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Piazza KM, Ashcraft LE, Rose L, Hall DE, Brown RT, Bowen MEL, Mavandadi S, Brecher AC, Keddem S, Kiosian B, Long JA, Werner RM, Burke RE. Study protocol: Type III hybrid effectiveness-implementation study implementing Age-Friendly evidence-based practices in the VA to improve outcomes in older adults. Implement Sci Commun 2023; 4:57. [PMID: 37231459 PMCID: PMC10209584 DOI: 10.1186/s43058-023-00431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Unmet care needs among older adults accelerate cognitive and functional decline and increase medical harms, leading to poorer quality of life, more frequent hospitalizations, and premature nursing home admission. The Department of Veterans Affairs (VA) is invested in becoming an "Age-Friendly Health System" to better address four tenets associated with reduced harm and improved outcomes among the 4 million Veterans aged 65 and over receiving VA care. These four tenets focus on "4Ms" that are fundamental to the care of older adults, including (1) what Matters (ensuring that care is consistent with each person's goals and preferences); (2) Medications (only using necessary medications and ensuring that they do not interfere with what matters, mobility, or mentation); (3) Mentation (preventing, identifying, treating, and managing dementia, depression, and delirium); and (4) Mobility (promoting safe movement to maintain function and independence). The Safer Aging through Geriatrics-Informed Evidence-Based Practices (SAGE) Quality Enhancement Research Initiative (QUERI) seeks to implement four evidence-based practices (EBPs) that have shown efficacy in addressing these core tenets of an "Age-Friendly Health System," leading to reduced harm and improved outcomes in older adults. METHODS We will implement four EBPs in 9 VA medical centers and associated outpatient clinics using a type III hybrid effectiveness-implementation stepped-wedge trial design. We selected four EBPs that align with Age-Friendly Health System principles: Surgical Pause, EMPOWER (Eliminating Medications Through Patient Ownership of End Results), TAP (Tailored Activities Program), and CAPABLE (Community Aging in Place - Advancing Better Living for Elders). Guided by the Pragmatic Robust Implementation and Sustainability Model (PRISM), we are comparing implementation as usual vs. active facilitation. Reach is our primary implementation outcome, while "facility-free days" is our primary effectiveness outcome across evidence-based practice interventions. DISCUSSION To our knowledge, this is the first large-scale randomized effort to implement "Age-Friendly" aligned evidence-based practices. Understanding the barriers and facilitators to implementing these evidence-based practices is essential to successfully help shift current healthcare systems to become Age-Friendly. Effective implementation of this project will improve the care and outcomes of older Veterans and help them age safely within their communities. TRIAL REGISTRATION Registered 05 May 2021, at ISRCTN #60,657,985. REPORTING GUIDELINES Standards for Reporting Implementation Studies (see attached).
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Affiliation(s)
- Kirstin Manges Piazza
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA.
| | - Laura Ellen Ashcraft
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Liam Rose
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University, Stanford, CA, USA
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Daniel E Hall
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rebecca T Brown
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Geriatrics and Extended Care Program, Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Mary Elizabeth Libbey Bowen
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- Education, and Clinical Center, VISN4 Mental Illness Research, Corporal Michael JCrescenz VA Medical Center, Philadelphia, PA, USA
| | - Shahrzad Mavandadi
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- School of Nursing, University of Delaware, Newark, DE, USA
| | | | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Family Medicine & Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bruce Kiosian
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Geriatrics and Extended Care Program, Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Judith A Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel M Werner
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Tsai J, Havlik J, Howell BA, Johnson E, Rosenthal D. Primary Care for Veterans Experiencing Homelessness: a Narrative Review of the Homeless Patient Aligned Care Team (HPACT) Model. J Gen Intern Med 2023; 38:765-783. [PMID: 36443628 PMCID: PMC9971390 DOI: 10.1007/s11606-022-07970-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
In 2011, the U.S. Department of Veterans Health (VA) implemented a homeless-tailored primary care medical home model called the Homeless Patient Aligned Care Teams (HPACTs). The impact of HPACTs on health and healthcare outcomes of veterans experiencing homelessness has not been adequately synthesized. This narrative review summarized peer-reviewed studies published in databases Ovid MEDLINE, Ovid EMBASE, and APA PsycInfo from 1946 to February 2022. Only original research studies that reported outcomes of the HPACT model were included in the review. Of 575 studies that were initially identified and screened, 26 studies met inclusion criteria and were included in this review. Included studies were categorized into studies that described the following: (1) early HPACT pilot implementation; (2) HPACT's association with service quality and utilization; and (3) specialized HPACT programs. Together, studies in this review suggest HPACT is associated with reductions in emergency department utilization and improvements in primary care utilization, engagement, and positive patient experiences; however, the methodological rigor of the included studies was low, and thus, these findings should only be considered preliminary. There is a need for randomized controlled trials assessing the impact of the PACT model on key outcomes of interest, as well as to determine whether the model is a viable way to manage healthcare for persons experiencing homelessness outside of the VA system.
