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Table 2 Methods and key implementation strategies in the substance use depression study

From: A process for developing an implementation intervention: QUERI Series

Study Component Description Relevant Literature
Purpose Test a multi-component implementation strategy vs. passive dissemination of evidence materials and implementation tools. [1, 34–36]
Design Randomized, quasi-experimental, hybrid design with patient-level clinical outcome data and formative evaluation data collected. [9, 37]
Sample/programs Four intensive outpatient SUD treatment programs in southern US, matched on program size/structure and current practices for assessing and treating depression. Two programs randomly selected as intervention sites.  
Evaluation types   
   • Diagnostic/developmental (formative evaluation) Site visits, observations of program operations, key informant interviews with staff, and interviews with veterans with depression in SUD clinics. [9, 13, 17, 38]
   • Implementation-and progress-focused (formative evaluation) Tracking of: rates of screening, fidelity to screening protocol, consults with program psychiatrists, and use of antidepressants. Frequent phone/e-mail contact with participants to document previously unforeseen barriers/problems and to brainstorm solutions. Number of contacts with site logged. [9, 38]
   • Interpretive (formative evaluation) Analysis of all formative evaluation data, including key informant interviews at close of implementation period to document stakeholder experiences. [9, 37–38]
   • Summative Quantitative analysis of patient outcomes. Fifty depression patients from each program surveyed during treatment and at 3- and 6-months post treatment. [37–38]
Implementation strategy   
   • Development Panels Local development teams made up of clinicians and administrators from each site and the PI considered barrier/facilitator data from development evaluation and literature on depression management implementation strategies/tools. Panel drafted locally-customized clinical care and implementation strategy/tools. Off-site experts consulted to insure that clinical and implementation tools were evidence-based. Panel iteratively redrafted strategy/tools until panel and experts approved of plans. [1–7, 13, 39–40]
   • Other implementation interventions considered by Panel Clinical reminders, audit and feedback, clinical education, marketing, consumer activation, clinical champions, and multi-component vs. single component interventions. [1, 3–4, 7, 13, 17, 41–46]
   • Facilitation Internal facilitators to be local "champions" who gather implementation-focused, present at staff meetings, maintain contact with study staff. External facilitation provided by study PI involved problem solving, technical assistance, and creation of educational and clinical support tools. [9, 17]