Table 1 Implementation facilitation activities

Engagement with the facilitation team

The IF and EF teams engage during monthly project-wide and separate site-specific team calls. The IF team also contacts the EF team whenever questions arise related to PIPS implementation, while the EF team engages the IF team outside of scheduled calls when the need arises.

Academic detailing/education

Educating providers and key stakeholders about PIPS or other pain management assessment and treatment tools. This strategy involves direct outreach by the IF team and sometimes the EF team to educate providers at a given site. The intent is to promote providers’ use of PIPS through clear and regular education about the program and pain management strategies, including CIH treatments. This strategy can include one-on-one interactions with providers about PIPS treatment, PIPS educational meetings with different stakeholder groups (e.g., providers, administrator, veteran patient/consumer group, family stakeholders), assessment of PIPS knowledge and motivation to enroll patients in PIPS, and providing positive feedback for improved clinical practices as they relate to PIPS objectives.

Problem-solving

This activity is based on ongoing assessment, either formal (interviews, surveys) or informal (conversations), of implementation barriers to PIPS implementation. This information is used to troubleshoot challenges as they arise, using regularly scheduled site-specific and project-wide calls or communication in between meetings as necessary.

Audit and feedback

This activity is conducted monthly unless another schedule is deemed necessary. In brief, it involves collecting and summarizing clinical performance data related to PIPS (e.g., number referred, enrolled, completed) and providing that feedback to the IF and local champion at the site. This activity allows the implementation team to review progress and adjust behavior as necessary to enhance enrollment.

Capturing and sharing local knowledge

This activity occurs on the project-wide calls, but may also occur through informal communication (e.g., email). This activity is meant to help sites capture and share what is working to facilitate PIPS implementation in their clinical setting.

Changing record systems

Altering record systems as needed for PIPS implementation. The main records for PIPS are the letter to patients (explaining PIPS), a consult template for referral to PIPS, and intake and progress note templates stored in the electronic medical record. Each site can modify these records to fit their culture and care processes.

Marketing and distribution of materials

This activity typically involves the use of flyers and announcements in meetings or via email. It may occasionally overlap with academic detailing in that some marketing materials will be educational, describing key PIPS components and potential benefits to patients and providers.

Changing the clinical teams

This activity involves altering the team that provides care to PIPS patients, whether that be through replacing providers, adding new members, or changing duties and responsibilities. For example, if a new clinical pharmacist is brought into the team to help with referrals to PIPS, then that would represent a change in the clinical team.

Changing the implementation team

Changing or adding an IF, EF, or local champion to the implementation team.

Developing materials and adding them to a shared library

Placing PIPS-related materials in a shared library (computer-based or other) for the purposes of making it easier to access items and information that could be used to teach clinical team members or other stakeholders about PIPS and for providers to deliver the program.

Informing local opinion leaders

Members of the implementation team reach out to providers or administrators at a site who are educationally influential to inform them about PIPS and encourage them to support PIPS implementation (e.g., by mentioning PIPS at a staff meeting or talking about the benefits of PIPS for their patients).

Engaging national and regional policy makers

This activity entails the EF or IF teams reaching out to national or regional leadership about PIPS, informing them about implementation progress, or soliciting feedback on potential modifications.

Providing technical assistance and coaching

This activity is intended to help the IF teams and local staff deliver a high-quality PIPS clinical program. It can include providing assistance on the use of the automated case-finding dashboard tool or consult template or helping the provider improve their PIPS-related skills (e.g., adjusting medication tapering protocols, providing recommendations for CIH treatments).

Participation in a community of practice (COP)

The COP meeting occurs monthly for IF team members and providers and is led by the clinical expert of the EF team. Given the challenges and skills required to work with patients on opioid tapering and motivating them to engage with CIH treatments, the purpose of the COP is to advance accurate knowledge, improved skills, and positive attitudes when working with patients in the PIPS program.