From single to multiple behaviour change approaches in implementation science

Justin Presseau, PhD
University of Ottawa

ABSTRACT:
Behaviour change theory-informed implementation intervention development and evaluation often focuses on improving sub-optimally performed clinical practice, redressing variations in care, or de-implementing lower-value care. In many instances, such approaches focus on a given clinical action as the target for change. However, the professional context of those delivering healthcare and the lived experience of those receiving healthcare are characterised by navigating contexts involving engaging in multiple behaviours; where engaging in a given action may impact on other competing demands and/or the actions of others. Predominant methodological approaches and theoretical lenses used in implementation science may not yet be accounting for this system of multiple behaviours. This talk will explore the challenges and opportunities of shifting from a single behaviour to a multiple behaviour approach in implementation science. With examples of implementation research across a variety of chronic disease topic areas, this talk will explore the implications and opportunities for shifting to a multiple behaviour change approach for: identifying gaps in care and selecting focal behaviour(s), identifying theory-informed barriers/enablers to change, selecting intervention strategies and change techniques, and evaluating implementation strategies.

The Stanford Lightning Report: An Implementation Science Rapid Qualitative Approach for Formative Evaluation

Catherine Brown Johnson, PhD
Stanford School of Medicine

Steve Asch, MD, MPH
Stanford School of Medicine

ABSTRACT:
The Stanford Lightning Report is a structured but flexible rapid qualitative approach used to increase the pace of learning in healthcare implementation. Supporting Learning Health System goals as well as large-scale research agendas, it can be applied across settings, from quality improvement and to randomized trials, ensuring more successful implementation. This talk includes examples of Lightning Report use in addiction settings (e-cigarettes and opioid use), step-by-step instructions on how to employ the approach, and hands-on just-in-time consultation on how to incorporate the Lightning Report into your projects.

System-level Evidence Based Practice Implementation Research: Same questions, different method.

Rebecca Lengnick-Hall, PhD
Washington University in St. Louis

Gracelyn Cruden, PhD
Oregon Social Learning Center

ABSTRACT:
This presentation brings together two researchers with overlapping system-level implementation research interests. While we often ask the same research questions, our methodological and disciplinary differences allow us to answer these questions in different, but complementary ways. The shared line of inquiry questions 1) How are implementation processes affected by multi-level factors over time, and 2) how can implementation support tools be designed to support these complex implementation processes in a manner that is generalizable across contexts, implementation phases, and evidence-based practices (EBPs)?  In this presentation, we will each share an example of our work aimed at understanding the process of responding to evidence-based policy or practice initiatives across implementation phases, while highlighting the unique methodological approaches. Dr. Rebecca Lengnick-Hall will explain how contracting arrangements act as a “bridge” between the public sector systems that fund and the community-based organizations that deliver EBPs. Dr. Gracelyn Cruden will describe a decision support tool based in a multi-criteria decision analysis framework that was developed to support EBP adoption for local implementation. To conclude, we will explore specific ways that our different methodological perspectives have both informed and pushed the other’s research agenda forward. We hope to conclude this presentation by engaging the PSMG community in a discussion about the integration of system science and qualitative methods to understand system-level EBP implementation.

The Emergency Department as an Implementation Science Laboratory: Evidence Based Treatment for Opioid Use Disorder

Lauren Whiteside MD MS
Assistant Professor
Department of Emergency Medicine
University of Washington

ABSTRACT:
The Emergency Department (ED) is at the forefront of opioid public health crisis with increasing ED visits for overdose and opioid.  Additionally, deaths related to opioids are increasing despite work that is ongoing around harm reduction and access to treatment.  There is a growing body of evidence that patients with OUD initiated on buprenorphine in the ED are more likely to be engaged in substance use treatment at 30-days compared to patients who are referred to outpatient treatment only.  Additionally, there is an increasing evidence-base for other ED-based interventions such as take-home naloxone and care navigation to improve care transitions.

This talk will discuss some unique challenges related to implementation of evidence-based treatment in the ED.  Next, I will share results from a qualitative study of Emergency physicians highlighting the barriers and facilitators of ED-initiated buprenorphine using the Consolidated Framework for Implementation Science.  Lastly, I will describe a pilot pragmatic randomized clinical trial of a care coordination intervention called ‘Emergency Department Integrated Care’ or ED-LINC and discuss innovative ways to improve provision of evidence-based treatment for patients with OUD from the ED.

Approaches for implementing digital treatments for drug use disorders into primary care: A qualitative study of patient perspectives

Joseph E. Glass, PhD, MSW
Kaiser Permanente Washington Health Research Institute

ABSTRACT:
Researchers and health systems do not know how to care for large numbers of primary care patients with opioid and other substance use disorders, even though these conditions are increasingly deadly and costly. Digital treatments, or software-based care delivered via apps and websites, could be used to reach large numbers of patients with effective treatments. However, there is inadequate knowledge about how to support the delivery of digital treatments in primary care. This presentation will describe findings from research that engaged patient stakeholders to develop a user-centered approach for offering digital treatments to patients with opioid, stimulant, and cannabis use disorders.