The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findi
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Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; 2National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Washington, DC, USA; 3Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
BACKGROUND: Integrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams’ quality improvement (QI) capability may increase the implementation readiness and success of EBI implementation. OBJECTIVES: Develop a QI training program (“Learn. Engage. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA). DESIGN: This was a pre-post evaluation of the LEAP program. MOVE! coordinators (N = 68) were invited to participate in LEAP; 24 were randomly assigned to four starting times. MOVE! coordinators formed teams to work on improvement aims. Pre-post surveys assessed team organizational readiness for implementing change and selfrated QI skills. Program satisfaction, assignment completion, and aim achievement were also evaluated. PARTICIPANTS: VHA facility-based MOVE! teams. INTERVENTIONS: LEAP is a 21-week QI training program. Core components include audit and feedback reports, structured curriculum, coaching and learning community, and online platform. MAIN MEASURES: Organizational readiness for implementing change (ORIC); self-rated QI skills before and after LEAP; assignment completion and aim achievement; program satisfaction. KEY RESULTS: Seventeen of 24 randomized teams participated in LEAP. Participants' self-ratings across six categories of QI skills increased after completing LEAP (p< 0.0001). Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06133-1) contains supplementary material, which is available to authorized users. Prior presentations Earlier versions of this abstract were presented at the Conference on the Science of Dissemination and Implementation in December 2017; The Annual Meeting of the Society of Behavioral Medicine in April 2018; the Institute for Healthcare Improvement Annual National Forum in December 2018; and the AcademyHealth Annual Research Meeting in June 2019. This work was presented as an oral presentation at the 11th Annual Conference on the Science of Dissemination and Implementation in December 2018. Received August 19, 2019 Accepted August 11, 2020
The ORIC measure showed no statistically significant change overall; the change efficacy subscale marginally improved (p < 0.08), and the change commitment subscale remained the same (p = 0.66). Depending on the assignment, 35 to 100% of teams completed the assignment. Nine teams achieved their aim. Most team members were satisfied or very satisfied (81–89%) with the LEAP components, 74% intended to continue using QI methods, and 81% planned to continue improvement work. CONCLUSIONS: LE
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