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Moulton JE, Botfield JR, Subasinghe AK, Withanage NN, Mazza D. Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review. J Clin Nurs 2024; 33:2971-3017. [PMID: 38500016 DOI: 10.1111/jocn.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
AIM To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care. DESIGN This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCE/REVIEW METHODS Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models. RESULTS One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy. CONCLUSION Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective. IMPACT Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally. REPORTING METHOD This review is reported against the PRISMA-ScR criteria. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION The study protocol is published in BJGP Open (Moulton et al., 2022).
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Affiliation(s)
- Jessica E Moulton
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Asvini K Subasinghe
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Nishadi Nethmini Withanage
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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Peracca SB, Lachica O, Lamkin RP, Jackson GL, Mohr DC, King HA, Whited JD, Fonseca AS, Morris IJ, Gifford AL, Weinstock MA, Oh DH. Implementation of Direct-to-Patient Mobile Teledermatology in VA. J Gen Intern Med 2024; 39:97-105. [PMID: 38252250 PMCID: PMC10937882 DOI: 10.1007/s11606-023-08480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Innovative technology can enhance patient access to healthcare but must be successfully implemented to be effective. OBJECTIVE We evaluated Department of Veterans Affairs' (VA's) implementation of My VA Images, a direct-to-patient asynchronous teledermatology mobile application enabling established dermatology patients to receive follow-up care remotely instead of in-person. DESIGN /PARTICIPANTS/APPROACH Following pilot testing at 3 facilities, the app was introduced to 28 facilities (4 groups of 7) every 3 months using a stepped-wedge cluster-randomized design. Using the Organizational Theory of Implementation Effectiveness, we examined the app's implementation using qualitative and quantitative data consisting of encounter data from VA's corporate data warehouse; app usage from VA's Mobile Health database; bi-monthly reports from facility representatives; phone interviews with clinicians; and documented communications between the operational partner and facility staff. KEY RESULTS Implementation policies and practices included VA's vision to expand home telehealth and marketing/communication strategies. The COVID-19 pandemic dominated the implementation climate by stressing staffing, introducing competing demands, and influencing stakeholder attitudes to the app, including its fit to their values. These factors were associated with mixed implementation effectiveness, defined as high quality consistent use. Nineteen of 31 exposed facilities prepared to use the app; 10 facilities used it for actual patient care, 7 as originally intended. Residents, nurse practitioners, and physician assistants were more likely than attendings to use the app. Facilities exposed to the app pre-pandemic were more likely to use and sustain the new process. CONCLUSIONS Considerable heterogeneity existed in implementing mobile teledermatology, despite VA's common mission, integrated healthcare system, and stakeholders' broad interest. Identifying opportunities to target favorable facilities and user groups (such as teaching facilities and physician extenders, respectively) while addressing internal implementation barriers including incomplete integration with the electronic health record as well as inadequate staffing may help optimize the initial impact of direct-to-patient telehealth. The COVID pandemic was a notable extrinsic barrier. CLINICAL TRIALS REGISTRATION NCT03241589.
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Affiliation(s)
- Sara B Peracca
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Olevie Lachica
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Rebecca P Lamkin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA
- Division of General Internal Medicine, Duke University School of Medicine, 6301 Herndon Road, Durham, NC, 27713, USA
| | - John D Whited
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Division of General Internal Medicine, Duke University School of Medicine, 6301 Herndon Road, Durham, NC, 27713, USA
| | - Allene S Fonseca
- Department of Dermatology, Wayne State University, 18101 Oakwood Boulevard #402, Dearborn, MI, 48124, USA
| | - Isis J Morris
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord Street, Boston, MA, 02118, USA
| | - Martin A Weinstock
- Department of Dermatology and Epidemiology, Brown University, 593 Eddy Street, Providence, RI, 02903, USA
- Center for Dermatoepidemiology, Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Dennis H Oh
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA.
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, San Francisco, CA, 94115, USA.
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Peracca SB, Fonseca AS, Lachica O, Jackson GL, Morris IJ, King HA, Misitzis A, Whited JD, Mohr DC, Lamkin RP, Gifford AL, Weinstock MA, Oh DH. Organizational Readiness for Patient-Facing Mobile Teledermatology to Care for Established Veteran Patients in the United States. Telemed J E Health 2023; 29:72-80. [PMID: 35612465 DOI: 10.1089/tmj.2022.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose: To improve patient access to skin care, the Department of Veterans Affairs (VA) developed a patient-facing asynchronous mobile teledermatology application (app), which allows patients to follow up remotely with dermatologists. To understand how the app would be received in VA, we examined Organizational Readiness for Change (ORC), an important prelude to effective implementation, which includes the shared resolve and collective ability of organizational members to implement a change. Methods: We used a mixed-methods multiple case study approach to assess ORC at three VA facilities. Data derived from a site process call, surveys, and semistructured telephone interviews of VA staff, field notes, and administrative data. Results: Participants at all three facilities supported the intervention and recognized the value of using the app to increase patients' access to dermatologists, but expressed concerns largely related to disruption of the pre-existing clinical workflow. Participants at the facility most actively using the app had the highest overall ORC score and reported the most facilitators. Facility leadership support when guided by a clinical champion minimized barriers by recognizing the complexities of health care provision at specialty clinics. Discussion: While provider buy-in remained a barrier, leadership, guided by the clinical champion, played a critical role instituting implementation strategies. The strong association between the ORC survey score and the presence of facilitators and barriers suggests that the ORC survey may be a rapid, convenient, and effective tool for health care systems to identify favorable sites for wider implementation of mobile telehealth care. Clinical Trials Identifier: NCT03241589.
