A method for tracking implementation strategies: an exemplarimplementing measurement-based care in community behavioral healthclinics

摘要

Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement based care (MBC), this study aimed to: 1) describe a method for tracking implementation strategies, 2) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition 3) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on implementation strategy reporting guidelines and taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of 6 meetings in 5 months. There was little variability in theuse of types of implementation strategies across sites with the following orderof prevalence: Quality Management (50.00%), Restructuring (16.53),Communication (15.68%), Education (8.90%), Planning(7.20%), and Financing (1.69%). We identified a new category ofstrategies not captured by the existing taxonomy, labeled“Communication.” There was no evidence that number ofimplementation strategies enacted was statistically significantly associatedwith changes in self-reported fidelity to MBC; however, Financing strategieswere associated with increased fidelity. This method has the capacity to yieldrich data that will inform investigations into tailored implementationapproaches.