Table 3 Strategy endorsement in each year and change between years
# | Strategy and Cluster | Year 1 N = 80 | Year 2 N = 105 | Change |
|---|---|---|---|---|
Infrastructure | ||||
1 | • Change physical structure and equipment | 53% | 51% | − 2% |
2 | • Change the record systems | 71% | 57% | − 14% |
3 | • Change the location of clinical service sites | 26% | 37% | 11% |
4 | • Develop a separate organization or group responsible for disseminating HCV care | 23% | 33% | 10% |
5 | • Mandate changes to HCV care | 55% | 52% | − 3% |
6 | • Create or change credentialing and/or licensure standards | 29% | 30% | 1% |
7 | • Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation | 4% | 11% | 7% |
8 | • Change accreditation or membership requirements | 4% | 1% | − 3% |
Financial | ||||
9 | • Access new funding | 30% | 41% | 11% |
10 | • Alter incentive/allowance structures | 5% | 10% | 5% |
11 | • Provide financial disincentives for failure to implement or use the clinical innovations | 0% | 2% | 2% |
12 | • Respond to proposals to deliver HCV care | 44% | 51% | 7% |
13 | • Change billing | 11% | 14% | 3% |
14 | • Place HCV medications on the formulary | 70% | 69% | − 1% |
15 | • Alter patient fees | 0% | 0% | 0% |
16 | • Use capitated payments | 0% | 1% | 1% |
17 | • Use other payment schemes | 5% | 2% | − 3% |
Support clinicians | ||||
18 | • Create new clinical teams | 46% | 50% | 4% |
19 | • Facilitate the relay of clinical data to providers | 56% | 68% | 12% |
20 | • Revise professional roles | 50% | 55% | 5% |
21 | • Develop reminder systems for clinicians | 34% | 44% | 10% |
22 | • Develop resource sharing agreements | 26% | 35% | 9% |
Provide interactive assistance | ||||
23 | • Use outside assistance often called “facilitation” | 8% | 12% | 4% |
24 | • Have someone from inside the clinic or center (often called “local technical assistance”) tasked with assisting the clinic | 15% | 25% | 10% |
25 | • Provide clinical supervision | 44% | 48% | 4% |
26 | • Use a centralized system to deliver facilitation | 28% | 28% | 0% |
Adapt and tailor to context | ||||
27 | • Use data experts to manage HCV data | 58% | 70% | 12% |
28 | • Use data warehousing techniques | 85% | 91% | 6% |
29 | • Tailor strategies to deliver HCV care | 63% | 81% | 18%* |
30 | • Promote adaptability | 55% | 75% | 20%* |
Train and educate stakeholders | ||||
31 | • Conduct educational meetings | 51% | 64% | 13% |
32 | • Have an expert in HCV care meet with providers to educate them | 41% | 53% | 12% |
33 | • Provide ongoing HCV training | 49% | 60% | 11% |
34 | • Facilitate the formation of groups of providers and fostered a collaborative learning environment | 44% | 43% | − 1% |
35 | • Developed formal educational materials | 39% | 35% | − 4% |
36 | • Distribute educational materials | 55% | 55% | 0% |
37 | • Provide ongoing consultation with one or more HCV treatment experts | 58% | 71% | 13% |
38 | • Train designated clinicians to train others | 20% | 26% | 6% |
39 | • Vary the information delivery methods to cater to different learning styles when presenting new information | 36% | 36% | 0% |
40 | • Give providers opportunities to shadow other experts in HCV | 33% | 22% | − 11% |
41 | • Use educational institutions to train clinicians | 11% | 15% | 4% |
Develop stakeholder interrelationships | ||||
42 | • Build a local coalition/team to address challenges | 53% | 53% | 0% |
43 | • Conduct local consensus discussions | 48% | 54% | 6% |
44 | • Obtain formal written commitments from key partners that state what they will do to implement HCV care | 4% | 4% | 0% |
45 | • Recruit, designate, and/or train leaders | 26% | 23% | − 3% |
46 | • Inform local opinion leaders about advances in HCV care | 49% | 46% | − 3% |
47 | • Share the knowledge gained from quality improvement efforts with other sites outside your medical center | 38% | 57% | 19%* |
48 | • Identify and prepare champions | 50% | 52% | 2% |
49 | • Organize support teams of clinicians who are caring for patients with HCV and given them time to share the lessons learned and support one another’s learning | 26% | 32% | 6% |
50 | • Use advisory boards and interdisciplinary workgroups to provide input into HCV policies and elicit recommendations | 26% | 22% | − 4% |
51 | • Seek the guidance of experts in implementation | 44% | 50% | 6% |
52 | • Build on existing high-quality working relationships and networks to promote information sharing and problem solving related to implementing HCV care | 61% | 71% | 10% |
53 | • Use modeling or simulated change | 13% | 15% | 2% |
54 | • Partner with a university to share ideas | 14% | 11% | − 3% |
55 | • Make efforts to identify early adopters to learn from their experiences | 16% | 24% | 8% |
56 | • Visit other sites outside your medical center to try to learn from their experiences | 15% | 20% | 5% |
57 | • Develop an implementation glossary | 3% | 6% | 3% |
58 | • Involve executive boards | 23% | 33% | 10% |
Use evaluative and iterative strategies | ||||
59 | • Assess for readiness and identify barriers and facilitators to change | 26% | 30% | 4% |
60 | • Conduct a local needs assessment | 45% | 43% | − 2% |
61 | • Develop a formal implementation blueprint | 34% | 36% | 2% |
62 | • Start with small pilot studies and then scale them up | 23% | 25% | 2% |
63 | • Collect and summarize clinical performance data and give it to clinicians and administrators to implement changes in a cyclical fashion using small tests of change before making system-wide changes | 21% | 26% | 5% |
64 | • Conduct small tests of change, measured outcomes, and then refined these tests | 19% | 21% | 2% |
65 | • Develop and use tools for quality monitoring | 41% | 32% | − 9% |
66 | • Develop and organize systems that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement | 30% | 28% | − 2% |
67 | • Intentionally examine the efforts to promote HCV care | 61% | 69% | 8% |
68 | • Develop strategies to obtain and use patient and family feedback | 20% | 20% | 0% |
Engage consumers | ||||
69 | • Involve patients/consumers and family members | 50% | 61% | 11% |
70 | • Engage in efforts to prepare patients to be active participants in HCV care | 63% | 57% | − 6% |
71 | • Intervene with patients/consumers to promote uptake and adherence to HCV treatment | 71% | 79% | 8% |
72 | • Use mass media to reach large numbers of people | 18% | 36% | 18%* |
73 | • Promote demand for HCV care among patients through any other means | 40% | 52% | 12% |