Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Cite this article. Table1 lists these questions and the final integrated meta-factor used in the analysis. : . volume21, Articlenumber:797 (2021) Facilities with reach within the middle quintile (n=25) were dropped from the analysis to build in a meaningful gap between the higher reach (i.e., upper 40%) and lower reach (i.e., bottom 40%) facilities; 102 facilities were in the analytic sample. Sorry, no results were found for your search criteria. Chambers DA, Norton WE. Black circles indicate the presence of the respective condition, an open circle indicates the absence of the condition, and blank space indicates that the condition is not part of that pathway. Two of the three meta-factors used 6-point ordinal scales (0=None to 5=Very high/highly active) to represent the degree of presence of a local MOVE! Recommendations included the need for integrated multi-component treatment [2], requiring coordination across domains of treatment including bariatric surgery, pharmacotherapy, and lifestyle intervention [27] to engage patients in treatments tailored to meet their needs. 2013;8:117. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. How staffing is currently performed. Same-Day Service Options At Individual Facilities. The overall model had a consistency score of 85% (40/47) and a coverage score of 78% (40/51). The final solution consisted of 5 distinct pathways comprising combinations of program components related to pharmacotherapy, bariatric surgery, and comprehensive Figure1 also lists overall model consistency and coverage scores that is an aggregated score across all five solution paths. The .gov means its official.Federal government websites often end in .gov or .mil. Coordinator was scaled based on the level of time dedicated to the program, with 6 possible responses ranging from 0 to 100%. /7 ^;0xRU faD 2018;15:E02. Configurational methods expressly allow for causal complexity (when several conditions must jointly appear for an outcome to occur) as well as equifinality (when multiple pathways lead to the same outcome), making it well-suited for discerning different solution pathways related to local context. The .gov means its official.Federal government websites often end in .gov or .mil. Hospital Compare Data helps consumers make decisions about where to get health care and encourages hospitals to improve the quality of care. Glasgow RE, Estabrooks PE. Part of Ragin CC. Terms and Conditions, Multiple pathways included conditions that spanned across the MOVE! Implement Sci. This work was supported by the National Center for Health Promotion and Disease Prevention, Veterans Health Administration. each week. For each facility, the score represented the total number of patients with at least one MOVE! VHA convened a State-of-the-Art (SOTA) conference in 2016 to address the epidemic of obesity in the U.S., including among Veterans. Weight Management Program. How the situation is expected to Facility-level conditions leading to higher reach: a configurational analysis of national VA weight management programming. The Adaptome: Advancing the Science of Intervention Adaptation. 2021;19(3):240248. Pragmatic Applications of RE-AIM for Health Care Initiatives in Community and Clinical Settings. This program evaluation qualified as non-research quality improvement activity conducted under the authority of VHA operations. Kahwati LC, Lewis MA, Kane H, Williams PA, Nerz P, Jones KR, et al. Transl Behav Med. We continued relaxing the consistency threshold until there were at least two potential configurations of facility-level conditions that met the specified consistency level and the 15% coverage threshold. A Longitudinal Assessment of the Effect of Resident-Centered Care on Quality in Veterans Health Administration Community Living Centers. , () , : , : , : , , , , (), () , : () , () , , , , , , , , , , , , , , , , , , , ! Each of the sections are color-coded. In this evaluation, configurational analyses revealed specific combinations of facility-level obesity treatment programming that consistently and uniquely distinguished higher-reach from lower-reach facilities. Oakland: Univ of California Press; 2014. Recent estimates of the prevalence of obesity among Veterans receiving care in VHA are over 40% [1]. The five pathways listed in Fig.1 are indicated by column. We next calculated quintiles of reach. One hundred twenty-seven MOVE! hWo6l 0%7 MR4i-D\i$8]0tD=w#. 2011;1(4):55160. Am J Public Health. 2016;315(21):228491. Weight Management Program, the VHA CLI, is the most commonly available: on average, more than 100,000 Veterans participate annually in MOVE!, compared to about 2500 Veterans receiving weight loss medications and a few hundred Veterans who undergo bariatric surgery [2, 6]. Facilities with reach scores within the upper two quintiles (i.e., the top 40%, n=51) and facilities within the bottom two quintiles (n=51) were included in the analyses. VA facility data is shown on some quality measures found on the Centers for Medicare and Medicaid Services (CMS) Care Compare website. Consistency is a metric that indicates how reliably a solution yields an outcome and is calculated as the number of cases with the solution configuration and the targeted outcome divided by the total number of cases with the solution configuration. For example, the survey item inquiring about the presence of a MOVE! The 5 pathways explained 78% (40/51) of the facilities in the higher-reach group with 85% consistency (40/47). Within low complexity medical centers (smaller, often rural centers), having maintenance programming with no restrictions on weight loss