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Affiliation(s)
- Jack Tsai
- Office of Homeless Programs, U.S. Department of Veterans Affairs, Washington D.C., USA.
- University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX, 77030, USA.
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - John Havlik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin A Howell
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Erin Johnson
- Office of Homeless Programs, U.S. Department of Veterans Affairs, Washington D.C., USA
| | - David Rosenthal
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- 4Catalyzer Inc., CT, Guilford, USA
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Smelson DA, Yakovchenko V, Byrne T, McCullough MB, Smith JL, Bruzios KE, Gabrielian S. Testing implementation facilitation for uptake of an evidence-based psychosocial intervention in VA homeless programs: A hybrid type III trial. PLoS One 2022; 17:e0265396. [PMID: 35298514 PMCID: PMC8929696 DOI: 10.1371/journal.pone.0265396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Healthcare systems face difficulty implementing evidence-based practices, particularly multicomponent interventions. Additional challenges occur in settings serving vulnerable populations such as homeless Veterans, given the population's acuity, multiple service needs, and organizational barriers. Implementation Facilitation (IF) is a strategy to support the uptake of evidence-based practices. This study's aim was to simultaneously examine IF on the uptake of Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking-Veterans Edition (MISSION-Vet), an evidence-based multicomponent treatment engagement intervention for homeless Veterans with co-occurring mental health and substance abuse, and clinical outcomes among Veterans receiving MISSION-Vet. METHODS This multi-site hybrid III modified stepped-wedge trial involved seven programs at two Veterans Affairs Medical Centers comparing Implementation as Usual (IU; training and educational materials) to IF (IU + internal and external facilitation). RESULTS A total of 110 facilitation events averaging 27 minutes were conducted, of which 85% were virtual. Staff (case managers and peer specialists; n = 108) were trained in MISSION-Vet and completed organizational readiness assessments (n = 77). Although both sites reported being willing to innovate and a desire to improve outcomes, implementation climate significantly differed. Following IU, no staff at either site conducted MISSION-Vet. Following IF, there was a significant MISSION-Vet implementation difference between sites (53% vs. 14%, p = .002). Among the 93 Veterans that received any MISSION-Vet services, they received an average of six sessions. Significant positive associations were found between number of MISSION-Vet sessions and outpatient treatment engagement measured by the number of outpatient visits attended. CONCLUSIONS While staff were interested in improving patient outcomes, MISSION-Vet was not implemented with IU. IF supported MISSION-Vet uptake and increased outpatient service utilization, but MISSION-Vet still proved difficult to implement particularly in the larger healthcare system. Future studies might tailor implementation strategies to organizational readiness. TRIAL REGISTRATION ClinicalTrials.gov, NCT02942979.
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Affiliation(s)
- David A. Smelson
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Vera Yakovchenko
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
| | - Thomas Byrne
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- School of Social Work, Boston University, Boston, Massachusetts, United States of America
| | - Megan B. McCullough
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
| | - Jeffrey L. Smith
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, United States of America
| | - Kathryn E. Bruzios
- Veterans Affairs Bridging the Care Continuum-Quality Enhancement Research Initiative, Bedford, Massachusetts, United States of America
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Sonya Gabrielian
- Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California, United States of America
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
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Crone B, Metraux S, Sbrocco T. Health Service Access Among Homeless Veterans: Health Access Challenges Faced by Homeless African American Veterans. J Racial Ethn Health Disparities 2021; 9:1828-1844. [PMID: 34402040 PMCID: PMC8367031 DOI: 10.1007/s40615-021-01119-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
Veteran homelessness is a public health crisis, especially among the disproportionate number of minority veterans in the homeless veteran population. African American homeless veterans in particular face unique challenges accessing appropriate health care services to meet their medical needs. Their needs are often underrepresented in the literature on veteran homelessness. Drawing together over 80 studies and government reports from the last two decades, this review provides a timely synopsis of homeless veterans' health care access, with a particular focus on the barriers faced by African American veterans. This review employs Penchansky and Thomas' Access Model to frame health access barriers faced by homeless veterans, dialing in on what is known about the experience of African American veterans, within the five dimensions of access: Availability, Accessibility, Accommodation, Affordability, and Acceptability. Actionable guidance and targeted interventions to address health access barriers for all veterans are delineated with a focus on the need to gather further data for African American homeless veterans and to consider tailoring interventions for this important and underserved group.
