Objectives Implementation science has shown to significantly improve the successful use of innovations in practice (Brunk et al, 2014, Fixsen et al, 2001, Forgatch & DeGarmo, 2011, Jackson et al, 2018), but no studies have explored the feasibility of using Implementation Science Software (ISS) as an Active Implementation Framework (AIF) tool. This study examines the impact of ISS to implement specific diagnostic spirometry testing [the intervention] throughout primary care in one Health Board in Wales. Spirometry is necessary for accurate COPD diagnosis, however around 25% of patients on GP registers have a record, which is incompatible with the condition (Baxter et al, 2015).
The objective was to instate one, currently employed, healthcare professional within each of the 75 GP practices in the region to implement the intervention with high fidelity. It was hypothesized that the ISS would achieve full implementation more efficiently (output/time) than a dissemination approach alone (without any AIF).
Method This was a real-world observational study comparing the differences between two methods for improving diagnostic testing quality over a 6-month period. Practitioners self-selected into two groups – Group A followed a traditional dissemination approach (let it happen) by a local intervention specialist, without any AIF; Group B was supported by implementation practice (make it happen) through ISS (AIF Implementation Software, The Institute of Clinical Science & Technology Ltd).
Aligned with published methodology (Fixsen & Blase, 2009), full implementation was achieved when 50% of all practitioners in the organization [primary care across one Health Board in Wales] provided services that met fidelity criteria. Fidelity criteria included quality-assured spirometry competency in practice evidenced by actual clinical practice reports from primary care. Practitioners from secondary care hospital settings were therefore excluded from the final analysis of fidelity assessment in practice.
Results No participant from group A achieved fidelity criteria in practice within 6 months. For group B, the AIF process within the software provided alignment with extended and supplementary implementation team activity through semi-automated coordination and virtual reinforced data feedback to practitioners and local implementation teams. This resulted in a total of 224 participants from primary and secondary care engaging with the programme through dissemination and 143 participants completing the education and the assessment of learning via Observed Structured Clinical Assessment (OSCE). A total of 88 candidates subsequently demonstrated quality in practice (fidelity assessment) at 6 months. Of the 75 GP practices [organization], 45 (60%) had at least one healthcare practitioner meeting fidelity criteria.
There was a nine-fold increase in participant engagement (n224 v n25) when using ISS rather than dissemination practice alone. Full implementation was only achieved in the ISS group where 60% of practitioners reaching fidelity at 6 months.
Abstract In this study, ISS has shown to improve dissemination and successful adoption of an intervention in practice when compared to traditional dissemination processes without an AIF. The factors relating to this success included a structured and aligned AIF, easy access not limited by time of day or implementation team member availability, consistent access to [coaching] support over the 6-month period studied and sustained fidelity assessment encapsulated within the ISS.
It is uncertain whether using ISS improves outcomes when compared to traditional implementation practice alone. However, where traditional interactive, non-linear, and additive implementation stages take between two and four years to accomplish full implementation (Brown et al, 2014, Saldana et al, 2012), the use of ISS in this case has achieved this goal in six months. Understanding the specific elements of implementation science methodology between the two approaches warrants future exploration.
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