Table 4.
Project-Tailored Definitions and Application of CFIR Constructs Guiding Implementation and Evaluation
| Construct19 | Project-Tailored Definition | Application |
|---|---|---|
| Intervention Characteristic | ||
| Relative advantage | Perceived advantages of My Dialysis Plan compared with the clinic’s existing care plan approach | Presented an opportunity to provide more individualized dialysis care that was responsive to patient-identified priorities and consistent with care team members’ desired practice |
| Adaptability | Ability to modify and tailor My Dialysis Plan program components and resources to fit changing clinic needs | Iteratively updated program throughout implementation in response to stakeholder feedback |
| Complexity | Perceived difficulty, burden, learning curve, and/or workflow disruption associated with My Dialysis Plan implementation | Assigned program responsibilities to align with existing job roles; minimized additional responsibilities; provided program trainings |
| Outer Setting | ||
| External policy & incentives | Alignment of My Dialysis Plan with CMS guidance and regulations | Developed program to support CMS Conditions of Coverage |
| Inner Setting | ||
| Structural characteristics | Clinic size, characteristics, and social architecture | Selected large suburban dialysis clinic to enhance transferability of developed implementation processes |
| Implementation climate | Clinic stakeholders’ readiness for My Dialysis Plan implementation (ie, buy-in from all clinic stakeholders, cultural norms and values) | Interviewed clinic stakeholders throughout program implementation; discussed program logistics at monthly staff meetings |
| Compatibility | Clinic stakeholders’ desire for a person-centered care planning; fit of My Dialysis Plan with existing clinic workflows | Collaboratively developed program with patients, care teams, and medical providers to enhance relevance; refined implementation processes with clinic stakeholders to ensure local fit |
| Access to information | Readily available health-literacy level appropriate My Dialysis Plan materials for patients and care teams | Developed mixed-media education/implementation resources; updated program resources in response to stakeholder input |
| Characteristics of Individuals | ||
| Knowledge & beliefs about the intervention | Clinic stakeholders’ attitudes and beliefs about person-centered care planning and dialysis care planning experiences | Provided education on person-centered care planning; collected and incorporated clinic personnel feedback on program components |
| Self-efficacy | Care team members’ beliefs in their abilities to elicit and align care with patient priorities and document appropriately | Provided initial administrative support and training materials to ease implementation; sought guidance from goal-directed care expert |
| Process | ||
| Planning | Degree to which tasks for implementing My Dialysis Plan were developed in advance, and the quality of the methods | Collaboratively developed implementation plan with clinic personnel; assigned responsibilities to align with individual skillsets/comfort |
| Engaging | Winning clinic stakeholder buy-in through education and training | Conducted clinic personnel informational and training sessions; proactively sought stakeholder feedback |
| Implementation leaders & champions | Engaging individuals with influence on attitudes and beliefs of care team members and identifying care team members to take primary responsibility for My Dialysis Plan implementation | Engaged clinic operations manager in implementation plan development; identified dietitian as program champion |
| Executing | Implementing My Dialysis Plan according to the collaboratively developed implementation plan | Adhered to implementation plan when feasible; iteratively modified resources and implementation plan as needed |
| Reflecting & evaluating | Obtaining feedback about My Dialysis Plan implementation via monthly debriefing interviews with clinic stakeholders | Held routine care team and QI support team meetings to address barriers/facilitators; interviewed clinic stakeholders |
Abbreviations and Definitions: care team, social workers, dietitians, nurses, and medical providers; CFIR, Consolidated Framework for Implementation Research; clinic stakeholders, patients, clinic personnel, and medical providers; CMS, Centers for Medicare & Medicaid Services; QI, quality improvement.