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Tracking Implementation Strategies in the Randomized Rollout of a Veterans Affairs National Opioid Risk Management Initiative
Shari S. Rogal
VA Pittsburgh Healthcare System
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8184-1546
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Implementation Science.
Background: In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete ‘case reviews’ for Veterans identified in the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard as high risk for adverse outcomes among patients prescribed opioids.. Half of facilities were randomly assigned to a Notice version including additional oversight. We evaluated implementation strategies used, whether strategies differed by randomization arm, and which strategies were associated with case review completion rates.
Methods: Facility points of contact completed a survey assessing their facility’s use of 68 implementation strategies based on the Expert Recommendations for Implementing Change taxonomy. We collected respondent demographic information, facility-level characteristics, and case review completion rates (percentage of high-risk patients who received a case review). We used Kruskal-Wallis tests and negative binomial regression to assess strategy use and factors associated with case reviews.
Results: Contacts at 89 of 140 facilities completed the survey (64%) and reported using a median of 23 (IQR: 16-31) strategies. The median case review completion rate was 71% (IQR: 48%-95%). Neither the number or types of strategies nor completion rates differed by randomization arm. The most common strategies were: using the STORM dashboard (97%); working with local opinion leaders (80%); and recruiting local partners (80%). Characteristics associated with case review completion rates included respondents being <35 years old (incidence rate ratio, IRR: 1.35, 95%CI: 1.09-1.67) and having <5 years in their primary role (IRR: 1.23; 95%CI: 1.01-1.51), and facilities having more prior academic detailing around pain and opioid safety (IRR: 1.40, 95%CI: 1.12-1.75). Controlling for these characteristics, implementation strategies associated with higher completion rates included: 1) monitoring and adjusting practices (adjusted IRR, (AIRR): 1.40, 95%CI: 1.11-1.77), 2) identifying adaptations while maintaining core components (AIRR: 1.28, 95%CI: 1.03-1.60), 3) conducting initial training (AIRR: 1.16, 95%CI: 1.02-1.50), and 4) regularly sharing lessons learned (AIRR: 1.32, 95%CI: 1.09-1.59).
Conclusions: In this national evaluation of strategies used to implement case reviews of patients at high risk of opioid-related adverse events, point of contact age and tenure in current role, prior pain-related academic detailing at the facility, and four specific implementation strategies were associated with case review completion rates, while randomization to additional centralized oversight was not.
Trial registration: This project is registered at the ISRCTN Registry with number ISRCTN16012111 (URL: http://www.isrctn.com/ISRCTN16012111). The trial was first registered on 5/3/2017.
Keywords
tailoring, evaluation, adaptation, monitoring
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CURRENT STATUS: Published
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Posted 02 Jun, 2020
Published
On 23 Jun, 2020
No community comments so far
Editorial decision: Accept
On 28 May, 2020
Editor assigned
On 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
No comments provided
Editorial decision: Minor revision
On 06 Apr, 2020
Review #2 received
Received 05 Apr, 2020
Reviewer #2 agreed
On 11 Mar, 2020
Review #1 received
Received 28 Feb, 2020
Reviewer #1 agreed
On 20 Feb, 2020
Reviewers invited
Invitations sent on 17 Feb, 2020
Editor assigned
On 05 Feb, 2020
First submitted
On 04 Feb, 2020
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On 04 Feb, 2020
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This preprint is under consideration at Implementation Science. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Tracking Implementation Strategies in the Randomized Rollout of a Veterans Affairs National Opioid Risk Management Initiative
Shari S. Rogal
VA Pittsburgh Healthcare System
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8184-1546
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 02 Jun, 2020
Published
On 23 Jun, 2020
No community comments so far
Editorial decision: Accept
On 28 May, 2020
Editor assigned
On 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
No comments provided
Editorial decision: Minor revision
On 06 Apr, 2020
Review #2 received
Received 05 Apr, 2020
Reviewer #2 agreed
On 11 Mar, 2020
Review #1 received
Received 28 Feb, 2020
Reviewer #1 agreed
On 20 Feb, 2020
Reviewers invited
Invitations sent on 17 Feb, 2020
Editor assigned
On 05 Feb, 2020
First submitted
On 04 Feb, 2020
Submission checks complete
On 04 Feb, 2020
Editor invited
On 04 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Implementation Science.
Background: In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete ‘case reviews’ for Veterans identified in the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard as high risk for adverse outcomes among patients prescribed opioids.. Half of facilities were randomly assigned to a Notice version including additional oversight. We evaluated implementation strategies used, whether strategies differed by randomization arm, and which strategies were associated with case review completion rates.
Methods: Facility points of contact completed a survey assessing their facility’s use of 68 implementation strategies based on the Expert Recommendations for Implementing Change taxonomy. We collected respondent demographic information, facility-level characteristics, and case review completion rates (percentage of high-risk patients who received a case review). We used Kruskal-Wallis tests and negative binomial regression to assess strategy use and factors associated with case reviews.
Results: Contacts at 89 of 140 facilities completed the survey (64%) and reported using a median of 23 (IQR: 16-31) strategies. The median case review completion rate was 71% (IQR: 48%-95%). Neither the number or types of strategies nor completion rates differed by randomization arm. The most common strategies were: using the STORM dashboard (97%); working with local opinion leaders (80%); and recruiting local partners (80%). Characteristics associated with case review completion rates included respondents being <35 years old (incidence rate ratio, IRR: 1.35, 95%CI: 1.09-1.67) and having <5 years in their primary role (IRR: 1.23; 95%CI: 1.01-1.51), and facilities having more prior academic detailing around pain and opioid safety (IRR: 1.40, 95%CI: 1.12-1.75). Controlling for these characteristics, implementation strategies associated with higher completion rates included: 1) monitoring and adjusting practices (adjusted IRR, (AIRR): 1.40, 95%CI: 1.11-1.77), 2) identifying adaptations while maintaining core components (AIRR: 1.28, 95%CI: 1.03-1.60), 3) conducting initial training (AIRR: 1.16, 95%CI: 1.02-1.50), and 4) regularly sharing lessons learned (AIRR: 1.32, 95%CI: 1.09-1.59).
Conclusions: In this national evaluation of strategies used to implement case reviews of patients at high risk of opioid-related adverse events, point of contact age and tenure in current role, prior pain-related academic detailing at the facility, and four specific implementation strategies were associated with case review completion rates, while randomization to additional centralized oversight was not.
Trial registration: This project is registered at the ISRCTN Registry with number ISRCTN16012111 (URL: http://www.isrctn.com/ISRCTN16012111). The trial was first registered on 5/3/2017.
Figure 1
Figure 2