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Affiliation(s)
- Baylee Crone
- Uniformed Service University of the Health Sciences, Bethesda, MD, USA.
| | | | - Tracy Sbrocco
- Uniformed Service University of the Health Sciences, Bethesda, MD, USA
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Yakovchenko V, McCullough MB, Smith JL, Gabrielian S, Byrne T, Bruzios KE, Koosis E, Smelson DA. Implementing a complex psychosocial intervention for unstably housed Veterans: A realist-informed evaluation case study. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211049483. [PMID: 37090015 PMCID: PMC9978638 DOI: 10.1177/26334895211049483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Only 7% of individuals with co-occurring mental health and substance use disorder (COD) receive services for both conditions. We implemented and evaluated maintaining independence and sobriety through systems integration, outreach and networking-Veteran's edition (MISSION-Vet), an evidence-based manualized psychosocial intervention for Veterans with CODs. This paper identifies the generative mechanisms that explain "how, for whom, and under what conditions" MISSION-Vet adoption, implementation, and fidelity work when applied in a complex adaptive system with facilitation support. Methods Within two VA healthcare systems (Sites A and B), a hybrid III trial tested facilitation to implement MISSION-Vet. We conducted a two-site case study based on 42 semi-structured consolidated framework for implementation research (CFIR) guided interviews with site leadership, implementers (social workers, peer specialists), and team members (facilitators, site leads). Interviews were coded and CFIR constructs used to generate "Context + Mechanism = Outcome" configurations to understand the conditions of MISSION-Vet adoption, implementation, and fidelity. Results Site A was low, and Site B was high in adoption, implementation, and fidelity. Adoption hesitancy/eagerness (outcome) resulted from the interaction of "external policy" (context) dampening/encouraging a "tension for change" (mechanism). Implementation intensity (outcome) was based on how "peer pressure" or practice culture (context) activated staff "self-efficacy" (mechanism) to engage with MISSION-Vet and appraise its "relative advantage" over current practices (mechanism). Fidelity relied on how "staffing structure and availability" (context) activated/muted "facilitation" (mechanism) to result in strategy and intervention adaptation (outcome). Conclusions We delineated how specific contexts activated certain mechanisms to drive the different stages of implementation of a multi-faceted COD treatment intervention. Trial registration ClinicalTrials.gov, NCT02942979. Plain language abstract Implementation is inherently dynamic and influenced by interdependent factors operating at the individual, organizational, and system levels. This is especially true for complex interventions addressing co-occurring mental health and substance use disorders because such interventions involve multiple treatment modalities delivered simultaneously, in busy practice settings, with challenging populations. This paper pairs consolidated framework for implementation research (CFIR) constructs with a realist evaluation approached to generate configurations important to the adoption, implementation, and adaptation stages of a highly complex intervention addressing the behavioural health and housing needs of a vulnerable population. Each configuration describes how contextual factors trigger mechanisms to generate implementation outcomes and answers "what works for whom, in what circumstances and in what respects, and how?" These findings further our understanding of possible mechanisms of change and push us to be more precise about identifying causal relationships among constructs that contribute to the success of implementing complex interventions. This work also moves us to think theoretically and methodologically in a more dynamic fashion, thereby leading to more responsive implementation practice.
