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Table 3 Recommended strategies to address organizational level barriers as described by RE-AIM

From: Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

Domain

Recommendations

Reach targeted participant population

• Design referral processes that are (1) compatible and integrated with existing clinical processes; (2) effective in identifying and engaging high-risk participants; and (3) easy to use

• Engage clinicians who are the primary source of referrals through personal outreach and by providing easy-to-access, targeted information about DPP highlighting its (1) evidence base, (2) compatibility with local clinical processes, (3) advantages compared to status quo, and (4) organizational and clinical priority for diabetes prevention

Effectiveness of program

• Schedule sessions at a time and place convenient for participants

Adoption by clinical settings; evidenced by visible demonstration of commitment by executive leaders

• Target education and information to executive leadership about DPP including its (1) evidence base, (2) compatibility with clinical processes, (3) advantages compared to the status quo, and (4) organizational and clinical priority to inspire them to adopt the program

• Obtain a formal agreement (e.g., memorandum of understanding), signed by executive leadership, to commit to implement DPP

Implementation with consistency (track costs and adaptations)

• Target education and information to mid-level and clinical managers about DPP including its (1) evidence base, (2) compatibility with clinical processes, (3) advantages compared to the status quo, and (4) organizational and clinical priority to inspire them to help implementation teams solve problems and review progress

• Ensure adequate time to hire and train skilled and enthusiastic implementation leaders and coaches to deliver DPP

• Provide high-quality materials to coaches and participants that can be used effectively to support delivery of effective coaching during sessions (e.g., see http://www.diabetesprevention.pitt.edu/).

• Ensure adequate space availability for sessions

• Schedule sessions at locations and times that are convenient to participants, e.g., in community settings outside of normal clinic hours

Maintenance of DPP in the clinical setting over time

• Effectively report on outcomes and other key benefits from the local DPP to executive leadership, managers, and clinicians (especially those who may refer their patients to DPP) to gain support for the program and build a robust referral network