defined as the degree to which an intervention is carried out as it was described and originally tested and/or as the developer intended”; von Thiele Schwarz U, Aarons GA, Hasson H. The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation. BMC Health Serv Res. 2019 Nov 21;19(1):868. doi: 10.1186/s12913-019-4668-y. PMID: 31752846; PMCID: PMC6873662.; Read full article for free at PubMed Central
Implementation: “any deliberately initiated attempt to introduce new, or modify existing, patterns of action in health care or some other formal organisational setting. Deliberate initiation means that an intervention is: institutionally sanctioned; formally defined; consciously planned; and intended to lead to a changed outcome”; May, C.R., Johnson, M. & Finch, T. Implementation, context and complexity. Implementation Sci 11, 141 (2016). https://doi.org/10.1186/s13012-016-0506-3; Read the full article on the publisher's website
Implementation Context: Much work still needs to be done to standardize the definition of the implementation context and how we measure it. References below provide some useful insights at our understanding of the term.; “Understanding what happens when an evidence-based practice, e.g. an intervention, programme, method or service, is “woven together” with a team, department or organization”; Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv Res. 2019 Mar 25;19(1):189. doi: 10.1186/s12913-019-4015-3. PMID: 30909897; PMCID: PMC6432749.; Read full article for free at PubMed Central; “a broad list of features such as the political or economic environment; …social relations, leadership, organisational culture and climate; … individual perceptions of the implementation effort, organisational characteristics, the wider political environment, and the multilevel concepts of culture and resources”; Rogers L, De Brún A, McAuliffe E. Defining and assessing context in healthcare implementation studies: a systematic review. BMC Health Serv Res. 2020 Jun 29;20(1):591. doi: 10.1186/s12913-020-05212-7. PMID: 32600396; PMCID: PMC7322847.; Read full article for free at PubMed Central
Implementation Strategy/ies: “methods or techniques used to improve adoption, implementation, sustainment, and scale-up of interventions”; Powell BJ, Fernandez ME, Williams NJ, Aarons GA, Beidas RS, Lewis CC, McHugh SM, Weiner BJ. Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda. Front Public Health. 2019 Jan 22;7:3. doi: 10.3389/fpubh.2019.00003. PMID: 30723713; PMCID: PMC6350272.; Read full article for free at PubMed Central
Partners and Stakeholders*: “individuals, organizations or communities that have a direct interest in the process and outcomes of a project, research or policy endeavor”; Deverka PA, Lavallee DC, Desai PJ, Esmail LC, Ramsey SD, Veenstra DL, et al. Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement. J Comp Eff Res. 2012;1(2):181–94.; Boaz A, Hanney S, Borst R, O'Shea A, Kok M. How to engage stakeholders in research: design principles to support improvement. Health Res Policy Syst. 2018 Jul 11;16(1):60. doi: 10.1186/s12961-018-0337-6. PMID: 29996848; PMCID: PMC6042393.; Read full article for free at PubMed Central
Process Mapping: “a tool used in Lean Six Sigma process improvement methodology and involves observing steps, identifying roles involved, and specifying process inputs and outputs. To be most useful, it must include perspectives of staff on the “front-line” who currently perform the process in question. Data gathered from direct observations and discussions are then used to create a diagram or flowchart to depict this process”; McCreight MS, Gilmartin HM, Leonard CA, Mayberry AL, Kelley LR, Lippmann BK, Coy AS, Radcliff TA, Côté MJ, Burke RE. Practical Use of Process Mapping to Guide Implementation of a Care Coordination Program for Rural Veterans. J Gen Intern Med. 2019 May;34(Suppl 1):67-74. doi: 10.1007/s11606-019-04968-x. PMID: 31098974; PMCID: PMC6542877.; Read full article for free at PubMed Central
QUERI: Quality Enhancement Research Initiative, located in the VA Office of Research and Development; Research is integral to advancing healthcare and improving the health and wellbeing of individuals and communities, yet it can take 17 years for research discoveries to be used in clinical care. QUERI was established in 1998 to accelerate the use of research evidence, tools, and methods into routine care and ensure U.S. Military Veterans benefit from research discoveries.; Visit the QUERI website
Stakeholder* Engagement: “an iterative process of actively soliciting the knowledge, experience, judgment and values of individuals selected to represent a broad range of direct interest in a particular issue, for the dual purposes of: creating a shared understanding; making relevant, transparent and effective decisions”; Deverka PA, Lavallee DC, Desai PJ, Esmail LC, Ramsey SD, Veenstra DL, Tunis SR. Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement. J Comp Eff Res. 2012 Mar;1(2):181-194. doi: 10.2217/cer.12.7. PMID: 22707880; PMCID: PMC3371639.; Read full article for free at PubMed Central; Boaz A, Hanney S, Borst R, O'Shea A, Kok M. How to engage stakeholders in research: design principles to support improvement. Health Res Policy Syst. 2018 Jul 11;16(1):60. doi: 10.1186/s12961-018-0337-6. PMID: 29996848; PMCID: PMC6042393.; Read full article for free at PubMed Central; *NOTE: The CDC recommends replacing "Stakeholder" with more culturally appropriate term. Examples: contributors, community, community members, community impacted, community affected, community of solution, coalition members, allies, colleagues, clients, tribes, advocacy groups, interested parties/groups, implementing partners, working partners, funders. Visit the CDC website, "Preferred Terms for Select Population Groups & Communities"

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