TY - JOUR
T1 - Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans
T2 - Evidence from a multi-site trial in the Veterans Health Administration
AU - Drake, Connor
AU - Wang, Virginia
AU - Stechuchak, Karen M.
AU - Sperber, Nina
AU - Bruening, Rebecca
AU - Coffman, Cynthia J.
AU - Choate, Ashley
AU - Van Houtven, Courtney Harold
AU - Allen, Kelli D.
AU - Colon-Emeric, Cathleen
AU - Jackson, George L.
AU - Tucker, Matthew
AU - Meyer, Cassie
AU - Kappler, Caitlin B.
AU - Hastings, Susan N.
N1 - Publisher Copyright:
© 2024 American Academy of Physical Medicine and Rehabilitation.
PY - 2024
Y1 - 2024
N2 - Introduction: The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed to promote quality improvement efforts and implementation of new clinical programs. Objective: This study examines the role of CONNECT, a complexity science-based implementation intervention to promote team readiness, for enhancing implementation of the ‘Assisted Early Mobility for Hospitalized Older Veterans’ program (STRIDE), an inpatient, supervised walking program. Design: We conducted a stepped-wedge cluster randomized trial using a convergent mixed-methods design. Within each randomly assigned stepped-wedge sequence, Veterans Affairs Medical Centers (VAMCs) were randomized to receive standardized implementation support only or additional training via the CONNECT intervention. Data for the study were obtained from hospital administrative and electronic health records, surveys, and semi-structured interviews with clinicians before and after implementation of STRIDE. Setting: Eight U.S. VAMCs. Participants: Three hundred fifty-three survey participants before STRIDE implementation and 294 surveys after STRIDE implementation. Ninety-two interview participants. Intervention: CONNECT, a complexity-science–based intervention to improve team function. Main Outcome Measures: The implementation outcomes included STRIDE reach and fidelity. Secondary outcomes included validated measures of team function (i.e., team communication, coordination, role clarity). Results: At four VAMCs randomized to CONNECT, reach was higher (mean 12.4% vs. 3.8%), and fidelity was similar to four non-CONNECT VAMCs. VAMC STRIDE delivery teams receiving CONNECT reported improvements in team function domains, similar to non-CONNECT VAMCs. Qualitative findings highlight CONNECT's impact and the influence of team characteristics and contextual factors, including team cohesion, leadership support, and role clarity, on reach and fidelity. Conclusion: CONNECT may promote greater reach of STRIDE, but improvement in team function among CONNECT VAMCs was similar to improvement among non-CONNECT VAMCs. Qualitative findings suggest that CONNECT may improve team function and implementation outcomes but may not be sufficient to overcome structural barriers related to implementation capacity.
AB - Introduction: The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed to promote quality improvement efforts and implementation of new clinical programs. Objective: This study examines the role of CONNECT, a complexity science-based implementation intervention to promote team readiness, for enhancing implementation of the ‘Assisted Early Mobility for Hospitalized Older Veterans’ program (STRIDE), an inpatient, supervised walking program. Design: We conducted a stepped-wedge cluster randomized trial using a convergent mixed-methods design. Within each randomly assigned stepped-wedge sequence, Veterans Affairs Medical Centers (VAMCs) were randomized to receive standardized implementation support only or additional training via the CONNECT intervention. Data for the study were obtained from hospital administrative and electronic health records, surveys, and semi-structured interviews with clinicians before and after implementation of STRIDE. Setting: Eight U.S. VAMCs. Participants: Three hundred fifty-three survey participants before STRIDE implementation and 294 surveys after STRIDE implementation. Ninety-two interview participants. Intervention: CONNECT, a complexity-science–based intervention to improve team function. Main Outcome Measures: The implementation outcomes included STRIDE reach and fidelity. Secondary outcomes included validated measures of team function (i.e., team communication, coordination, role clarity). Results: At four VAMCs randomized to CONNECT, reach was higher (mean 12.4% vs. 3.8%), and fidelity was similar to four non-CONNECT VAMCs. VAMC STRIDE delivery teams receiving CONNECT reported improvements in team function domains, similar to non-CONNECT VAMCs. Qualitative findings highlight CONNECT's impact and the influence of team characteristics and contextual factors, including team cohesion, leadership support, and role clarity, on reach and fidelity. Conclusion: CONNECT may promote greater reach of STRIDE, but improvement in team function among CONNECT VAMCs was similar to improvement among non-CONNECT VAMCs. Qualitative findings suggest that CONNECT may improve team function and implementation outcomes but may not be sufficient to overcome structural barriers related to implementation capacity.
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U2 - 10.1002/pmrj.13190
DO - 10.1002/pmrj.13190
M3 - Article
C2 - 38967454
AN - SCOPUS:85197724984
SN - 1934-1482
JO - PM and R
JF - PM and R
ER -