Creating a Practice-Based Implementation Network: Facilitating Practice Change Across Health Care Systems
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Address correspondence to Sara J. Landes, PhD, South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA. Extended author information available on the last page of the article
Practice-based implementation network
RUZEK ET AL.
organizational learning. One hundred thirty-four clinicians in 18 VA clinics received brief training in the use of the PTSD checklist (PCL) in clinical care. Two implementation strategies, external facilitation and technical assistance, were used to encourage the use of outcomes data to inform treatment decisions and increase discussion of results with patients. There were mixed results for changes in the frequency of PCL administration, but consistent increases in clinician use of data and incorporation into the treatment process via discussion. Programs and clinicians were successfully recruited to participate in a 2-year initiative, suggesting the feasibility of using this organizational structure to facilitate the implementation of new practices in treatment systems.
Despite the development of evidence-based psychotherapies (EBPs) for many mental health problems and the delineation of best practices in clinical practice guidelines, there remains an enormous gap between the services available in routine care and those supported by research evidence and/or espoused in guidelines.1 Implementation science theory and research has emerged to study and address these discrepancies.2, 3 To effectively facilitate the ongoing implementation of best practices, however, it is important to create pathways to distribute information about EBPs thereby creating dissemination infrastructure. Practice-based research networks (PBRNs) are groups of providers and researchers working together to examine health care processes in broad populations of patients and settings in an effort to improve health care outcomes. This model was adapted to develop a practice-based implementation network in the US Department of Veteran Affairs (VA) and the Department of Defense (DoD). Potentially, the establishment of a standing practice-based implementation network (PBI network) could represent one key element of organizational dissemination and implementation infrastructure intended to enable more rapid and effective implementation of new practices. The PBI network is a first-of-its-kind collaboration between stakeholders in the VA and DoD—providers, clinics, evaluators, and leadership—brought together to help improve the implementation of mental health practice changes on a national scale. The rationale for the creation of standing PBI networks includes several elements. First, they can enable the study of factors affecting uptake and sustainment of practice changes. Second, if established as ongoing operations, they can increase the speed of implementation by offering immediately available implementation laboratories to pilot-test implementation prior to larger-scale or enterprise-wide implementation
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