Table 3.
Strategy endorsement in each year and change between years
| # | Strategy and Cluster | Year 1 N = 80 |
Year 2 N = 105 |
Change |
|---|---|---|---|---|
| Infrastructure | ||||
| 1 | • Change physical structure and equipment | 53% | 51% | − 2% |
| 2 | • Change the record systems | 71% | 57% | − 14% |
| 3 | • Change the location of clinical service sites | 26% | 37% | 11% |
| 4 | • Develop a separate organization or group responsible for disseminating HCV care | 23% | 33% | 10% |
| 5 | • Mandate changes to HCV care | 55% | 52% | − 3% |
| 6 | • Create or change credentialing and/or licensure standards | 29% | 30% | 1% |
| 7 | • Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation | 4% | 11% | 7% |
| 8 | • Change accreditation or membership requirements | 4% | 1% | − 3% |
| Financial | ||||
| 9 | • Access new funding | 30% | 41% | 11% |
| 10 | • Alter incentive/allowance structures | 5% | 10% | 5% |
| 11 | • Provide financial disincentives for failure to implement or use the clinical innovations | 0% | 2% | 2% |
| 12 | • Respond to proposals to deliver HCV care | 44% | 51% | 7% |
| 13 | • Change billing | 11% | 14% | 3% |
| 14 | • Place HCV medications on the formulary | 70% | 69% | − 1% |
| 15 | • Alter patient fees | 0% | 0% | 0% |
| 16 | • Use capitated payments | 0% | 1% | 1% |
| 17 | • Use other payment schemes | 5% | 2% | − 3% |
| Support clinicians | ||||
| 18 | • Create new clinical teams | 46% | 50% | 4% |
| 19 | • Facilitate the relay of clinical data to providers | 56% | 68% | 12% |
| 20 | • Revise professional roles | 50% | 55% | 5% |
| 21 | • Develop reminder systems for clinicians | 34% | 44% | 10% |
| 22 | • Develop resource sharing agreements | 26% | 35% | 9% |
| Provide interactive assistance | ||||
| 23 | • Use outside assistance often called “facilitation” | 8% | 12% | 4% |
| 24 | • Have someone from inside the clinic or center (often called “local technical assistance”) tasked with assisting the clinic | 15% | 25% | 10% |
| 25 | • Provide clinical supervision | 44% | 48% | 4% |
| 26 | • Use a centralized system to deliver facilitation | 28% | 28% | 0% |
| Adapt and tailor to context | ||||
| 27 | • Use data experts to manage HCV data | 58% | 70% | 12% |
| 28 | • Use data warehousing techniques | 85% | 91% | 6% |
| 29 | • Tailor strategies to deliver HCV care | 63% | 81% | 18%* |
| 30 | • Promote adaptability | 55% | 75% | 20%* |
| Train and educate stakeholders | ||||
| 31 | • Conduct educational meetings | 51% | 64% | 13% |
| 32 | • Have an expert in HCV care meet with providers to educate them | 41% | 53% | 12% |
| 33 | • Provide ongoing HCV training | 49% | 60% | 11% |
| 34 | • Facilitate the formation of groups of providers and fostered a collaborative learning environment | 44% | 43% | − 1% |
| 35 | • Developed formal educational materials | 39% | 35% | − 4% |
| 36 | • Distribute educational materials | 55% | 55% | 0% |
| 37 | • Provide ongoing consultation with one or more HCV treatment experts | 58% | 71% | 13% |
| 38 | • Train designated clinicians to train others | 20% | 26% | 6% |
| 39 | • Vary the information delivery methods to cater to different learning styles when presenting new information | 36% | 36% | 0% |
| 40 | • Give providers opportunities to shadow other experts in HCV | 33% | 22% | − 11% |
| 41 | • Use educational institutions to train clinicians | 11% | 15% | 4% |
| Develop stakeholder interrelationships | ||||
| 42 | • Build a local coalition/team to address challenges | 53% | 53% | 0% |
| 43 | • Conduct local consensus discussions | 48% | 54% | 6% |
| 44 | • Obtain formal written commitments from key partners that state what they will do to implement HCV care | 4% | 4% | 0% |
| 45 | • Recruit, designate, and/or train leaders | 26% | 23% | − 3% |
| 46 | • Inform local opinion leaders about advances in HCV care | 49% | 46% | − 3% |
| 47 | • Share the knowledge gained from quality improvement efforts with other sites outside your medical center | 38% | 57% | 19%* |
| 48 | • Identify and prepare champions | 50% | 52% | 2% |
| 49 | • Organize support teams of clinicians who are caring for patients with HCV and given them time to share the lessons learned and support one another’s learning | 26% | 32% | 6% |
| 50 | • Use advisory boards and interdisciplinary workgroups to provide input into HCV policies and elicit recommendations | 26% | 22% | − 4% |
| 51 | • Seek the guidance of experts in implementation | 44% | 50% | 6% |
| 52 | • Build on existing high-quality working relationships and networks to promote information sharing and problem solving related to implementing HCV care | 61% | 71% | 10% |
| 53 | • Use modeling or simulated change | 13% | 15% | 2% |
| 54 | • Partner with a university to share ideas | 14% | 11% | − 3% |
| 55 | • Make efforts to identify early adopters to learn from their experiences | 16% | 24% | 8% |
| 56 | • Visit other sites outside your medical center to try to learn from their experiences | 15% | 20% | 5% |
| 57 | • Develop an implementation glossary | 3% | 6% | 3% |
| 58 | • Involve executive boards | 23% | 33% | 10% |
| Use evaluative and iterative strategies | ||||
| 59 | • Assess for readiness and identify barriers and facilitators to change | 26% | 30% | 4% |
| 60 | • Conduct a local needs assessment | 45% | 43% | − 2% |
| 61 | • Develop a formal implementation blueprint | 34% | 36% | 2% |
| 62 | • Start with small pilot studies and then scale them up | 23% | 25% | 2% |
| 63 | • Collect and summarize clinical performance data and give it to clinicians and administrators to implement changes in a cyclical fashion using small tests of change before making system-wide changes | 21% | 26% | 5% |
| 64 | • Conduct small tests of change, measured outcomes, and then refined these tests | 19% | 21% | 2% |
| 65 | • Develop and use tools for quality monitoring | 41% | 32% | − 9% |
| 66 | • Develop and organize systems that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement | 30% | 28% | − 2% |
| 67 | • Intentionally examine the efforts to promote HCV care | 61% | 69% | 8% |
| 68 | • Develop strategies to obtain and use patient and family feedback | 20% | 20% | 0% |
| Engage consumers | ||||
| 69 | • Involve patients/consumers and family members | 50% | 61% | 11% |
| 70 | • Engage in efforts to prepare patients to be active participants in HCV care | 63% | 57% | − 6% |
| 71 | • Intervene with patients/consumers to promote uptake and adherence to HCV treatment | 71% | 79% | 8% |
| 72 | • Use mass media to reach large numbers of people | 18% | 36% | 18%* |
| 73 | • Promote demand for HCV care among patients through any other means | 40% | 52% | 12% |
The bold and * represent statistically significant changes between years