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Table 3 Strategy endorsement in each year and change between years

From: Longitudinal assessment of the association between implementation strategy use and the uptake of hepatitis C treatment: Year 2

# 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%
  1. The bold and * represent statistically significant changes between years