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Implementing a Mandated Program Across a Regional Health Care System

A Rapid Qualitative Assessment to Evaluate Early Implementation Strategies

Sperber, Nina R. PhD; Bruening, Rebecca A. MPH; Choate, Ashley MPH; Mahanna, Elizabeth MPH; Wang, Virginia PhD; Powell, Byron J. PhD; Damush, Teresa PhD; Jackson, George L. PhD; Van Houtven, Courtney H. PhD; Allen, Kelli D. PhD; Hastings, Susan N. MD

doi: 10.1097/QMH.0000000000000221
Original Research

Background: Rapid qualitative assessment was used to describe early strategies to implement an evidence-based walking program for hospitalized older adults, assiSTed eaRly mobIlity for hospitalizeD older vEterans (STRIDE), mandated by a regional Department of Veterans Affairs health care system office (Veterans Integrated Service Network [VISN]).

Methods: Data were collected from 6 hospital sites via semistructured interviews with key informants, observations of telephone-based technical assistance, and review of VISN-requested program documents (eg, initial implementation plans). An overarching framework of actionable feedback for VISN leadership and specification of locally initiated implementation strategies, using the Expert Recommendations for Implementing Change (ERIC) compilation, was used. Actionable feedback was shared with VISN leadership 1 month after the initiative.

Results: ERIC implementation strategies identified were as follows: (1) promoting adaptability—4 sites had physical therapists/kinesiotherapists instead of assistants walk patients; (2) promoting network weaving—strengthening nursing and PT/KT partnership with regular communication opportunities or a point person was important for implementation; (3) distributing educational materials—2 sites distributed information about STRIDE via e-mail and in person; and (4) organizing clinician implementation team meetings—3 sites used interdisciplinary team meetings to communicate with the clinical staff about STRIDE.

Conclusion: This qualitative study sheds light on early experiences with implementing STRIDE; the results have been instructive for ongoing implementation and future dissemination of STRIDE, and the approach can be applied across contexts to inform implementation of other programs.

Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina (Drs Sperber, Wang, Jackson, Van Houtven, Allen, and Hastings and Mss Bruening, Choate, and Mahanna); Department of Population Health Sciences (Drs Sperber, Wang, Jackson, Van Houtven, and Hastings), Division of General Internal Medicine (Dr Wang), and Division of Geriatrics, Department of Medicine and Center for the Study of Aging (Dr Hastings), Duke University School of Medicine, Durham, North Carolina; Department of Health Policy and Management, Gillings School of Global Public Health (Dr Powell), and Department of Medicine & Thurston Arthritis Research Center (Dr Allen), University of North Carolina, Chapel Hill, North Carolina; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana (Dr Damush); and Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (Dr Damush).

Correspondence: Nina R. Sperber, PhD, Center of Innovation in Health Services Research, Durham VA Health Care System, 411 West Chapel Hill St, Ste 600, Durham, NC 27701 (

This study was funded by the Department of Veterans Affairs Quality Enhancement Research Initiative (QUE-16-170) and supported by the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), (CIN 13-410) at the Durham VA Health Care System. Susan N. Hastings was supported by the Duke Older American Independence Center, National Institutes of Health, National Institute on Aging grant no. AG028716. Byron Powell was supported by the National Institute of Mental Health through K01MH113806.

The contents do not represent the views of the US Department of Veterans Affairs or the US government.

The authors have no conflicts of interest.

© 2019Wolters Kluwer Health | Lippincott Williams & Wilkins