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Affiliation(s)
- Sara B Peracca
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - Allene S Fonseca
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Olevie Lachica
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Isis J Morris
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angelica Misitzis
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - John D Whited
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Rebecca P Lamkin
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts, USA.,Department of Medicine, Section of General Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Dennis H Oh
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA.,Department of Dermatology, University of California at San Francisco, San Francisco, California, USA
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Schleyer T, Williams L, Gottlieb J, Weaver C, Saysana M, Azar J, Sadowski J, Frederick C, Hui S, Kara A, Ruppert L, Zappone S, Bushey M, Grout R, Embi PJ. The Indiana Learning Health System Initiative: Early experience developing a collaborative, regional learning health system. Learn Health Syst 2021; 5:e10281. [PMID: 34277946 PMCID: PMC8278436 DOI: 10.1002/lrh2.10281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Learning health systems (LHSs) are usually created and maintained by single institutions or healthcare systems. The Indiana Learning Health System Initiative (ILHSI) is a new multi-institutional, collaborative regional LHS initiative led by the Regenstrief Institute (RI) and developed in partnership with five additional organizations: two Indiana-based health systems, two schools at Indiana University, and our state-wide health information exchange. We report our experiences and lessons learned during the initial 2-year phase of developing and implementing the ILHSI. METHODS The initial goals of the ILHSI were to instantiate the concept, establish partnerships, and perform LHS pilot projects to inform expansion. We established shared governance and technical capabilities, conducted a literature review-based and regional environmental scan, and convened key stakeholders to iteratively identify focus areas, and select and implement six initial joint projects. RESULTS The ILHSI successfully collaborated with its partner organizations to establish a foundational governance structure, set goals and strategies, and prioritize projects and training activities. We developed and deployed strategies to effectively use health system and regional HIE infrastructure and minimize information silos, a frequent challenge for multi-organizational LHSs. Successful projects were diverse and included deploying a Fast Healthcare Interoperability Standards (FHIR)-based tool across emergency departments state-wide, analyzing free-text elements of cross-hospital surveys, and developing models to provide clinical decision support based on clinical and social determinants of health. We also experienced organizational challenges, including changes in key leadership personnel and varying levels of engagement with health system partners, which impacted initial ILHSI efforts and structures. Reflecting on these early experiences, we identified lessons learned and next steps. CONCLUSIONS Multi-organizational LHSs can be challenging to develop but present the opportunity to leverage learning across multiple organizations and systems to benefit the general population. Attention to governance decisions, shared goal setting and monitoring, and careful selection of projects are important for early success.
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Affiliation(s)
- Titus Schleyer
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Linda Williams
- Center for Health Services ResearchRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
- VA HSR&D EXTEND QUERIRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA
| | - Jonathan Gottlieb
- Department of Health AdministrationUniversity of ProvidenceGreat FallsMontanaUSA
| | - Christopher Weaver
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Physician AdministrationIndiana University HealthIndianapolisIndianaUSA
| | - Michele Saysana
- Physician AdministrationIndiana University HealthIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jose Azar
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Division of Quality and Patient SafetyIndiana University HealthIndianapolisIndianaUSA
| | - Josh Sadowski
- Department of Infection PreventionIndiana University HealthIndianapolisIndianaUSA
| | - Chris Frederick
- AdministrationRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Siu Hui
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of Biostatistics & Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - Areeba Kara
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Laura Ruppert
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Sarah Zappone
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Michael Bushey
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of PsychiatryIndiana University HealthIndianapolisIndianaUSA
| | - Randall Grout
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
- InformaticsEskenazi HealthIndianapolisIndianaUSA
| | - Peter J. Embi
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- AdministrationRegenstrief Institute, IncIndianapolisIndianaUSA
- AdministrationIndiana University HealthIndianapolisIndianaUSA
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Nevedal AL, Reardon CM, Jackson GL, Cutrona SL, White B, Gifford AL, Orvek E, DeLaughter K, White L, King HA, Henderson B, Vega R, Damschroder L. Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study. Implement Sci Commun 2020; 1:61. [PMID: 32885216 PMCID: PMC7427879 DOI: 10.1186/s43058-020-00053-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual "Shark Tank" competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. METHODS Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5-2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. RESULTS Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. CONCLUSIONS Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA's DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability.
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Affiliation(s)
- Andrea L. Nevedal
- Center for Innovation to Implementation, VHA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025 USA
| | - Caitlin M. Reardon
- Center for Clinical Management Research, VHA Ann Arbor Healthcare System, 2215 Fuller Rd., 152, Ann Arbor, MI 48105 USA
| | - George L. Jackson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701 USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Brandolyn White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Section of General Internal Medicine & Department of Health Law, Policy & Management, Boston University, 715 Albany St., Talbot Building, T2W, Boston, MA 02118 USA
| | - Elizabeth Orvek
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Lindsay White
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
| | - Heather A. King
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701 USA
| | - Blake Henderson
- Diffusion of Excellence, VHA Innovation Ecosystem, 810 Vermont Avenue NW, Washington, DC, 20420 USA
| | - Ryan Vega
- VHA Office of Discovery, Education and Affiliate Networks, 810 Vermont Avenue NW, Washington, DC, 20420 USA
| | - Laura Damschroder
- Center for Clinical Management Research, VHA Ann Arbor Healthcare System, 2215 Fuller Rd., 152, Ann Arbor, MI 48105 USA
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