Table 4.
Strategies significantly associated with treatment in both years vs. only Year 1 or Year 2
| Both years | Year 1 only | Year 2 only |
|---|---|---|
| Change infrastructure | ||
| • Change physical structure/equipment • Change the location of clinical service sites |
• Change accreditation or membership requirements • Liability reform |
• Change the record systems |
| Financial strategies | ||
| • Alter incentive/allowance structures | ||
| Support clinicians | ||
| • Create new clinical teams • Revise professional roles |
• Develop resource sharing agreements | • Facilitate the relay of clinical data to providers |
| Provide interactive assistance | ||
| • Provide clinical supervision | • Local technical assistance • Use a centralized system to deliver facilitation |
|
| Adapt and tailor to the context | ||
| • Use data experts to manage HCV data | ||
| Train/educate providers | ||
| • Facilitate the formation of groups of providers and foster a collaborative learning environment | • Conduct educational meetings • Have an expert in HCV care meet with providers to educate them • Provide ongoing HCV training • Vary information delivery methods |
• Use educational institutions to train clinicians • Distribute educational materials |
| Develop stakeholder interrelationships | ||
| • Build a local coalition/team to address challenges • Conduct local consensus discussions • Recruit, designate, and/or train leaders • Use modeling or simulated change • Make efforts to identify early adopters to learn from their experiences |
• Partner with a university • Visit other sites outside your medical center to try to learn from their experiences • Identify and prepare champions • Inform local opinion leaders • Share the knowledge gained from quality improvement efforts with other sites • Build on existing high-quality working relationships and networks to promote information sharing and problem solving |
• 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 • Involve executive boards |
| Use evaluative and iterative strategies | ||
| • 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 | • Assess for readiness and identify barriers and facilitators to change • Develop a formal implementation blueprint • Develop and organize systems that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement • Intentionally examine the efforts to promote HCV care • Conduct small tests of change, measured outcomes, and then refined these tests • Develop strategies to obtain and use patient and family feedback |
|
| Engage consumers | ||
| • Engage in efforts to prepare patients to be active participants in HCV care | ||