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and
Implementation Research, Bedford, MA, USA
- VA Bridging the Care Continuum-Quality Enhancement Research
Initiative, Bedford, MA, USA
| | - Megan B. McCullough
- Center for Healthcare Organization and
Implementation Research, Bedford, MA, USA
- VA Bridging the Care Continuum-Quality Enhancement Research
Initiative, Bedford, MA, USA
- Boston University School of Public
Health, Boston, MA, USA
| | - Jeffrey L. Smith
- Central Arkansas Veterans
Healthcare System, Little Rock, AR, USA
| | - Sonya Gabrielian
- Veterans Affairs Greater Los Angeles
Health Care System, Los Angeles, CA, USA
| | - Thomas Byrne
- Center for Healthcare Organization and
Implementation Research, Bedford, MA, USA
- VA Bridging the Care Continuum-Quality Enhancement Research
Initiative, Bedford, MA, USA
- Boston University School of School of Social Work, Boston, MA,
USA
| | - Kathryn E. Bruzios
- Center for Healthcare Organization and
Implementation Research, Bedford, MA, USA
- VA Bridging the Care Continuum-Quality Enhancement Research
Initiative, Bedford, MA, USA
- Department of Psychiatry, University of
Massachusetts Medical School, Worcester, MA, USA
| | - Ella Koosis
- Veterans Affairs Greater Los Angeles
Health Care System, Los Angeles, CA, USA
| | - David A. Smelson
- Center for Healthcare Organization and
Implementation Research, Bedford, MA, USA
- VA Bridging the Care Continuum-Quality Enhancement Research
Initiative, Bedford, MA, USA
- Department of Psychiatry, University of
Massachusetts Medical School, Worcester, MA, USA
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Public Health Practice-Driven Research to Improve HIV Prevention in the United States. J Acquir Immune Defic Syndr 2020; 82 Suppl 3:S279-S285. [PMID: 31764264 DOI: 10.1097/qai.0000000000002194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The evidence-practice gap in HIV prevention and the care continuum in the United States often reflects a mismatch between the perspectives of researchers and public health practitioners. The traditional research paradigm of sequential progress from efficacy research to implementation in practice and widespread scale-up is not well-aligned with the reality of health department program implementation. SETTING This article focuses on public health practice carried out by state and local health departments in the United States and the research intended to inform it. METHODS AND RESULTS In this narrative review, we discuss approaches to HIV prevention and care continuum research that are shaped by and responsive to public health practice implementation priorities and what is needed to promote productive and successful university-health department research partnerships. We review research methods of particular relevance to health departments to evaluate the effectiveness of HIV prevention and care continuum interventions and how these approaches diverge from traditional research approaches. Finally, we highlight the roles of federal agencies in supporting practice-driven HIV implementation research. CONCLUSIONS Health departments are key stakeholders, consumers, and generators of the evidence base for public health practice. High-impact research to improve HIV prevention and the care continuum is informed by health department priorities and current practice from the start. Long-term, equitable relationships between universities and health departments are crucial to advance practice-driven research.
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Timko C, Nash A, Owens MD, Taylor E, Finlay AK. Systematic Review of Criminal and Legal Involvement After Substance Use and Mental Health Treatment Among Veterans: Building Toward Needed Research. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221819901281. [PMID: 32132821 PMCID: PMC7040926 DOI: 10.1177/1178221819901281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 11/15/2022]
Abstract
Evidence indicates that substance use and mental health treatment is often associated with reduced criminal activity. The present systematic review examined this association among military veterans, and aimed to provide a comprehensive summary of needed research to further contribute to reduced criminal activity among veterans. This systematic review was derived from a scoping review that mapped existing research on justice-involved veterans' health. For the current systematic review, a subset of 20 publications was selected that addressed the question of whether criminal activity declines among veterans treated for substance use and mental health disorders. Generally, veterans improved on criminal outcomes from pre- to post-treatment for opioid use, other substance use, or mental health conditions, and more sustained treatment was associated with better outcomes. This occurred despite high rates of criminal involvement among veterans prior to entering treatment. Needed are substance use and mental health treatment studies that include women justice-involved veterans, follow criminally-active veterans for longer periods of time, and use validated and reliable measures of criminal activity with fully transparent statistical procedures. Future randomized trials should evaluate new treatments against evidence-based treatments (versus no-treatment control conditions). Subsequent studies should examine how to link veterans to effective treatments, facilitate sustained treatment engagement, and ensure the availability of effective treatments, and examine mechanisms (mediators and moderators) that explain the association of treatment with reduced criminal activity among veterans. Best practices are needed for reducing criminal activity among the minority of justice-involved veterans who do not have diagnosed substance use and/or mental health disorders.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Amia Nash
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA
| | - Mandy D Owens
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington
| | - Emmeline Taylor
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, USA.,National Center on Homelessness Among Veterans, Department of Veterans Affairs
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An implementation science primer for psycho-oncology: translating robust evidence into practice. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/or9.0000000000000014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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