medication refills led to higher reach; this pathway explained all 11 low complexity sites with higher reach in our dataset. No single condition explained the 51 facilities with the higher-reach outcome; rather, combinations of specific conditions consistently and uniquely distinguished higher reach facilities from lower reach facilities. ! Edward J. Miech. Reach scores were calculated by dividing the total number of Veterans who are candidates for obesity treatment by the number of new MOVE! Veterans Affairs Center for Health Information & Communication, VA EXTEND QUERI, Roudebush VA Medical Center, Indianapolis, USA, Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA, Michelle B. Freitag,Richard R. Evans,Jennifer A. Burns,Wyndy L. Wiitala,Ann Annis&Laura J. Damschroder, National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina, USA, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA, You can also search for this author in 2017. Breland JY, Phibbs CS, Hoggatt KJ, Washington DL, Lee J, Haskell S, et al. Facilities listed in red italics represent cases that are uniquely covered by that solution pathway. , : .. () () , () : , . How modeling works for operations and maintenance. patients consistently lead to higher reach. . ( .) 2016;51(4 Suppl 2):S124-31. The comparative method: Moving beyond qualitative and quantitative strategies. 2020.https://doi.org/10.5465/amr.2009.0298. hbbd``b`k@D` Evaluating the public health impact of health promotion interventions: the RE-AIM framework. , . (CC&ICM) framework, ICM services correspond with a complex level of care coordination. program. We generated condition tables by specifying a consistency threshold of 100% and a coverage score of at least 15% to avoid overfitting. An official website of the United States government. Thus, it is insufficient to offer only lifestyle intervention without the availability of pharmacotherapies, or pharmacotherapies without bariatric surgery options. Facility Listing - Locations - Veterans Affairs The Complex Interplay Between Specific Operational Changes and Local Context When Improving Cardiovascular Outcomes. Sociol Methods Res. Configurational analysis is one method within a broader family of configurational comparative methods, which include Qualitative Comparative Analysis and more recently Coincidence Analysis. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. The first was the 2017 HAIG survey of facility-level weight management programs, which had 78 items. 2017;32(Suppl 1):7982. VHA Office of Capital Asset Management Engineering and . Facilities are classified into three levels with Level 1 representing the most complex facilities, Level 2 moderately complex facilities, and Level 3 the least complex Cragun D. Configurational comparative methods. A de-identified version of the configurational data used in the analysis is available from the corresponding author on reasonable request. Our next step was to reduce the number of factors by creating three ordinal meta-factors that combined information from multiple individual factors from the original HAIG survey. The National Center for Health Promotion and Disease Prevention (NCP) leads weight management policy and provides support to MOVE! These findings will guide system recommendations about optimal program structures to maximize reach to patients who would benefit from obesity treatment such as the MOVE! Baumgartner M, Thiem A. WebLook up health care performance and satisfaction information at a VA facility. However, achieving high reach in practice can be difficult, especially with comprehensive behavioral interventions. . WebDetails of the complexity and diversity of VHA facilities. For medium complexity centers, the Be Active and MOVE! (BAM) physical activity adjunct program combined with maintenance programming led to higher reach. . Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Department of Veterans Affairs. Overall reach to patients who would benefit from obesity treatment in VHA remains suboptimal, as is the case with most health systems [8, 9]. We then generated a condition table to list and organize the Boolean output. Coverage is a metric that indicates how broadly a solution accounts for an outcome and is calculated as the number of cases with the configuration and the outcome present divided by the total number of cases with the outcome. For high complexity centers, the combination of BAM with restrictions on weight loss medication refills led to higher reach. This survey data was linked to reach scores available through administrative data. An official website of the United States government. Coordinator is a key program leadership position. coordinator who works with MOVE! WebFacilities with medium-high volume, medium risk patients, some complex clinical programs, and medium sized research and teaching programs 2-Medium complexity Facilities with For example, the role of MOVE! Though coverage was high (78%), 11 of the 51 higher reach facilities were not included in any of the five solution pathways, indicating a possible role for additional factors beyond those in the model. Ambuehl M, Baumgartner M. cna: Causal Modeling with Coincidence Analysis. The analytic objective of configurational analysis is to identify necessary and sufficient conditions for an outcome to occur, a fundamentally different search target than those used in correlation-based methods [11,12,13]. Location (zip, city/state, full address) Radius. Facilities types (level of care types) are listed in the VISN tables below as: Network System Headquarters (HQ) Network Health Care System (HCS) VA medical centers
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