TABLE 4.
Exemplar use of the analysis of framework for reporting adaptations and modifications‐expanded data (A‐FRAME) matrix for seven projects.
| Project summary | What was modified? (thematic group) | How was it modified? | Why was it modified? | Impact: Was the core function altered? How? |
|---|---|---|---|---|
| Project A: Home‐based senior care program aimed at providing primary care to homebound patients at their place of residence. The program evaluation sought to examine patient and caregiver outcomes using surveys, observations of home visits, and patient and caregiver interviews | Intervention: Delivery | In‐person home visits shifted to phone outreach and video visits; paused enrollment of new patients | Limiting in person contact to reduce risk of virus exposure and spread | Yes, impacted access: limited access to care |
| Intervention: Delivery | Changed visit protocol to include protective equipment; provided COVID‐19 testing at patient's home | Improve safety and access to testing to reduce risk of virus exposure and spread | No | |
| Evaluation: Data collection | Added questions about COVID‐19 to interviews; conducted phone interviews in lieu of in‐home observations with interviews | Wanted to understand impact of COVID‐19 on patients; limit in person contact to reduce risk | No | |
| Project B: Neurology clinic initiative to conduct a phased gradual roll‐out of video visits for ambulatory care appointments to understand acceptability, appropriateness, and sustainability. Mixed methods data collection and analysis with patient and provider surveys, provider interviews, and observations | Intervention: Delivery | Shifted to 100% video visits rather than a phased gradual roll‐out | In‐person appointments reduced due to COVID‐19; virtual visits preferred operationally | No |
| Evaluation: Study design | Stepped‐wedge design changed to 100% rapid roll‐out of video visits with no comparison group | (same as above) | Yes, impacted knowledge on effectiveness: design weakened | |
| Evaluation: Data collection | Conducted phone interviews in lieu of observations with interviews; patient surveys changed to interviews; data collection expanded to include more participant views; rapid data analysis rather than full coding | Unable to visit clinics in person; needed more in‐depth and rapid feedback to reach goals on time | No | |
| Project C: Initiative to develop a platform and workflow to reduce operating room case cycle times (the total time of the procedure plus the time it takes to clean and set‐up the room for the next surgery) | Project discontinuation | Project suspended and resources reallocated | Regional mandates to cancel elective surgeries; project deprioritized in favor of a project related to changes due to COVID‐19 (telehealth) | Project not completed |
| Project D: Hospital‐based initiative to implement a palliative predictive model to identify patients for advance care planning (ACP) and a workflow to support providers in having ACP conversations | Project discontinuation | Project suspended and resources reallocated | Project deprioritized by operational leaders in favor of a project to address COVID‐19 (clinical deterioration) | Project not completed |
| Project E: Palliative care program expansions or pilots at seven health systems to provide comprehensive palliative care for people with serious illness with the goals of increasing reach, reducing suffering, and increasing goal concordant care. Program components included hiring, training staff, and educating patients and referring providers. Mixed methods evaluation with aggregate patient data, interviews with providers, and site visits to assess effectiveness and implementation outcomes | Intervention: Training | Delayed or cancelled trainings needed to upskill staff | Unable to meet in person and trainings not yet moved to virtual format | Yes, impacted implementation: reduced ability to deliver intervention |
| Intervention: Staffing | Hiring freezes resulted in incomplete and understaffed teams | Financial uncertainty at the organizational level | Yes, impacted reach: limited capacity to deliver intervention | |
| Intervention: Delivery | In‐person visits shifted to video or telephone visits | Shelter in place orders and limiting in‐person contact | No | |
|
Evaluation: Data collection |
Postponed and changed data collection to virtual format; added interviews to ask about COVID‐19 impact | Unable to meet in person; wanted to understand impact of COVID‐19 on programs | No | |
| Project F: Palliative care intervention during the perioperative period for patients with upper gastrointestinal cancer seeking curative treatment. Phase of research included patient caregiver recruitment, and data collection of surveys and interviews to understand patient experience | Intervention: Delivery | Because surgeries were cancelled, there were no eligible patients for the study and the intervention was paused until surgeries resumed | Regional mandates to cancel non‐essential surgeries to prepare for surge | No |
|
Evaluation: Recruitment and data collection |
Recruitment paused as surgeries were suspended; once resumed, recruitment and data collection shifted to remote methods | Regional mandates to cancel non‐essential surgeries; unable to physically be in clinics | No | |
| Project G: A learning collaborative to promote supportive care practices in dialysis centers for patients with end‐stage kidney disease. Evaluation of the collaborative and supportive care practices included collection of health utilization data, observation of webinars and learning sessions, site visits to dialysis centers, surveys, and interviews | Intervention: Training | Content changed to focus on the pandemic rather than planned content; in‐person learning session moved to virtual format | Focus shifted to COVID‐19; unable to travel | Yes, impacted participation/reach: content changed and lower virtual session attendance |
| Intervention: Delivery | Some dialysis centers stopped identifying seriously ill patients and having goals of care discussions | Focus shifted to managing patient care and minimizing time in the dialysis center | Yes, impacted adoption: intervention activities not completed | |
|
Evaluation: Data collection |
Site visits cancelled; survey timing and content for patients changed to ask questions about COVID‐19 | Unable to travel; wanted to understand impact of COVID‐19 on implementers | No |